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ACEs are not equal: Examining the relative impact of household dysfunction versus childhood maltreatment on mental health in adolescence

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Abstract

Rationale: Adverse Childhood Experiences (ACEs) have shown substantial effects on health across the lifespan. However, many studies on this topic discount the individual items as well as the distinction between household dysfunction and maltreatment experiences. Objective: The current study examined individual ACEs items as well as the relative contribution of the household dysfunction scale versus the childhood maltreatment scale for predicting mental health outcomes in adolescence. Lastly, we examined the utility of a cut-off score for ACEs in predicting mental health. Methods: Data were from Time 4 of a longitudinal study of the effects of maltreatment on adolescent development (n = 352; Mean age = 18). Self reported ACEs were assessed via structured interview and mapped onto the original ACEs questionnaire (Kaiser-CDC). Mental health outcomes were symptoms of depression, anxiety, trauma, and externalizing behavior. Results: MANCOVA showed few mean differences between those endorsing 'yes' versus 'no' for the household dysfunction items, with the exception of witnessing parental Intimate Partner Violence (IPV). Those who endorsed witnessign IPV reported more symptoms of depression, anxiety, and trauma. On the other hand, all of the maltreatment items were asscociated with significantly higher scores on at least three of the four outcomes for those endorsing versus not. Sexual abuse and physical abuse were associated with symptoms of depression, trauma, and externalizing behavior. Neglect was associated with depressive, trauma, and anxiety symptoms. Emotional abuse and emotional neglect were both associated with all four mental health outcomes. When household dysfunction and maltreatment sum scores were entered into the model together, maltreatment primarily accounted for mental health symptoms. Finally, our results did not indicate a meaningful cutoff for the number of ACEs needed to predict mental health outcomes. Conclusions: Our findings support the assessment of maltreatment events as more salient than household dysfunction in mental health treatment and caution health providers against only using the total ACEs score in clinical decision-making.

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... drawbacks related to conceptual and measurement issues that were unaddressed within the original ACEs study (McLennan et al., 2020;Negriff, 2020;White et al., 2019) and persist in contemporary adaptations of the original ACEs measure (Conway & Lewin, 2022;Finkelhor et al., 2015;Karatekin & Hill, 2019). A meta-analysis by Hughes et al. (2017) found considerable heterogeneity in the outcomes of ACEs, which is likely due to definitional, methodological, and cultural differences across studies (Briggs et al., 2021;Kalmakis & Chandler, 2014). ...
... Using the summation of the 10 dichotomous indicators to predict distal outcomes is also problematic. The scoring procedures for the overall scale assume that each of the 10 ACEs equally reflects the latent construct of adversity and has a similar impact on distal outcomes, which has been empirically questioned (e.g., Narayan et al., 2017;Negriff, 2020;Rampersaud et al., 2022). Statistically, summing the 10 items together imposes a statistical model that assumes the latent variable of childhood adversity is indicated by the 10 ACE questions, and the factor loadings are constrained to be 1 and measured without error. ...
... For example, the summation of the 10 ACE items assumes that having a parent with depression is just as reflective of the construct of childhood adversity as being molested or raped either "often" or "very often" in childhood. When assessing the face validity of the ACEs scale, it is difficult to reconcile that parental depression and frequent sexual abuse equally represent the concept of adversity (Briggs et al., 2021;Charuvastra & Cloitre, 2008;Negriff, 2020). Likewise, it is difficult to argue that the experience of molestation and rape has the same impact on one's health and well-being as living with a parent who has depression (e.g., predictive validity). ...
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The landmark adverse childhood experiences (ACEs) study conducted by Kaiser Permanente and the Centers for Disease Control shook the bedrock of the scientific community, highlighting the commonality of ACEs and identifying a dose–response relationship with poor health outcomes. The seminal findings led to a surge in ACEs research and a growing body of empirical literature; however, the ACEs measure has numerous conceptual and measurement issues that are often overlooked in the research. Such problems include a lack of a clear conceptual definition of what constitutes an ACE, item formulation and coverage, item scoring, and lack of contextual information. The current article aims to integrate existing critiques of the ACEs measure, extend critiques in greater detail, and proffer new ideas related to the conceptualization and study of ACEs. In preference to conceptualizing ACEs consistent with existing literature, we make a case that there are four unique and conceptually distinct subcategories of ACEs that should be conceptualized independently as individual adversities that frequently co-occur. We provide recommendations for researchers and discuss the utility of the ACEs measure as a screening tool.
... ACE counts as low as two have been associated (odds ratios [ORs] of 2.0 to 5.0) with depression and anxiety symptomatology (King, 2021). Even unitary exposures (Negriff, 2020) can portend later forms of psychosocial maladjustment (Bright et al., 2016;Mersky et al., 2013;Negriff, 2020). ACE research has been expanded more recently to include analyses of predictor variables such as exposure to family suicidality, death, physical disability, and/or single, teen, foster, or homeless parenting (King, 2020a). ...
... ACE counts as low as two have been associated (odds ratios [ORs] of 2.0 to 5.0) with depression and anxiety symptomatology (King, 2021). Even unitary exposures (Negriff, 2020) can portend later forms of psychosocial maladjustment (Bright et al., 2016;Mersky et al., 2013;Negriff, 2020). ACE research has been expanded more recently to include analyses of predictor variables such as exposure to family suicidality, death, physical disability, and/or single, teen, foster, or homeless parenting (King, 2020a). ...
... A total CSA score was calculated from the two recording periods. The CSA index has been linked to different maladjustment indicators (King, 2020a, b;King et al., 2018King et al., , 2019bKing & Russell, 2017;Mangold & King, 2021;Norton-Baker et al., 2019;Pocknell & King, 2019, 2020 with internal consistency established in each analysis. Childhood physical abuse (CPA). ...
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Early medical histories have seldom been examined as adversity risk indictors. This survey analysis of college students (N = 2,636) examined links between four forms of childhood illness (migraine headaches, acne, asthma, and eneuresis) and adult mental health symptomatology. All four medical illnesses significantly raised the odds (ORM = 2.04) of lifetime depressive and anxiety disorder diagnoses. Current symptomatology was raised as well for all but one (eneuresis) medical condition. These effects were found after control of respondent age and various forms of childhood maltreatment (sexual, physical, and/or emotional abuse). Heightened awareness of medical histories during clinical intake assessments seems warranted. Adversity researchers might also consider the inclusion of childhood medical conditions as future maladjustment risk indicators. Study limitations included the cross-sectional design and unclearly specified timing of the self-reported psychological and health recollections. The role of modulating variables such as gender, ethnicity, and family climate in physical-mental health relationships warrants continued focus.
... A meta-analysis of CM and depression in children and adolescents found a moderate effect size (Z ¼ 0.45), of exposure to CM on depressive symptoms (Humphreys et al., 2020). A recent study by Negriff and colleagues that compared adolescents exposed to adverse childhood experiences to non-exposed found a small to moderate effect size for anxiety symptoms and a moderate effect size for depressive symptoms (Negriff, 2020). The formerly mentioned study by Negriff et al. found no significant differences in externalizing behavior between adolescents with adverse childhood experiences and their non-exposed peers (Negriff, 2020). ...
... A recent study by Negriff and colleagues that compared adolescents exposed to adverse childhood experiences to non-exposed found a small to moderate effect size for anxiety symptoms and a moderate effect size for depressive symptoms (Negriff, 2020). The formerly mentioned study by Negriff et al. found no significant differences in externalizing behavior between adolescents with adverse childhood experiences and their non-exposed peers (Negriff, 2020). However, a large Australian cohort study found significantly higher rates of externalizing behavior in adolescents exposed to CM than their non-exposed peers (Mills et al., 2013). ...
... However, a large Australian cohort study found significantly higher rates of externalizing behavior in adolescents exposed to CM than their non-exposed peers (Mills et al., 2013). These studies point to the increased risk of internalizing problems such as symptoms of anxiety and depression associated with experiencing CM, but also that the strength of the association is inconclusive (Humphreys et al., 2020;Negriff, 2020). Currently, there seem to be some conflicting findings regarding the association between CM and externalizing behavior that need to be elaborated upon (Mills et al., 2013;Negriff, 2020). ...
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The current study aimed to compare mental health outcomes of children and adolescents with maltreatment experiences to a general population sample. A secondary aim was to examine sex differences in mental health outcomes, and the association between polyvictimization and mental health. The two samples were age-and sex-matched, and data was collected from caregiver-reports and self-reports. 1378 participants aged 5 to 18 years were included in the study. Children and adolescents exposed to maltreatment had more mental health problems than the general population sample. Large effect sizes (d ≥ 0.8) were found for emotional problems (d = 1.19), hyperactivity problems (d = 0.88), peer problems (d = 0.86), and the impact score (d = 0.93). A moderate to large effect size was found on the conduct problems subscale (d = 0.68), and a small effect size was found on the prosocial subscale (d = −0.22). There was a dose-response relationship between cumulative maltreatment exposure and the severity of mental health problems. Childhood maltreatment was associated with considerably more emotional problems, hyperactivity problems, and peer problems, which in turn can impact the daily life of the exposed children and adolescents. Effective support measures for maltreated young people must be a priority.
... Discerning whether the two established subscales (e.g., (Mersky et al., 2017) can be combined into a total score is a critical need with implications for theory, research, practice, and policy. Indeed, scholars have recently raised similar concerns of the ACEs measure (Clemens et al., 2019;Negriff, 2020); therefore, the primary objective is to empirically test whether maltreatment and household dysfunction can be combined to create an overall index of ACEs by comparing the contributions of the overall ACE score, maltreatment, and household dysfunction on mental health, defined by clinical and subclinical levels of psychopathology, including sleep problems, posttraumatic stress, depression, and loneliness. Specifically, we focused on women under correctional custody due to greater variation of ACEs compared to the general population, providing an optimal sample from which to study the associations between ACEs and mental health. ...
... Thus, there are differences in both the conceptualization and measurement that could occlude the true nature of the associations between ACEs and distal health outcomes. The aforementioned issues raise substantial questions about using the total score (Negriff, 2020), and recent empirical research has begun to address how ACEs are thought about and measured. Instead, the separate examination of maltreatment and household dysfunction may prove to be one alternative strategy with a stronger conceptual and empirical foundation. ...
... In additional to conceptual issues related to the ACEs measure, empirical research has provided additional support. Studies of adults have shown that the correlations between maltreatment and mental health outcomes are consistent, whereas the associations between household dysfunction and mental health are largely nonsignificant, with the exception of exposure to domestic violence (Negriff, 2020). Maltreatment has stronger and more consistent associations with mental health outcomes compared to household dysfunction including socioemotional functioning, self-control, sleep problems, anxiety, depression, posttraumatic stress, aggressive behavior, and cognitive impairment (Albers et al., 2022;Meldrum et al., 2020;Narayan et al., 2017;Sayyah et al., 2022;Yuan et al., 2022). ...
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Adverse childhood experiences (ACEs) have been consistently linked to mental health problems. There have been recent conceptual and empirical critiques that suggest maltreatment and household dysfunction to not be combined to create a composite ACE score. Women in correctional custody demonstrate disproportionately high ACE levels and greater mental health problems as to racial minorities. The present study compared the effects of varying operationalizations of the ACEs measure on women’s mental health stratified across race using a sample of White, African American, and Native American women in correctional custody in Oklahoma. The cross-sectional study administered a paper-and-pencil survey to 494 women. Structural equation modeling was used to test hypotheses. Maltreatment was a significant predictor of women’s mental health across all racial groups but demonstrated the strongest effect among African American inmates. Household dysfunction was not a significant predictor of mental health for any racial group. When comparing the maltreatment-only model to the maltreatment and household dysfunction model, and the overall ACE score model, there was little explained variance lost. These findings indicate that maltreatment demonstrates unique associations with women’s mental health and may be the driving force behind the relationship between ACEs and adult mental health among women within correctional custody. Researchers are advised to not use the overall ACE score and instead break down the measure into the maltreatment and household dysfunction subscales.
... Studies examining multiple variables have found that childhood abuse can predict anxiety, with abuse and neglect during childhood affecting adolescent mental health, and individuals with a history of abuse being more prone to anxiety symptoms 22 . Longitudinal research has closely linked childhood abuse (emotional, sexual, and physical neglect) to anxiety symptoms 23 , with all three factors being independent risk factors for anxiety symptoms in adolescents. Additionally, a survey in the Czech Republic supports the notion that adverse childhood experiences are risk factors for anxiety 24 . ...
... Physical-emotional abuse has been identified as a significant predictor of anxiety in university students 56,57 , and increased levels of anxiety resulting from abuse experiences can lead to a range of comorbid mental health issues 58 . Abuse significantly predicts anxiety 23,59 . In summary, the results of this study establish that anxiety mediates the relationship between physical-emotional abuse and internet addiction among university students. ...
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This study aimed to explore the relationship between physical and emotional abuse (physical-emotional abuse) and Internet addiction in university students, as well as the mediating role of anxiety and the moderating role of physical activity. The data of physical-emotional abuse, anxiety and Internet addiction, and physical activity were measured by subjective questionnaire with convenience sampling in March 2024. A total of 1591 participants (806 males and 692 females) from Shanxi, Henan, Hunan and Hubei provinces in China were investigated. Subsequently, the relationships among the variables were explored using pearson correlation analysis. Finally, mediation and moderation models were assessed using the SPSS PROCESS macro plugin. After controlling for participants’ gender, grade level, and place of residence, only-child status, the study findings revealed that physical-emotional abuse significantly and positively predicted internet addiction and anxiety among university students (β = 0.157, β = 0.271, p < 0.001). However, upon the inclusion of anxiety as a variable, the predictive effect of physical-emotional abuse on internet addiction among university students became non-significant (β = 0.035, p > 0.05). Anxiety was found to have a significant complete mediating effect between physical-emotional abuse and internet addiction among university students. Additionally, physical activity significantly and negatively predicted anxiety (β = -0.062, p < 0.05), and the interaction term between physical-emotional abuse and physical activity also significantly and negatively predicted anxiety (β = − 0.053, p < 0.05). Physical activity moderated the first half of the mediation pathway from “physical-emotional abuse to anxiety to internet addiction.” Anxiety may be the internal mechanism of physical-emotional abuse affecting university students’ Internet addiction, and physical activity plays a moderator role in the relationship between physical-emotional abuse and university students’ Internet addiction. The study will provide new perspectives and strategies for the public health field to address physical-emotional abuse and Internet addiction among university students. It is also critical that future studies validate these findings on a large, multi-country basis.
... For example, the combination of family member substance abuse and a parent not understanding the child's problems (an ACE score of 2) is indistinguishable from the ACE score of 2 that is a combination of experiencing both physical and sexual abuse. These identical scores are likely to have very different associations with health and behaviors in adulthood (Negriff, 2020). Recognizing this type of confounding, some researchers have investigated the association between single ACE events and later health outcomes (Romm & Berg, 2024). ...
... In addition, "the combination of physical and emotional abuse, plus CSA and/or family dysfunction [may] be important factors in the relationship between ACEs and perpetration of violence in adulthood (Zietz et al., 2020, p. 10). As important, our findings in regard to SI and CSA in Class 2 are consistent with previous findings by Negriff (2020) that CSA as a form of child maltreatment is positively associated with depression, anxiety, substance use and trauma in adulthood-all of which can lead to SI and suicide attempts or death. ...
Article
Exposure to adverse childhood experiences (ACEs) is associated with harmful biopsychosocial and behavioural outcomes in adulthood and with reduced community capacity. We investigated the prevalence of ACEs and differential risk of adverse adult outcomes based on latent class assignment in a resource- limited, high violence, and understudied setting of urban Haiti, i.e., Cité Soleil. 100% (N= 673; 41.4% men, 58.6% women, mean age 28.5) reported at minimum one ACE, 70% reported physical and emotional abuse as ACEs, and 47% reported experience of child sexual abuse (CSA). We identified 3 distinct latent classes and evaluated associations between ACE class membership and correlates (e.g., experience of non-partner sexual violence as adults [NPSV], suicidal ideation [SI], substance use to manage stress). Family dysfunction (domestic violence, substance abuse, mental illness, divorce, or incarceration of caregivers) existed across all three classes. Patterns of ACEs reported by members of Class 2 support their identification as a distinct class that is at greatest risk for adverse adult outcomes. Specifically, the increased odds of exposure to CSA distinguished members of Class 2 from Classes 1 and 3. Members of Class 2 also had increased odds of substance use, SI, fear of going outside, NPSV experience, and hypervigilance. Class 2 members further showed reduced odds of education, access to health care, and being men survivors of NPSV. The prevalence of ACEs in this sample are unprecedented. Haiti needs ACE prevention and compassionate but trauma-informed care at the population level.
... Despite the well-established association between child maltreatment and adult health harms, there are limited data on co-occurrence of all five forms of child maltreatment experienced from infancy through to age 18 years and the extent to which each maltreatment type is associated with subsequent mental health disorders . Although child maltreatment stands as a pervasive issue in the general population (Feng et al., 2023;Negriff, 2020), relatively few studies have examined its impact on individuals identifying with a diverse gender identity, that is, a person whose gender identity differs from their sex assigned at birth (Poteat et al., 2023). In the United States, approximately three quarters of gender diverse individuals have experienced emotional abuse, nearly one in two physical abuse, and one in five sexual abuse (Thoma et al., 2021). ...
... Subtypes of child maltreatment among diverse gender individuals have often been studied through the lens of ACEs. While household dysfunction and familial adversities negatively impact mental health, some researchers have suggested that the child maltreatment items within the broader ACEs framework have stronger effects on negative life outcomes than other childhood adversities (Atzl et al., 2019;Negriff, 2020), raising the question of whether a more thorough examination of the specific impacts of child maltreatment is warranted. While household dysfunction and child maltreatment often co-occur, previous research has often studied the increased risk of adversities overall rather than focusing specifically on child maltreatment, which is the key focus of the current study. ...
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This study examined rates of mental health disorders and health risk behaviors in people with diverse gender identities and associations with five types of child maltreatment. We used data from the Australian Child Maltreatment Study (ACMS), a nationally representative survey of Australian residents aged 16 years and more, which was designed to understand the experience of child maltreatment (physical abuse, sexual abuse, emotional abuse, neglect, exposure to domestic violence). Mental disorders—major depressive disorder, generalized anxiety disorder (GAD), alcohol use disorder, post-traumatic stress disorder (PTSD), and health risk behaviors—smoking, binge drinking, cannabis dependence, self-harm, and suicide attempt in the past 12 months were assessed. People with diverse gender identities who experienced child maltreatment were significantly more likely to have GAD (43.3%; 95% CI [30.3, 56.2]) than those who had experienced child maltreatment who were either cisgender men (13.8%; [12.0, 15.5]) or cisgender women (17.4%; [15.7, 19.2]). Similarly, higher prevalence was found for PTSD (21.3%; [11.1, 31.5]), self-harm (27.8%; [17.1, 38.5]) and suicide attempt (7.2%; [3.1, 11.3]) for people with diverse gender identities. Trauma-informed approaches, attuned to the high likelihood of any child maltreatment, and the co-occurrence of different kinds may benefit people with diverse gender identities experiencing GAD, PTSD, self-harm, suicidal behaviors, or other health risk behaviors.
... Consistent with the ACE study (Felitti et al. 1998;Negriff 2020), two trauma exposure domains (i.e., maltreatment/neglect and household dysfunction) were estimated in a simultaneous measurement model. Frequency of inquiring about physical abuse (β = 0.924), emotional abuse (β = 0.926), and neglect (β = 0.910) significantly loaded onto the maltreatment variable. ...
... All three have a proximate influence on the health and well-being of the child and are associated with the treatment and nurturing of children provided by parents or caregivers. Behavioral factors refer to the treatment that children receive from the moment they are born and throughout their childhood and adolescence, whether they are raised with love and respect or whether they are mistreated (Chamberlain et al. 2019;Negriff 2020). These types of factors include ACEs that are triggered in the family or are exerted directly on the child, whether with verbal, psychological, or physical violence by a family member, caregiver, or their parents (Felitti et al. 1998;Cronholm et al. 2015;Kaminer et al. 2023). ...
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Argentina is one of the countries in the Latin American region with the highest incidence of childhood obesity. The incidence of childhood overweight and obesity among children under five years of age is approximately 15%, according to the 2020 MICS survey. Obesity is a nutritional disorder that is explained not only by biological factors but also by socioeconomic and family circumstances. The objective of this study is to investigate the factors and risks that determine childhood overweight and obesity in Argentine children under five years of age. To explain this, this article presents an integrative model of two theoretical frameworks, social determinants of health (SDH) and adverse childhood experiences (ACEs), called hereafter “IM-SDH-ACEs”, in order to understand how these determinants are related to influence childhood malnutrition. This study performs a Chi-square test to empirically corroborate that SDH and ACEs influence this type of weight disorder; thus, it is shown that socioeconomic status (SES) and age groups together with ACEs are factors associated with childhood overweight and obesity. Likewise, a multinomial logistic regression model is estimated, and the results show that the highest risks of suffering from overweight and obesity in childhood are predicted by physical violence (PV) inflicted on the child as well as an interaction of the variables of deprivation in health care and a secondary education level of mothers or carers. It is concluded that a more inclusive social policy is required to reduce childhood obesity in Latin American societies.
... While our aim was to efficiently capture subjective perceived loneliness, this may limit the generalizability of our findings.This study did not assess the potential effects of individual types of ACE. Negriff (2020) found that childhood maltreatment had a stronger effect than household dysfunction in a common model for mental health symptoms, and she warned healthcare providers not to use only the total ACE score in clinical decision-making. ...
... Childhood adversities, including physical and sexual abuse, are risk factors for mood and anxiety disorders [1][2][3][4]. Neurobiological mechanisms may underpin this association and may include developmental effects of childhood adversities on the hypothalamicpituitary-adrenal axis, immune/inflammatory systems, anatomical brain development and epigenetic changes [5]. These effects often persist into adulthood [4,[6][7][8][9][10], including older adulthood [11]. ...
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The COVID-19 pandemic had a global impact on mental health. Identification of individuals at higher or lower risk of mental health problems may assist with targeting prevention, support and treatment efforts during future pandemics. Using a Canadian national mental health survey that collected data during the pandemic period (March 2022–December 2022), this study examined the vulnerability of participants reporting abuse during their childhood by examining the annual prevalence of mood, anxiety and substance use disorders. Psychiatric disorders were identified using a version of the Composite International Diagnostic Interview (CIDI). Because childhood adversities are well-known risk factors for mental disorders, the analysis focused on interactions between childhood adversities and pandemic-related stressors by estimating the relative excess risk due to interaction (RERI). RERIs provide evidence of synergy based on the occurrence of greater than additive interactions. Physical and sexual abuse interacted synergistically with pandemic-related stressors in predicting mood and anxiety disorders. No synergies were found for substance use disorders. Childhood adversities increase vulnerability to later stressors and may be useful for the identification of individuals more likely to have mental health needs during this type of public health emergency.
... ACEs are broad and include many types of aversive experiences, so equal implications cannot be assumed. For instance, Negriff (2020) found that the more personally threatening and victimizing ACEs (e.g., abuse versus household dysfunction), the greater the impact on the person's psychological health. However, one may fail to see this unique contribution when studying ACEs using a cumulative risk approach. ...
Article
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Previous research indicates that over 60% of Americans have experienced at least one Adverse Childhood Experience, or ACE (Finkelhor et al., 2011; Merrick et al., JAMA Pediatrics, 172(11), 1038–1044, 2018). Exposure to direct or indirect violence in childhood can lead to an increased risk for polyvictimization (i.e., being victimized in multiple ways) and increased susceptibility to psychological distress in adulthood (Finkelhor et al., 2011). The CDC (2021b) recently recognized peer victimization as an ACE, which was not universally considered an ACE previously. Given the association between experiencing childhood polyvictimization and substantial health risks among adults (Hughes et al., The Lancet Public Health, 2(8), e356–e366, 2017), the present study sought to answer the questions: (1) are victimizing ACEs, peer victimization, and cyber victimization all independently related to psychological distress? and (2) Is there a gender difference in these associations? Young adults (N = 496; 58.7% female, 41.3% male, 60% White) completed self-report electronic surveys assessing current levels of psychological distress and retrospective accounts of exposure to victimizing ACEs, traditional peer victimization, and cyber victimization before the age of 18. Using hierarchical regression, victimizing ACEs, peer victimization, and cyber victimization were all individually related to psychological distress for both males and females. Gender interactions indicated that for males, the association between cyber victimization and psychological distress remained the same at all levels of cyber victimization, but for females, greater cyber victimization was associated with greater psychological distress, but the inverse relationship was found for males. Findings from this study suggest that victimizing ACEs, peer victimization, and cyber victimization are all related to higher psychological distress. When working with male and female clients, practitioners should be aware that most may have mental health difficulties regardless of the number of adverse events they have experienced. For females, cyber victimization was particularly associated with greater mental health challenges.
... Children impacted by CM (i.e., physical abuse, emotional abuse, sexual abuse, and neglect) are at increased risk of experiencing adverse short and long-term physical (e.g. cardiovascular and respiratory diseases) and mental health outcomes (e.g., depression, suicidal ideation and attempts), as well as risky health behaviors and societal outcomes (e.g., substance use and violence perpetration and revictimization) (Anda et al., 2008;Brown et al., 2010;Felitti et al., 1998;Fergusson & Woodward, 2002;Hawkins et al., 1998;Kugler et al., 2019;Lanier et al., 2010;Moylan et al., 2010;Negriff, 2020;Whitfield et al., 2003;Widom et al., 2008). To prevent and address CM and the related adverse consequences, it is important to ensure that relevant evidence-based programing is available and accessible to all who could benefit. ...
... For respondents who completed the READI Scale and IPV-BI knowledge items, the secondary objective 1) examine the factors that impact paramedic readiness, and IPV-knowledge was examined. A multivariate analysis of covariance (MANCOVA) using Pillai's trace statistics (0-1 range, 0= no contribution, 1= maximum contribution; Ben-Ezra et al., 2008;Ferrer-Pérez et al., 2019;Negriff, 2020) was used to examine the professional and personal factors that impact readiness and IPV-BI knowledge. This approach was selected as it accounts for interactions between many variables of interest (Tutty et al., 2021). ...
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Purpose Survivors of intimate partner violence (IPV; synonymous with dating violence and partner abuse) frequently attempt to access and navigate the healthcare system. Paramedics commonly supersede the emergency department as the first contact. In Canada, absent national standards may impact paramedics readiness to care for patients experiencing IPV. Primary objective: measure the readiness of paramedics to encounter patients experiencing IPV. Secondary objectives: analyze factors that contribute to readiness, and compare IPV-caused brain injury (IPV-BI) knowledge as a component of readiness. Method Paramedics practicing in western Canada were eligible. The online survey included the READIness to encounter patients experiencing partner abuse (READI) Scale and IPV-BI knowledge items (both 7-point Likert). Descriptive statistics were calculated for total readiness (constructs), and IPV-BI knowledge. Factors affecting readiness were analyzed with a MANCOVA. Between construct differences were analyzed with an ANOVA (significance = p< 0.05). Results Paramedic (N = 693; Women = 48%, Men = 41%, Non-Binary and Not Listed = 1%, No Response = 10%) total readiness was 5.4±0.7 (mean construct scores: self-efficacy = 4.8±1.0, emotional readiness = 4.9±1.3, motivational readiness = 6.5±0.6, and IPV knowledge = 6.0±0.7). The mean IPV-BI knowledge score was 4.4±1.0 (n=646). Gender (Women) and previous experience with IPV (Yes) each had medium positive effects on readiness (p≤0.015). Differences between all constructs, and IPV knowledge and IPV-BI knowledge were observed (p<0.001, medium to extra large effect sizes), excluding self-efficacy versus emotional readiness (p=0.624). Conclusion Paramedics demonstrated moderate levels of readiness, with gender and previous IPV experience yielding main effects. IPV-BI knowledge scores were poor. Nationally mandated education, training, and infrastructure are required to ensure all survivors of IPV receive gold-standard care regardless of which paramedics are on duty.
... 95 For example, childhood maltreatment may be more impactful than household dysfunction. 96 The current study examined the relationships between the grouping of ACEs and behaviors associated with mental wellbeing but did not examine these relationships by individual ACEs types. Finally, ACE scores do not account for multiple occurrences of a given adversity and the impact this may have on a person's wellbeing. ...
Article
Objectives: The purpose is to examine the relationship between Adverse Childhood Experiences (ACEs), protective factors, and select maladaptive coping behaviors in postsecondary students. Participants: Undergraduate students attending Dalhousie University. Methods: An online anonymous survey was conducted. Zero order one-tailed correlations were computed to measure relationships between ACEs, levels of maladaptive coping behaviors and protective factors. A structural equation mediation model examined direct and indirect pathways between measures. Results: 42.5% of respondents (n = 327) reported ≥3ACEs. Higher ACEs were associated with higher expression of maladaptive coping behaviors. Respondents with high ACEs and low levels of protective factors reported lower levels of hope and forgiveness and higher levels of stress and rumination. Conclusion: Higher levels of protective factors were associated with lower levels of maladaptive coping behaviors in students with high ACEs.
... However, unlike those studies, this study explored whether the addition of a cumulative PCE score added any protective value above the individual factors. Previous ACEs researchers have found that not all ACEs are equal, with certain ACEs having greater impacts than others on negative outcomes (Lacey & Minnis, 2020;Negriff, 2020;Sayyah et al., 2022). Thus, this study suggests that the most salient protective factors may have a stronger association with childhood obesity. ...
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While rates of childhood obesity continue to rise in the United States, multiple studies have linked childhood obesity to adverse childhood experiences (ACEs). ACEs researchers have begun to develop frameworks that identify protective factors that build resilience against ACEs. However, these frameworks have a limited evidence base. Utilizing data from the 2018–2020 National Survey of Children’s Health, this study compared the effectiveness of the National Scientific Council on the Developing Child (NSCDC), Health Outcomes from Positive Experiences (HOPE), and cumulative positive childhood experiences (PCEs) frameworks in mitigating the impact of ACEs on childhood obesity. Based on hierarchical logistic regression conducted on data from 46,672 children between the ages of 10 and 17 years old, this study found that both the NSCDC and HOPE frameworks were associated with childhood obesity, with each framework explaining a similar amount of variance in childhood obesity across analyses. The cumulative PCEs framework did not strengthen the association between either framework and childhood obesity. Across analyses, strong self-regulation, mastery/after-school activities, and living in a supportive neighborhood had the strongest association with childhood obesity. The findings suggest that the most salient protective factors may be those most closely associated with the direct causes of childhood obesity, with the need to identify factors across ecological levels. Future research is needed to validate these frameworks further and explore these frameworks with other outcomes. The findings have important implications for future ACEs research and ACEs interventions. Public Relevance By understanding which resilience frameworks and protective factors have the strongest relationship with childhood obesity among children who experienced ACEs, interventions can potentially be developed using these findings to mitigate the harmful impact of ACEs on childhood obesity. Key Findings This study found that the National Scientific Council on the Developing Child (NSCDC) and Health Outcomes from Positive Experiences (HOPE) frameworks were associated with childhood obesity after controlling for adverse childhood experiences (ACEs) in a sample of children between the ages of 10 and 17 years old. The strongest protective factors against childhood obesity were strong self-regulation, mastery/after-school activities, and living in a supportive neighborhood. Given the relationship between these protective factors along with several covariates in the study with childhood obesity, future ACEs interventions should potentially target these protective factors and other social determinants of health to reduce the negative impact of ACEs on childhood obesity.
... It can be utilized to calculate a cumulative score (Balistreri & Alvira-Hammond, 2016;Bright et al., 2016;Elkins et al., 2018). However, a limitation of this approach is that household dysfunction, in contrast to maltreatment experiences, has been shown to exert weaker effects on mental health outcomes (Atzl et al., 2019;Finkelhor et al., 2015;Negriff, 2020). Therefore, this study employed the five CM items and one item on exposure to domestic violence as our measure for CM. ...
... This may be explained, in part, by the fact that analysis in this study did not include ACEs scores focusing on physical and sexual abuse. Negriff (2020) explains that the disadvantage of the dose-response approach is that it treats each of the individual items as having equivalent effect on the outcome, whereas the evidence indicates that higher cumulative adversity has stronger impact on different aspects of health because those with more ACEs have more severe events occurring (e.g. sexual abuse, co-occurring abuse) as opposed to a linear cumulative effect. ...
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Objectives Adverse Childhood Experiences (ACEs) increase health risks leading to negative pregnancy outcomes, thus prompting the need for preconception care to address these risks. The aim of this study is to assess the association between ACEs score and self-report of having pre-pregnancy health conversations with a healthcare provider. Methods Secondary analysis of PRAMS data from 2016 to 2020 was performed from 3 states and Washington, DC. ACEs score was categorized as 0 (low risk), 1–3 (intermediate risk), and ≥ 4 (high risk). Pre-pregnancy health conversations were measured using reports of being asked about the desire to have children, use birth control to prevent pregnancy, and/or improve health during any visit in the 12 months prior to pregnancy. Multivariate Poisson Regression was performed to adjust for potential confounders: age, race/ethnicity, income, education, insurance type, marital status, pregnancy intention, and parity. Results A total of 10,448 PRAMS survey responses from 2016 to 2020 were included in the analysis. More than half of women reported having at least 1 ACE (51%). Those with an ACE score of ≥ 4 had 1.19 (95% CI: 1.01–1.41) times higher adjusted Prevalence Ratio (aPR) and those with an ACE score of 1–3 had about the same aPR 1.00 (95% CI: 0.93–1.09) of reporting pre-pregnancy health conversations with a healthcare provider compared to those with no ACEs. Conclusions for practice The overall low percentage of respondents reporting receipt of pre-pregnancy health conversations with a health care provider indicates the need for these conversations to be had on a more routine basis.
... Estos datos sugieren que la presencia de estas adversidades en el contexto mexicano es escasa más no inexistente, por lo que se tendría que valorarse la posibilidad de excluir estos eventos del constructo de EAI. Sin embargo, esto no aplica con el abuso sexual, que ha sido un evento fuertemente asociado con consecuencias negativas (Negriff, 2020) y que ha formado parte del constructo desde sus inicios (Felitti et al., 1998). ...
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La comprensión de las Experiencias Adversas en la Infancia (EAI) es clave para atender los retos que enfrenta la población mexicana durante la infancia. Esta revisión teórica tiene como objetivo explorar las EAI presentes en México, a partir de la revisión de la evolución conceptual del constructo, los dominios y categorías de adversidad, y la descripción de adversidades específicas encontradas en este contexto. En la discusión se sintetizan los principales hallazgos y conclusiones de cada aspecto considerado para la revisión teórica, los retos metodológicos y limitaciones del estudio de las EAI en México, así como las implicaciones para la investigación y la práctica en futuros estudios.
... Regardless of the answer to those mysteries, though, Anda's review was indeed essential to ACEs' strategic framing because it included only adversities with Despite the epidemiologically valid method of measuring experienced categories rather than number of exposures and treating them as equal in weight, it is important to note the significant qualitative differences across types of original adversities -some are singular; others are chronic. Despite a lack of consideration for key factors such as severity, timing, or duration (White et al., 2019, p. 457;Irving & Delpierre, 2019, p. 451;Hartas, 2019, p. 436;Negriff, 2020), the ACE score framework represents each as a single "biologic stress dose" (Anda, 2012, 12:50). ...
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This discourse analysis of Adverse Childhood Experiences (ACEs) applies theories of genealogy to trace the lineages upon which ACEs is premised and to theorize how, as a product of their continuities and discontinuities, ACEs emerged as a truth regime and contemporary biopolitics. I unearth the lost history of the phrase “adverse childhood experiences” beginning in 1948, a full 50 years before Robert Anda and Vincent Felitti were able to publish the ACE Study (Felitti et al., 1998). I highlight the significant contributions of psychiatrist and psychologist Sir Michael Rutter, the credited founder of child psychiatry; developmental epidemiology; developmental genetics; and developmental psychopathology. It was Rutter who first applied the pharmacology of “dose-effect” to measure “doses” of deprivation (King's College London, 2021), a methodological contribution that would become foundational to ACE research , and whose scholarship examined adverse childhood experiences and the protective factors of resilience nearly two decades before the ACEs studies – but who Anda and Felitti never acknowledged, instead claiming their roles as pioneers of ACE science. I then consider the rise of neoliberal shifts that led to the emergence of the second revolution of public health, in which the Healthy People Initiative, the United States’ leading public health framework, characterized contemporary biopolitical strategies for the role of individuals in public health outcomes and called for biometric surveillance strategies to measure, predict, and optimize wellness and increase national human capital. My genealogy contextualizes these shifts amidst adjacent events, which supported the expansion of public health agendas and paved the way for the ACE campaign. I argue that the biopolitics of ACEs – a dispositif whose truth regime; multinational, multi-sector public health campaign; frame for social policy; global data gathering regime, and centerpiece of intervention strategies – contribute to its eugenic genealogical continuities and neoliberal distinctions.
... This result was partially consistent with the previous Japanese WHO survey data, which showed parental mental illness and physical abuse strongly affected the onset of mood disorder 28 . With a few exceptions 43 , few paper suggested that physical neglect had a significant impact on mental health; but we should note that those with physical neglect has high comorbidity of ACEs (e.g., childhood poverty, emotional abuse/neglect) in this study. Many studies suggested that emotional abuse and neglect had great impacts on mental health [44][45][46][47] . ...
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The study aimed to examine the association of expanded adverse childhood experiences (ACEs) with psychological distress in adulthood. The data from nation-wide online cohort was used for analysis. Community dwelling adults in Japan were included. The ACEs was assessed by 15 items of ACE-J, including childhood poverty and school bullying. Severe psychological distress was determined as the score of Kessler 6 over 13. Multivariable logistic regression analysis was conducted, by using sample weighting. A total of 28,617 participants were analyzed. About 75% of Japanese people had one or more ACEs. The prevalence of those with ACEs over 4 was 14.7%. Those with ACEs over 4 showed adjusted odds ratio = 8.18 [95% CI 7.14–9.38] for severe psychological distress. The prevalence of childhood poverty was 29% for 50–64 year old participants and 40% of 65 or older participants. The impact of childhood poverty on psychological distress was less than other ACEs in these age cohorts. Bullying was experienced 21–27% in young generations, but 10% in 65 or older participants. However, the impact on psychological distress in adulthood was relatively high in all age groups. ACEs have impacted mental health for a long time. Future research and practice to reduce ACEs are encouraged.
... Additionally, items on the NSCH undergo extensive testing and purposely avoid asking about physical and sexual abuse, which suggests that such bias is minimal. Third, NSCH did not assess childhood maltreatment, such as abuse and neglect, which has been shown to have more predictive of mental health than household dysfunction (Negriff, 2020). Moreover, binary variables of ACEs did not consider the timing, length of exposure, and severity of the adverse experience. ...
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Background Adverse childhood experiences (ACEs) have been associated with poor health outcomes in the general population. However, their impact on autistic youth remains unclear. Objective The primary objective was to understand how childhood adversity is related to the general health, mental health, and physical health of transition-age autistic youth. Participants and Setting Using data from the 2018–2021 National Survey of Children’s Health, this cross-sectional study involved 2056 autistic youth aged 12–17. Methods Logistic regression was employed to test the association between three measures of ACEs - individual ACEs, cumulative ACEs, and grouped ACEs based on contexts, and health outcomes of autistic youth. Results Our study observed a high prevalence of ACEs among autistic youth, with a substantially higher proportion experiencing multiple ACEs than their neurotypical peers. Individual ACEs were significantly associated with specific health issues. Cumulative ACEs demonstrated a clear dose-response relationship with health outcomes, with higher ACE counts increasing the likelihood of experiencing poor general health, mental health conditions, and physical health issues. Moreover, grouped ACEs associated with health differently, with community-based ACEs being particularly linked to general health status, mental health conditions, and physical health conditions, while family-based ACEs correlated more with more severe mental health conditions and being overweight. Conclusion These findings collectively emphasize the importance of addressing ACEs as a public health concern among transition-age autistic youth, highlighting the need for targeted interventions, prevention strategies, and support services to mitigate the negative impact of ACEs on the overall well-being of this growing community.
... Not all stressful events during childhood seem to be equally associated with negative health outcomes. Several studies have shown that the experience of childhood abuse or neglect has a more profound impact on mental health problems across the lifespan when compared to other types of CA (Atzl et al., 2019;Hovens et al., 2015;Lee et al., 2020;Narayan et al., 2017;Negriff, 2020). Also, the impact of CA is assumed to depend on the frequency and age of CA exposure (Hughes et al., 2017;Hovens et al., 2015;Agorastos et al., 2014;Dunn et al., 2017Dunn et al., , 2018Li et al., 2022), the type of CA (Narayan et al., 2017;Dye, 2020;Källström et al., 2020), the relationship to the perpetrator (Källström et al., 2020;Ullman, 2007) and environmental risk and protective factors (Austin et al., 2020;Younas et al., 2022). ...
... Currently, ACEs include direct or indirect incidences of maltreatment that occur before the age of 18, such as serious accidents, childhood illnesses, presence of domestic or community violence, discrimination, natural disasters, caregivers who suffer from mental illness, substance abuse, incarceration, divorced parents, and poverty (Ferrer, 2022). These events usually have physical, psychological, emotional, and social consequences (Bellis et al., 2019;Crouch et al., 2019;Sheffler et al., 2020;Trinidad, 2021) during childhood, predict negative outcomes in youth, extend into adulthood, and even replicate generationally (Afifi et al., 2020;Narayan et al., 2021;Negriff, 2020;Splett et al., 2013). ...
Article
Concerns regarding college students’ mental health are growing worldwide. Adverse childhood experiences (ACEs) are associated with depression and anxiety symptoms. However, resilience buffers their negative impact on mental health. This study assessed the prevalence and association of anxiety, depression, resilience, with the types of ACEs in psychology students. A cross-sectional design was employed with a sample of 337 Mexican psychology students. Of the students, 70% had four or more ACEs, and the most frequent ACEs were emotional neglect, family violence, emotional abuse, and physical abuse. Most students did not report depression or clinical anxiety symptoms. Two probabilistic models were obtained; 1) physical abuse increased the probability of depression (odds ratio, OR 14.1; 95% confidence interval, CI 1.7, 113.9), and resilience in competence (OR .914; 95% CI .851, .981) and acceptance (OR .776; 95% CI .668, .902) dimensions decreased the likelihood of depression; and 2) resilience in acceptance (OR .774; 95% CI .630, .855) dimension decreased the probability of clinical anxiety. ACEs are highly prevalent among psychology students. Physical abuse increases the probability of depression, whereas resilience decreases the probability of depression and/or anxiety symptoms. Impact of resilience on the negative outcomes of ACEs should be evaluated in future.
... | 1219 macrosystem, and chronosystem, with the microsystem being the most influential level within the ecological systems theory. When considering adolescent mental health, it is noteworthy that microsystems such as schools, families, and peer groups may have a greater impact than the natural environment (Aldridge & McChesney, 2018;Han et al., 2023;Negriff, 2020). Therefore, it is plausible that the impact of the natural environment will be diminished even further, leading to a destabilizing effect on the predictive relationship between nature connectedness and adolescent depressive symptoms. ...
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Introduction Following the conservation of resource theory and natural stress reduction theory, the current study investigated mediated pathways, reverse mediated pathways, and reciprocal pathways between connectedness to nature, depressive symptoms, and adolescent learning burnout via a half‐longitudinal analysis, and discussed gender differences in the three models. Methods Two waves of data were collected in December 2022 (T1) and June 2023 (T2) for this study. The sample consisted of 1092 Chinese adolescents (52.20% girls, Mage = 13.03, SD = 1.43). Semi‐longitudinal analyses were conducted to examine the relationship between connectedness to nature, depressive symptoms, and adolescent academic burnout. Results The results indicated that connectedness to nature can serve as a positive resource to alleviate the levels of depressive symptoms among adolescents and thereby decrease learning burnout. However, the protective effect of connectedness to nature was smaller, and the decreasing effect of learning burnout on connectedness to nature was stronger than the alleviating effect of connectedness to nature on learning burnout. Additionally, the study found that depressive symptoms and academic burnout have a mutually reinforcing effect over time and that the effects of this interaction are more pronounced in females. Conclusions The present study emphasizes the protective role of nature connectedness and the detrimental effects of learning burnout in adolescents.
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Background Early life adversity has long-term effects; however, the influence on changes in body size across the life course is not well understood. Objectives of this study were to define trajectories of body size across the life course and to evaluate the association between adverse childhood experiences (ACEs) and perceived life course body size trajectories. Methods A longitudinal study using data from the Canadian Longitudinal Study on Aging (CLSA) was conducted (n=11 830). Adults aged 49–93 were asked to recall eight ACEs and their perceived body size at ages 25, 45, 55, 65 and current using pictograms. Body size trajectories were identified using latent class growth mixture modelling. Multinomial logistic regression was used to estimate ORs and 95% CIs for the association between ACEs and perceived body size trajectories. Effect modification by sex was explored. Results Six distinct life course body size trajectories were identified: consistently low (9.7%), consistently mid-size (24.7%), moderate increase (37.4%), strong increase (14.7%), decline (4.9%) and consistently high (8.6%). High ACE exposure, compared with none, was associated with increased odds of the strong increase (OR: 1.49; 95% CI: 1.21 to 1.83) and consistently high (OR: 1.36; 95% CI: 1.08 to 1.73) body size trajectories, compared with the moderate-increase trajectory. For females, there was a strong association for those who reported 4–8 ACEs with the consistently high trajectory (OR: 1.70; 95% CI: 1.24 to 2.34) but no association for males (OR: 0.99; 95% CI: 0.69 to 1.41). Discussion Distinct patterns of body size throughout the life course exist. ACEs are associated with trajectories that are characterised by obesity incidence in both early and later life.
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Child maltreatment is a major public and global health issue with well-documented intergenerational patterns. Social-emotional development, which is detrimentally impacted by child maltreatment, has been associated with parenting behaviors and implicated as a mechanism of intergenerational transmission of child maltreatment. This scoping review sought to synthesize information on the social-emotional skills that contribute to or protect against intergenerational maltreatment. Following the JBI Manual for Evidence Synthesis systematic scoping review methodology, 23 studies were identified as having met all inclusion criteria. Eligible studies were empirical, primary, peer-reviewed and published work written in English. Included studies contained a parental history of maltreatment, maltreatment or risk thereof to the child, and at least one independent parental social-emotional factor. Studies were organized, and findings were conceptually mapped according to Collaborative for Academic, Social, and Emotional Learning (CASEL) social-emotional competency domains. Key findings included determining self-management as the most well-studied CASEL competency area, whereas there was a paucity of research on relationship skills and responsible decision-making. Studies focused almost exclusively on assessing risk. The most well-documented risk factors for intergenerational maltreatment included parental emotion dysregulation, low self-control, aggression, and dissociation. Measurement and consideration of the developmental timing of maltreatment was identified as a critical oversight in the literature. Future work should explore developmentally specific models and elucidate more comprehensive profiles of social-emotional risk and resilience as a means of developing more effective prevention strategies.
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The increasing prevalence of adolescent psychological health issues worldwide has become a significant public health concern affecting the future. Families, as the primary environment providing material and emotional support for adolescent development, play a crucial role in fostering growth and psychological well-being. This study employed a literature review methodology, using keywords such as family dysfunction, adolescents, and psychological health, to search for definitions of family dysfunction and relevant literature about its effects on adolescents' psychological health. The review study summarized the definitions of family dysfunction, related research, and its impact on adolescent psychological health. The findings suggest that addressing the impact of family dysfunction on adolescent psychological health effectively requires collaborative efforts from families, schools, and society. Establishing collaborative prevention and intervention mechanisms among family, schools and society, providing educational programs to improve family function, and adopting family-centered intervention strategies are essential steps toward solving this critical issue. Article visualizations: </p
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Research over the last two decades has established Adverse Childhood Experiences (ACEs) as one of the most important determinants of mental and physical health outcomes over the lifespan. Despite compelling evidence, the integration of Adverse Childhood Experiences (ACEs) or trauma-informed approaches into public health policies and healthcare services has been slow, underscoring the urgent need for heightened awareness and advocacy. This chapter provides an in-depth exploration of ACE studies, beginning with their origins, followed by discussions on defining ACEs and exploring various types. Subsequently, the chapter scrutinizes the evidence linking ACE exposure to prevalent mental health conditions, with a special focus on recent evidence from Asian and African countries. Finally, it synthesizes potential biological and psychological mechanisms through which ACEs get “under the skin.”
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There is increased recognition for solutions that address the social determinants of health (SDOHs)—the context in which families are raising children. Unfortunately, implementing solutions that address inequities in the SDOHs has proven to be difficult. Many child and family serving systems and communities do not know where to start or do not have the capacity to identify and implement upstream SDOH strategies. As such, we conducted a scoping review to assess the status of evidence connecting strategies that address the SDOHs and child well-being. A total of 29,079 records were identified using natural language processing with 341 records meeting inclusion criteria (e.g., outcomes focused on child well-being, interventions happening at a population level, and evaluations of prevention strategies in the United States). Records were coded, and the findings are presented by the SDOH domain, such as strategies that addressed economic stability (n = 94), education access and quality (n = 17), food security (n = 106), healthcare access and quality (n = 96), neighborhood and built environment (n = 7), and social and community context (n = 12). This review provides an overview of the associations between population-level SDOH strategies and the impact—good and bad—on child well-being and may be a useful resource for communities and practitioners when considering equitable solutions that promote thriving childhoods.
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By young adulthood, 1 in 5 teens will experience an episode of major depression. The second leading cause of death among youths aged 15 to 24 years is suicide, most of which will have been caused by untreated or undiagnosed depression. Depression is a highly heritable condition: depressed children often have depressed parents. Support to caregivers is important because depressed parents can have negative effects on children’s development and future mental health. Groups more vulnerable to mental health disorders such as depression include Black, Indigenous, and persons of color and lesbian, gay, bisexual, transgender, or queer/questioning, who in recent years have the highest rate of suicide attempts (Black teens, sexual minority youth), the highest increases in suicide rates (Black children and youths), and the highest suicide rates (American Indian/Alaskan native). They frequently experience more adverse childhood events, which increases the risk of depression and suicide attempts. Pediatricians are most likely to care for these vulnerable youths, who often are less engaged in specialty mental health care for a variety of reasons, including stigma and barriers to access. By offering behavioral and mental health care to vulnerable populations in primary care, mental health equity may be achieved. Screening for depression and assessment for suicide are within the scope of pediatric practice and among the competencies recommended by the American Academy of Pediatrics and The American Board of Pediatrics.
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Depression treatment strategies are within the scope of pediatric practice and among the competencies recommended by the Academy of Pediatrics and The American Board of Pediatrics. Treatments that may be provided through collaborative care include nonpharmacologic therapies such as psychosocial treatments and evidence-based psychotherapies, and pharmacotherapy and monitoring processes for depression. Abundant support and guidance are available to pediatricians in depression care, including mental health consultation and online materials.
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Importance Child physical and emotional abuse and neglect may affect epigenetic signatures of accelerated aging several years after the exposure. Objective To examine the longitudinal outcomes of early-childhood and midchildhood exposures to maltreatment on later childhood and adolescent profiles of epigenetic accelerated aging. Design, Setting, and Participants This cohort study used data from the Future of Families and Child Wellbeing Study (enrolled 1998-2000), a US birth cohort study with available DNA methylation (DNAm) data at ages 9 and 15 years (assayed between 2017 and 2020) and phenotypic data at birth (wave 1), and ages 3 (wave 3), 5 (wave 4), 9 (wave 5), and 15 (wave 6) years. Data were analyzed between June 18 and December 10, 2023. Exposures Emotional aggression, physical assault, emotional neglect, and physical neglect via the Parent-Child Conflict Tactics Scale at ages 3 and 5 years. Main Outcomes and Measures Epigenetic accelerated aging (DNAmAA) was measured using 3 machine learning–derived surrogates of aging (GrimAge, PhenoAge, and DunedinPACE) and 2 machine learning–derived surrogates of age (Horvath and PedBE), residualized for age in months. Results A total of 1971 children (992 [50.3%] male) representative of births in large US cities between 1998 and 2000 were included. Physical assault at age 3 years was positively associated with DNAmAA for PhenoAge (β = 0.073; 95% CI, 0.019-0.127), and emotional aggression at age 3 years was negatively associated with PhenoAge DNAmAA (β = −0.107; 95% CI, −0.162 to −0.052). Emotional neglect at age 5 years was positively associated with PhenoAge DNAmAA (β = 0.051; 95% CI, 0.006-0.097). Cumulative exposure to physical assault between ages 3 and 5 years was positively associated with PhenoAge DNAmAA (β = 0.063; 95% CI, 0.003-0.123); emotional aggression was negatively associated with PhenoAge DNAmAA (β = −0.104; 95% CI, −0.165 to −0.043). The association of these measures with age 15 years PhenoAge DNAmAA was almost fully mediated by age 9 years PhenoAge DNAm age acceleration. Similar patterns were found for GrimAge, DunedinPACE, and PhenoAge, but only those for PhenoAge remained after adjustments for multiple comparisons. Conclusions and Relevance In this cohort study, altered patterns of DNAmAA were sensitive to the type and timing of child maltreatment exposure and appeared to be associated with more proximate biological embedding of stress.
Article
Using a descriptive-correlational approach, this study aimed to quantify the prevalence of ACEs (adverse childhood experiences) and aggression among young adults in Malita. It specifically determines the level of ACEs and aggression, the significant relationship between ACEs and aggression, and the area of the independent variable that was most strongly associated with the aggression of young adults. 98 respondents were randomly selected to take part in the study. The independent variable was measured using two adapted questionnaires, namely, the Adverse Childhood Experiences (ACEs) Questionnaire [47] and the Childhood Trauma Questionnaire [26], while Buss-Perry Aggression Questionnaire (1992) [22] for the dependent variable. The researchers made used of a variety of statistical methods, including the mean, Spearman's rho, and step-wise multiple regression. Among the five types of abuse, results showed that emotional abuse was a commonly reported form of adversity in childhood. Meanwhile, at the level of aggression, verbal aggression was shown to have the highest responses out of the three different types of aggression. The findings of the study showed no statistical significance between varia-bles. While emotional neglect, among other forms of adversity in childhood, was the lone predictor of aggression in young adults.
Chapter
In this exploration of child abuse and its impact on survivors' lives and well-being, well-being was defined as feeling physically, mentally, and emotionally well and functioning positively as an individual and a member of society. The primary categories of child abuse addressed were physical, psychological, and sexual abuse and neglect. Intimate personal violence as a form of child abuse was also addressed. Short- and long-term physical, psychological, social, and individual outcomes for child abuse survivors throughout the life course were explored. Interventions and strategies aimed at helping child abuse survivors and their caregivers recover from the aftermath of child abuse were explored. This work focused on what child abuse survivors and their caregivers found the most helpful on their journeys to well-being. While well-being outcomes for survivors of childhood abuse were found to be deleterious in many psychological, social, and individual areas, recovery and improvement in overall well-being were found to be possible for both child abuse survivors and their caregivers.
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Αdverse childhood experiences refer to various potentially traumatic situations that impactchildren before the age of 18. It is a relatively new concept with important, and largely unknown,implications for Social Work. This article aims to assess the impact of these experiences onphysical and mental health and explore the role of social workers in this field. A literature reviewwas conducted using Pubmed, PsychInfo, and Google Scholar databases, with relevantkeywords, and publications were reviewed without chronological restriction. The study durationwas 4 months (May-August 2023). The results indicated that adverse childhood experiencesare common in the general population and can have both short-term and long-term negativeeffects on an individual's physical and mental health. Notably, they are associated with anincreased likelihood of adopting health-damaging behaviors (e.g., smoking, substance use),various chronic diseases (e.g., cardiovascular and respiratory diseases), and increasedpremature mortality. The implications for mental health are also significant, with strongassociations identified between these experiences and adverse mental health outcomes inadulthood, such as depression and suicide. Their negative effects may start in childhood. Socialworkers can play a crucial role in preventing these adverse experiences, detecting them early,and effectively managing their consequences by collaborating with professionals from relatedscientific fields. This collaborative approach aims to interrupt the "vicious cycle" of theseexperiences and their transgenerational transmission, ultimately ensuring a higher level ofhealth and well-being for individuals and societies.
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African American women are at disproportionate risk of experiencing intimate partner violence (IPV) and consistently report more severe and recurrent IPV victimization in comparison to their White and Hispanic counterparts. IPV is more likely to occur in families with children than in couples without children. Parenting in the wake of IPV is a challenging reality faced by many African American women in the United States. Despite the urgent need to support mothers who have survived IPV, there is currently no culturally adapted parenting intervention for African American mothers following exposure to IPV. The aim of this review is to summarize and integrate two disparate literatures, hitherto unintegrated; namely the literature base on parenting interventions for women and children exposed to IPV and the literature base on parenting interventions through the lens of African American racial and cultural factors. Our review identified 7 questions that researchers may consider in adapting IPV parenting interventions for African American women and children. These questions are discussed as a possible roadmap for the adaptation of more culturally sensitive IPV parenting programs.
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Background Adverse childhood experiences (ACEs) are well‐established risk factors for self‐harm and depression. However, despite their high comorbidity, there has been little focus on the impact of developmental timing and the duration of exposure to ACEs on co‐occurring self‐harm and depression. Methods Data were utilised from over 22,000 children and adolescents participating in three UK cohorts, followed up longitudinally for 14–18 years: the Avon Longitudinal Study of Parents and Children (ALSPAC), the Millennium Cohort Study (MCS) and the Environmental Risk (E‐Risk) Longitudinal Twin Study. Multinomial logistic regression models estimated associations between each ACE type and a four‐category outcome: no self‐harm or depression, self‐harm alone, depression alone and self‐harm with co‐occurring depression. A structured life course modelling approach was used to examine whether the accumulation (duration) of exposure to each ACE, or a critical period (timing of ACEs) had the strongest effects on self‐harm and depression in adolescence. Results The majority of ACEs were associated with co‐occurring self‐harm and depression, with consistent findings across cohorts. The importance of timing and duration of ACEs differed across ACEs and across cohorts. For parental mental health problems, longer duration of exposure was strongly associated with co‐occurring self‐harm and depression in both ALSPAC (adjusted OR: 1.18, 95% CI: 1.10–1.25) and MCS (1.18, 1.11–1.26) cohorts. For other ACEs in ALSPAC, exposure in middle childhood was most strongly associated with co‐occurring self‐harm and depression, and ACE occurrence in early childhood and adolescence was more important in the MCS. Conclusions Efforts to mitigate the impact of ACEs should start in early life with continued support throughout childhood, to prevent long‐term exposure to ACEs contributing to risk of self‐harm and depression in adolescence.
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Childhood adversity can have long-term deleterious effects on adulthood mental health outcomes, but more research is needed examining how type and timing of childhood adversity affect mental health specifically during pregnancy. The current study examined the effects of total adverse childhood experiences (ACEs) on depression and posttraumatic stress disorder (PTSD) symptoms during pregnancy, unpacked effects of total adversity into childhood maltreatment versus family dysfunction experiences, and assessed age of onset effects of child maltreatment-specific experiences. Participants were 101 low-income pregnant women (M = 29.10 years, SD = 6.56, range = 18-44; 37% Latina, 22% African American, 20% White, 13% biracial/multiracial, 8% other; 26% Spanish-speaking) who completed instruments on childhood adversity, PTSD and depression symptoms during pregnancy, and demographics. Results indicated that total ACEs predicted elevated PTSD and depression symptoms during pregnancy, as did maltreatment ACEs, but not family dysfunction ACEs. Early childhood onset of maltreatment significantly predicted elevated PTSD symptoms during pregnancy, whereas middle childhood and adolescent onset did not. No age of onset of maltreatment variable significantly predicted depression symptoms during pregnancy. Findings underscore the importance of differentiating between childhood maltreatment versus family dysfunction ACEs and examining the timing and accumulation of maltreatment experiences during childhood, because these factors affect mental health during pregnancy. Findings also support universal prenatal screening for PTSD symptoms to identify at-risk pregnant women who could benefit from interventions to disrupt the intergenerational transmission of risk and give families the healthiest possible beginning. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Childhood abuse is a major public health problem that has been linked to depression in adulthood. Although different types of childhood abuse often co-occur, few studies have examined their unique impact on negative mental health outcomes. Most studies have focused solely on the consequences of childhood physical or sexual abuse; however, it has been suggested that childhood emotional abuse is more strongly related to depression. It remains unclear which underlying psychological processes mediate the effect of childhood emotional abuse on depressive symptoms. In a cross-sectional study in 276 female college students, multiple linear regression analyses were used to determine whether childhood emotional abuse, physical abuse, and sexual abuse were independently associated with depressive symptoms, emotion dysregulation, and interpersonal problems. Subsequently, OLS regression analyses were used to determine whether emotion dysregulation and interpersonal problems mediate the relationship between childhood emotional abuse and depressive symptoms. Of all types of abuse, only emotional abuse was independently associated with depressive symptoms, emotion dysregulation, and interpersonal problems. The effect of childhood emotional abuse on depressive symptoms was mediated by emotion dysregulation and the following domains of interpersonal problems: cold/distant and domineering/controlling. The results of the current study indicate that detection and prevention of childhood emotional abuse deserves attention from Child Protective Services. Finally, interventions that target emotion regulation skills and interpersonal skills may be beneficial in prevention of depression.
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Depression is a common mental illness and research has focused on late childhood and adolescence in an attempt to prevent or reduce later psychopathology and/or social impairments. It is important to establish and study population-averaged trajectories of depressive symptoms across adolescence as this could characterise specific changes in populations and help identify critical points to intervene with treatment. Multilevel growth-curve models were used to explore adolescent trajectories of depressive symptoms in 9301 individuals (57% female) from the Avon Longitudinal Study of Parents and Children, a UK based pregnancy cohort. Trajectories of depressive symptoms were constructed for males and females using the short mood and feelings questionnaire over 8 occasions, between 10 and 22 years old. Critical points of development such as age of peak velocity for depressive symptoms (the age at which depressive symptoms increase most rapidly) and the age of maximum depressive symptoms were also derived. The results suggested that from similar initial levels of depressive symptoms at age 11, females on average experienced steeper increases in depressive symptoms than males over their teenage and adolescent years until around the age of 20 when levels of depressive symptoms plateaued and started to decrease for both sexes. Females on average also had an earlier age of peak velocity of depressive symptoms that occurred at 13.5 years, compared to males who on average had an age of peak velocity at 16 years old. Evidence was less clear for a difference between the ages of maximum depressive symptoms which were on average 19.6 years for females and 20.4 for males. Identifying critical periods for different population subgroups may provide useful knowledge for treating and preventing depression and could be tailored to be time specific for certain groups. Possible explanations and recommendations are discussed.
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Adverse childhood experiences (ACE) are associated with increased risk for psychopathology over the life course. However, few studies have examined the differential impact of ACE and posttraumatic stress disorder (PTSD) for racially and ethnically diverse adolescent populations. The findings from the few studies that examine differential effects are contradictory. This study uses data from the National Comorbidity Survey-Adolescent Supplement (NCS-A), a nationally representative adolescent sample (N = 10,123) to examine the impact of race/ethnicity on the association between ACE and PTSD among youth in a nationally representative sample in the United States. A multivariate logistic regression model was used to examine the main effects of ACE and race/ethnicity on PTSD, as well as the moderating role of race/ethnicity adjusting for socio-demographic variables. Findings suggest that race/ethnicity moderates the association between ACE and PTSD. Higher ACE score increased probability of lifetime PTSD for White non-Hispanic, Black, and Hispanic adolescents with White non-Hispanic adolescents presenting with a much higher probability of lifetime PTSD compared to their Hispanic and Black peers. Implications for future research and practice are discussed, specifically trauma informed strategies and culturally inclusive/specific practices that address the structural, interpersonal, and intrapersonal influences adolescent outcomes.
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Background: A growing body of research identifies the harmful effects that adverse childhood experiences (ACEs; occurring during childhood or adolescence; eg, child maltreatment or exposure to domestic violence) have on health throughout life. Studies have quantified such effects for individual ACEs. However, ACEs frequently co-occur and no synthesis of findings from studies measuring the effect of multiple ACE types has been done. Methods: In this systematic review and meta-analysis, we searched five electronic databases for cross-sectional, case-control, or cohort studies published up to May 6, 2016, reporting risks of health outcomes, consisting of substance use, sexual health, mental health, weight and physical exercise, violence, and physical health status and conditions, associated with multiple ACEs. We selected articles that presented risk estimates for individuals with at least four ACEs compared with those with none for outcomes with sufficient data for meta-analysis (at least four populations). Included studies also focused on adults aged at least 18 years with a sample size of at least 100. We excluded studies based on high-risk or clinical populations. We extracted data from published reports. We calculated pooled odds ratios (ORs) using a random-effects model. Findings: Of 11 621 references identified by the search, 37 included studies provided risk estimates for 23 outcomes, with a total of 253 719 participants. Individuals with at least four ACEs were at increased risk of all health outcomes compared with individuals with no ACEs. Associations were weak or modest for physical inactivity, overweight or obesity, and diabetes (ORs of less than two); moderate for smoking, heavy alcohol use, poor self-rated health, cancer, heart disease, and respiratory disease (ORs of two to three), strong for sexual risk taking, mental ill health, and problematic alcohol use (ORs of more than three to six), and strongest for problematic drug use and interpersonal and self-directed violence (ORs of more than seven). We identified considerable heterogeneity (I2 of >75%) between estimates for almost half of the outcomes. Interpretation: To have multiple ACEs is a major risk factor for many health conditions. The outcomes most strongly associated with multiple ACEs represent ACE risks for the next generation (eg, violence, mental illness, and substance use). To sustain improvements in public health requires a shift in focus to include prevention of ACEs, resilience building, and ACE-informed service provision. The Sustainable Development Goals provide a global platform to reduce ACEs and their life-course effect on health. Funding: Public Health Wales.
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Children ages 0–2 are exposed to disproportionate rates of trauma and neglect and yet little is known about the longitudinal impact of adverse childhood experiences in early childhood. Objectives of this study were to utilize longitudinal data to examine the independent and cumulative contribution of various childhood adversities from age 0–2 on adult health. Data derived from the age 0–2 and age 18 waves of the Midwest cohort of the Longitudinal Studies on Child Abuse and Neglect (LONGSCAN) dataset. Logistic regression was used to explore the relationship between early childhood ACE scores and adult health outcomes. Independent regression models with ACE score and specific ACE categories predicted health outcomes in young adults. Exposure to caregiver mental illness and physical neglect had independent influences on health outcomes in young adults. This study highlights the impact of experiences of adversity from age 0–2 on adult health outcomes and underscores the need for comprehensive interdisciplinary preventive screening and early intervention efforts for trauma-exposed children.
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BackgroundA dose-dependent effect of Adverse Childhood Experiences (ACE) on the course and severity of psychiatric disorders has been frequently reported. Recent evidence indicates additional impact of type and timing of distinct ACE on symptom severity experienced in adulthood, in support of stress-sensitive periods in (brain) development. The present study seeks to clarify the impact of ACE on symptoms that are often comorbid across various diagnostic groups: symptoms of posttraumatic stress disorder (PTSD), shutdown dissociation and depression. A key aim was to determine and compare the importance of dose-dependent versus type and timing specific prediction of ACE on symptom levels. Methods Exposure to ten types of maltreatment up to age 18 were retrospectively assessed in N = 129 psychiatric inpatients using the Maltreatment and Abuse Chronology of Exposure (MACE). Symptoms of PTSD, shutdown dissociation, and depression were related to type and timing of ACE. The predictive power of peak types and timings was compared to that of global MACE measures of duration, multiplicity and overall severity. ResultsA dose-dependent effect (MACE duration, multiplicity and overall severity) on severity of all symptoms confirmed earlier findings. Conditioned random forest regression verified that PTSD symptoms were best predicted by overall ACE severity, whereas type and timing specific effects showed stronger prediction for symptoms of dissociation and depression. In particular, physical neglect at age 5 and emotional neglect at ages 4–5 were related to increased symptoms of dissociation, whereas the emotional neglect at age 8–9 enhanced symptoms of depression. Conclusion In support of the sensitive period of exposure model, present results indicate augmented vulnerability by type x timing of ACE, in particular emphasizing pre-school (age 4–5) and pre-adolescent (8–9) periods as sensitive for the impact of physical and emotional neglect. PTSD, the most severe stress-related disorder, varies with the amount of adverse experiences irrespective of age of experience. Considering type and timing of ACE improves understanding of vulnerability, and should inform diagnostics of psychopathology like PTSD, dissociation and depression in adult psychiatric patients.
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Despite the expanding research on adverse childhood experiences (ACEs) and corpus of studies on intergenerational maltreatment in high-risk families, studies have not examined intergenerational ACEs more broadly, much less in severely disadvantaged families. This study investigated the intergenerational continuity of ACEs in mothers and young children aged 4 to 6 years living in emergency homeless shelters. It also examined whether unpacking ACEs into categories of exposure to maltreatment versus family dysfunction affected intergenerational continuity patterns or child socioemotional problems in school. Negative parenting, in the form of observed inept coercive discipline with children, and cumulative sociodemographic risk were examined as additional predictors of child ACEs and socioemotional problems. Mothers (N = 95; aged 20-45; 64.2% African American, 3.2% African Native, 11.6% Caucasian, 7.4% biracial/multiracial, and 13.6% other) completed questionnaires on parent and child ACEs and cumulative risk factors. They participated in videotaped parent-child interactions rated for observed coercive discipline, and teachers provided reports of children's socioemotional problems. Results indicated that higher parental ACEs predicted higher child ACEs, with higher numbers of parental ACEs in either category (maltreatment or family dysfunction) predicting higher levels of child ACEs in both categories. However, child exposure to maltreatment, but not family dysfunction, significantly predicted elevations in children's socioemotional problems. Findings underscore the role of intergenerational childhood adversity in homeless families and also emphasize that unpacking ACEs in children may illuminate key areas of vulnerability for school adjustment. (PsycINFO Database Record
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Objective: Adverse childhood experiences (ACEs) are associated with myriad health conditions and risk behaviors in both adolescents and adults. In this study we examine the association between ACEs and specific physical, mental, and developmental conditions, as well as their comorbidity, in a nationally representative sample of children 0-17 years. Methods: Data from the 2011-2012 National Survey for Child Health (NSCH) were used. A total of 95,677 random-digit-dial interviews with parents of children 0-17 years were conducted across all 50 states and the District of Columbia. Outcomes included singular condition domains (physical, mental, and developmental) as well as combinations of condition domains (e.g., physical plus mental, mental plus developmental, etc.). Results: Twenty-three percent of parents reported that their child experienced 1 ACE; 9.2 % experienced 2 ACEs, and 10.3 % experienced three or more. Across all three condition domains and combinations of domains, children who experienced at least one ACE were more likely than children who experienced 0 ACEs to have at least one condition. Additionally, greater ACEs was associated with increased likelihood of at least one condition in each domain and in multiple domains. Conclusions: for practice These findings support the extension of existing family environment screening tools in pediatric practices as well as the establishment of a system for monitoring ACEs in families with multiple or complex conditions.
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Objective: The purpose of the current investigation is to assess and validate the factor structure of the Behavioral Risk Factor Surveillance System's (BRFSS) Adverse Childhood Experience (ACE) module. Method: ACE data available from the 2009 BRFSS survey were fit using exploratory factor analysis (EFA) to estimate an initial factorial structure. The exploratory solution was then validated using confirmatory factor analysis (CFA) with data from the 2010 BRFSS survey. Lastly, ACE factors were tested for measurement invariance using multiple group factor analysis. Results: EFA results suggested that a 3-factor solution adequately fit the data. Examination of factor loadings and item content suggested the factors represented the following construct areas: Household Dysfunction, Emotional/Physical Abuse, and Sexual Abuse. Subsequent CFA results confirmed the 3-factor solution and provided preliminary support for estimation of an overall latent ACE score summarizing the responses to all available items. Measurement invariance was supported across both gender and age. Conclusions: Results of this study provides support for the use of the current ACE module scoring algorithm, which uses the sum of the number of items endorsed to estimate exposure. However, the results also suggest potential benefits to estimating 3 separate composite scores to estimate the specific effects of exposure to Household Dysfunction, Emotional/Physical Abuse, and Sexual Abuse.
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Adverse childhood experiences (ACEs) have been associated with negative health outcomes, but the evidence has had limited application in primary care practice. The purpose of this study was to systematically review the research on associations between ACEs and adult health outcomes to inform nurse practitioners (NPs) in primary care practice. The databases PubMed, CINAHL, PsycINFO, and Social Abstracts were searched for articles published in English between 2008 and 2013 using the search term "adverse childhood experiences." Forty-two research articles were included in the synthesis. The evidence was synthesized and is reported following the preferred reporting items for systematic reviews and meta-analysis procedure (PRISMA). ACEs have been associated with health consequences including physical and psychological conditions, risk behaviors, developmental disruption, and increased healthcare utilization. Generalization of the results is limited by a majority of studies (41/42) measuring childhood adversity using self-report measures. NPs are encouraged to incorporate assessment of patients' childhood history in routine primary care and to consider the evidence that supports a relationship between ACEs and health. Although difficult, talking about patient's childhood experiences may positively influence health outcomes. ©2015 American Association of Nurse Practitioners.
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The study objectives were to (a) examine the association between total number of trauma types experienced and child/adolescent behavioral problems and (b) determine whether the number of trauma types experienced predicted youth behavioral problems above and beyond demographic characteristics, using a diverse set of 20 types of trauma. Data came from the National Child Traumatic Stress Network's (NCTSN) Core Data Set (CDS), which includes youth assessed and treated for trauma across the United States. Participants who experienced at least one type of trauma were included in the sample (N = 11,028; age = 1&frac12;-18 years; 52.3% girls). Random effects models were used to account for possible intraclass correlations given treatment services were provided at different NCTSN centers. Logistic regression analyses were used to investigate associations among demographic characteristics, trauma, and emotional and behavioral problems as measured by the Child Behavior Checklist (CBCL). Significant dose-response relations were found between total number of trauma types and behavior problems for all CBCL scales, except Sleep, one of the subscales only administered to 1&frac12;- to 5-year-olds. Thus, each additional trauma type endorsed significantly increased the odds for scoring above the clinical threshold. Results provide further evidence of strong associations between diverse traumatic childhood experiences and a diverse range of behavior problems, and underscore the need for a trauma-informed public health and social welfare approach to prevention, risk reduction, and early intervention for traumatized youth.
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This article provides an overview of mental and physical health outcomes of child maltreatment to help health care providers identify the consequences of maltreatment and consider treatment options. Child maltreatment is associated with a variety of negative physical and mental health outcomes that affect the individual throughout the lifespan and place a substantial burden on both victims and the population as a whole. The review begins with an overview of the role of physicians in identifying abuse and neglect in the clinic setting. Next, current research findings on physical and mental health outcomes in children, adolescents, and adults are reviewed. Finally, opportunities for primary prevention of abuse and neglect are discussed. Primary prevention strategies can avoid risk for maltreatment, and subsequent interventions for victims have the potential to greatly improve their health.
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This review evaluates the quality of recent meta-analyses on child sexual abuse and adult psychopathology. Using systematic review methods, seven recently published, English-language meta-analyses met the inclusion criteria of assessing outcome of child sexual abuse. Some methodological weaknesses were identified, such as failure to assess the validity of the primary studies. Child sexual abuse was found to be a nonspecific risk factor in the development of adult mental health difficulties, but the effect sizes varied (partly related to sample type and size). No gender difference was consistently found on adult mental health difficulties but was for victims' perceived mental health consequence. Future meta-analyses need to consider their methods of assessing primary studies to allow for an evidence-based model of adult psychopathology.
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To describe the history, factor structure, reliability, and validity of the Multidimensional Anxiety Scale for Children (MASC). In two separate school-based population studies, principal-components factor analysis was used, first, to test a theory-driven factor structure, and second, to develop an empirically derived factor structure for the MASC. In a separate study using a clinical population, test-retest reliability at 3 weeks and 3 months, interrater concordance, and convergent and divergent validity were examined. The final version of the MASC consists of 39 items distributed across four major factors, three of which can be parsed into two subfactors each. Main and subfactors include (1) physical symptoms (tense/restless and somatic/autonomic), (2) social anxiety (humiliation/rejection and public performance fears), (3) harm avoidance (perfectionism and anxious coping), and (4) separation anxiety. The MASC factor structure, which presumably reflects the in the vivo structure of pediatric anxiety symptoms, is invariant across gender and age and shows excellent internal reliability. As expected, females show greater anxiety on all factors and subfactors than males. Three-week and 3-month test-retest reliability was satisfactory to excellent. Parent-child agreement was poor to fair. Concordance was greatest for easily observable symptom clusters and for mother-child over father-child or father-mother pairs. Shared variance with scales sampling symptom domains of interest was highest for anxiety, intermediate for depression, and lowest for externalizing symptoms, indicating adequate convergent and divergent validity. The MASC is a promising self-report scale for assessing anxiety in children and adolescents.
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Lifetime trauma histories were ascertained for females with confirmed histories of childhood sexual abuse and comparison females participating in a longitudinal, prospective study. Abused participants reported twice as many subsequent rapes or sexual assaults (p = .07), 1.6 times as many physical affronts including domestic violence (p = .01), almost four times as many incidences of self-inflicted harm (p = .002), and more than 20% more subsequent, significant lifetime traumas (p = .04) than did comparison participants. Sexual revictimization was positively correlated with posttraumatic stress disorder symptoms (PTSD), peritraumatic dissociation, and sexual preoccupation. Physical revictimization was positively correlated with PTSD symptoms, pathological dissociation, and sexually permissive attitudes. Self-harm was positively correlated with both peritraumatic and pathological dissociation. Competing theoretical explanations for revictimization and self-harm are discussed and evaluated.
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Adverse childhood experiences (ACEs) have been consistently linked to psychiatric difficulties in children and adults. However, the long-term effects of ACEs on mental health during the early adult years have been understudied. In addition, many studies are methodologically limited by use of non-representative samples, and few studies have investigated gender and racial differences. The current study relates self-reported lifetime exposure to a range of ACEs in a community sample of high school seniors to three mental health outcomes-depressive symptoms, drug abuse, and antisocial behavior-two years later during the transition to adulthood. The study has a two-wave, prospective design. A systematic probability sample of high school seniors (N = 1093) was taken from communities of diverse socioeconomic status. They were interviewed in person in 1998 and over the telephone two years later. Gender and racial differences in ACE prevalence were tested with chi-square tests. Each mental health outcome was regressed on one ACE, controlling for gender, race/ethnicity, and SES to obtain partially standardized regression coefficients. Most ACEs were strongly associated with all three outcomes. The cumulative effect of ACEs was significant and of similar magnitude for all three outcomes. Except for sex abuse/assault, significant gender differences in the effects of single ACEs on depression and drug use were not observed. However, boys who experienced ACEs were more likely to engage in antisocial behavior early in young adulthood than girls who experienced similar ACEs. Where racial/ethnic differences existed, the adverse mental health impact of ACEs on Whites was consistently greater than on Blacks and Hispanics. Our sample of young adults from urban, socio-economically disadvantaged communities reported high rates of adverse childhood experiences. The public health impact of childhood adversity is evident in the very strong association between childhood adversity and depressive symptoms, antisocial behavior, and drug use during the early transition to adulthood. These findings, coupled with evidence that the impact of major childhood adversities persists well into adulthood, indicate the critical need for prevention and intervention strategies targeting early adverse experiences and their mental health consequences.
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Rationale: It is well established that exposure to a greater number of adverse childhood experiences (ACEs) increases the risk of poor physical and mental health outcomes. Given the predictive validity of ACE scores and other cumulative risk metrics, a similar measurement approach may advance the study of risk in adulthood. Objective: We examined the prevalence and interrelations of 10 adverse adult experiences, including household events such as intimate partner violence and extrafamilial events such as crime victimization. We also tested the relation between cumulative adult adversity and later mental health problems, and we examined whether adult adversity mediates the link between childhood adversity and mental health. Methods: Data were collected from 501 women in the Families and Children Thriving Study, a longitudinal investigation of low-income families that received home visiting services in Wisconsin. We conducted correlation analyses to assess interrelations among study measures along with multivariate analyses to test the effects of childhood and adult adversity on three outcomes: depression, anxiety, and posttraumatic stress disorder (PTSD). We then fit a structural equation model to test whether the effects of childhood adversity on mental health are mediated by adult adversity. Results: Over 80% of participants endorsed at least one adverse adult experience. Adult adversities correlated with each other and with the mental health outcomes. Controlling for ACEs and model covariates, adult adversity scores were positively associated with depression, anxiety, and PTSD scores. Path analyses revealed that the ACE-mental health connection was mediated by adult adversity. Conclusion: Our findings indicate that mental health problems may be better understood by accounting for processes through which early adversity leads to later adversity. Pending replication, this line of research has the potential to improve the identification of populations that are at risk of poor health outcomes.
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Importance Adverse childhood experiences (ACEs) have been associated with poor mental and physical health outcomes. However, the mechanism of this effect, critical to enhancing public health, remains poorly understood. Objective To investigate the neurodevelopmental trajectory of the association between early ACEs and adolescent general and emotional health outcomes. Design, Setting, and Participants A prospective longitudinal study that began when patients were aged 3 to 6 years who underwent neuroimaging later at ages 7 to 12 years and whose mental and physical health outcomes were observed at ages 9 to 15 years. Sequential mediation models were used to investigate associations between early ACEs and brain structure, emotion development, and health outcomes longitudinally. Children were recruited from an academic medical center research unit. Exposure Early life adversity. Main Outcomes and Measures Early ACEs in children aged 3 to 7 years; volume of a subregion of the prefrontal cortex, the inferior frontal gyrus, in children aged 6 to 12 years; and emotional awareness, depression severity, and general health outcomes in children and adolescents aged 9 to 15 years. Results The mean (SD) age of 119 patients was 9.65 (1.31) years at the time of scan. The mean (SD) ACE score was 5.44 (3.46). The mean (SD) depression severity scores were 2.61 (1.78) at preschool, 1.77 (1.58) at time 2, and 2.16 (1.64) at time 3. The mean (SD) global physical health scores at time 2 and time 3 were 0.30 (0.38) and 0.33 (0.42), respectively. Sequential mediation in the association between high early ACEs and emotional and physical health outcomes were found. Smaller inferior frontal gyrus volumes and poor emotional awareness sequentially mediated the association between early ACEs and poor general health (model parameter estimate = 0.002; 95% CI, 0.0002-0.056) and higher depression severity (model parameter estimate = 0.007; 95% CI, 0.001-0.021) in adolescence. An increase from 0 to 3 early ACEs was associated with 15% and 25% increases in depression severity and physical health problems, respectively. Conclusions and Relevance Study findings highlight 1 putative neurodevelopmental mechanism by which the association between early ACEs and later poor mental and physical health outcomes may operate. This identified risk trajectory may be useful to target preventive interventions.
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Research shows that adverse events experienced during childhood (i.e., adverse childhood experiences [ACEs]) are problematic, but few studies have examined race differences in the prevalence and impact of ACEs on delinquency. This study investigated these relationships using prospective data from approximately 600 high-risk families in the Longitudinal Studies of Child Abuse and Neglect. Ten ACEs were measured, five types of child maltreatment and five types of household dysfunction. White youth experienced a significantly greater number of ACEs (4.08) compared to Black youth (2.90) and a greater prevalence of seven individual ACEs. According to logistic regression analyses, the number of ACEs significantly increased the likelihood of self-reported alcohol use, marijuana use, violence (in some models), and arrest at age 16 among Blacks but not Whites; race differences were statistically significant for alcohol use, marijuana use, and arrest. The findings support the need for juvenile justice officials to recognize the trauma histories of youth offenders when determining appropriate treatment and sanctions.
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The negative influence of adverse childhood experiences (ACEs) on social, emotional, and behavioral (SEB) outcomes are well documented. However, no research to date has examined the effect of ACEs on SEB outcomes in youth who received mental health services after reporting to the child welfare system. This study's analyses of data from the National Survey of Child and Adolescent Well-Being II revealed that the most prevalent ACEs included hospitalization for a medical condition, neglect, and exposures to domestic and community violence. Logistic regression of this data showed that the odds of being diagnosed with internalizing problems increased with age and when sexual abuse was reported. The results also showed that compared to Caucasian youth, Latinos were less likely to be diagnosed with externalizing behaviors, even when sexual abuse had been reported. Contrary to one of this study's hypotheses, mental health service use within the past 18 months increased the odds of being diagnosed with SEB problems. These findings highlight the persistence of SEB problems despite receipt of mental health services. Future research should assess the impact of interventions that aim to mitigate poor SEB outcomes due to ACEs, especially sexual abuse.
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The goal of this short-term longitudinal study was to examine whether adverse childhood experiences (ACEs) could be used to identify college students at risk for mental health problems and whether current level of stress mediates the relationship between ACEs and mental health. Data on ACEs and mental health (depression, anxiety and suicidality) were collected at the beginning of the semester, and data on current stressors and mental health were collected toward the end of the semester (n = 239). Findings indicated that ACEs predicted worsening of mental health over the course of a semester and suggested current number of stressors as a mediator of the relationship between ACEs and mental health. Results suggest that screening for ACEs might be useful to identify students at high risk for deterioration in mental health. Results further suggest that stress-related interventions would be beneficial for students with high levels of ACEs and point to the need for more research and strategies to increase help-seeking in college students.
Article
Research on adverse childhood experiences (ACEs) has unified the study of interrelated risks and generated insights into the origins of disorder and disease. Ten indicators of child maltreatment and household dysfunction are widely accepted as ACEs, but further progress requires a more systematic approach to conceptualizing and measuring ACEs. Using data from a diverse, low-income sample of women who received home visiting services in Wisconsin (N = 1,241), this study assessed the prevalence of and interrelations among 10 conventional ACEs and 7 potential ACEs: family financial problems, food insecurity, homelessness, parental absence, parent/sibling death, bullying, and violent crime. Associations between ACEs and two outcomes, perceived stress and smoking, were examined. The factor structure and test-retest reliability of ACEs was also explored. As expected, prevalence rates were high compared to studies of more representative samples. Except for parent/sibling death, all ACEs were intercorrelated and associated at the bivariate level with perceived stress and smoking. Exploratory factor analysis confirmed that conventional ACEs loaded on two factors, child maltreatment and household dysfunction, though a more complex four-factor solution emerged once new ACEs were introduced. All ACEs demonstrated acceptable test-retest reliability. Implications and future directions toward a second generation of ACE research are discussed.
Article
Objectives: Adverse childhood experiences (ACEs) have been consistently linked in a strong and graded fashion to a host of health problems in later adulthood but few studies have examined the more proximate effect of ACEs on health and emotional well-being in adolescence. Study design: Nationally representative cross-sectional study. Methods: Using logistic regression on the 2011/12 National Survey of Children's Health, we examined the cumulative effect of total ACE score on the health and emotional well-being of US adolescents aged 12 to 17 years. We investigated the moderating effect of family functioning on the impact of ACE on adolescent health and emotional well-being. Results: Adolescents with higher ACE scores had worse reported physical and emotional well-being than adolescents with fewer ACEs net of key demographic and socio-economic characteristics. Family functioning moderated the negative impact of cumulative ACE on adolescent health and emotional well-being. Conclusions: Adolescent well-being has enduring consequences; identifying children with ACE exposure who also have lower-functioning family could also help identify those families at particular risk.
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Current knowledge of Adverse Childhood Experiences (ACEs) relies on data predominantly collected from white, middle- / upper-middle-class participants and focuses on experiences within the home. Using a more socioeconomically and racially diverse urban population, Conventional and Expanded (community-level) ACEs were measured to help understand whether Conventional ACEs alone can sufficiently measure adversity, particularly among various subgroups. Participants from a previous large, representative, community-based health survey in Southeast Pennsylvania who were aged ≥18 years were contacted between November 2012 and January 2013 to complete another phone survey measuring ACEs. Ordinal logistic regression models were used to test associations between Conventional and Expanded ACEs scores and demographic characteristics. Analysis was conducted in 2013 and 2014. Of 1,784 respondents, 72.9% had at least one Conventional ACE, 63.4% at least one Expanded ACE, and 49.3% experienced both. A total of 13.9% experienced only Expanded ACEs and would have gone unrecognized if only Conventional ACEs were assessed. Certain demographic characteristics were associated with higher risk for Conventional ACEs but were not predictive of Expanded ACEs, and vice versa. Few adversities were associated with both Conventional and Expanded ACEs. To more accurately represent the level of adversity experienced across various sociodemographic groups, these data support extending the Conventional ACEs measure. Copyright © 2015 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.
Article
This study examines whether the items from the original Adverse Childhood Experiences (ACE) scale can be improved in their prediction of health outcomes by adding some additional widely recognized childhood adversities. The analyses come from the National Survey of Children's Exposure to Violence 2014, a telephone survey conducted from August 2013 through April 2014 with a nationally representative sample of 1,949 children and adolescents aged 10-17 and their caregivers who were asked about adversities, physical health conditions and mental health symptoms. The addition of measures of peer victimization, peer isolation/rejection, and community violence exposure added significantly to the prediction of mental health symptoms, and the addition of a measure of low socioeconomic status (SES) added significantly to the prediction of physical health problems. A revised version of the ACES scale is proposed. Copyright © 2015 Elsevier Ltd. All rights reserved.
Article
The adjustment problems associated with sexual abuse, physical abuse, psychological maltreatment, neglect, and witnessing family violence during childhood were examined in three studies. Study 1 demonstrated significant overlap between maltreatment types in parent reports (N = 50) of maltreatment experiences of their child aged 5–12 years. Parental sexual punitiveness, traditionality, family adaptability and family cohesion significantly predicted scores on 4 maltreatment scales and children's externalizing behavior problems. Level of maltreatment predicted internalizing, externalizing, and sexual behavior problems. In Study 2, significant overlap was found between adults' retrospective reports (N = 138) of all 5 types of maltreating behaviors. Parental sexual punitiveness, traditionality, family adaptability, and family cohesion during childhood predicted the level of maltreatment and current psychopathology. Although child maltreatment scores predicted psychopathology, childhood family variables were better predictors of adjustment. Study 3 demonstrated that child maltreatment scores predicted positive aspects of adult adaptive functioning (N = 95).
Article
Research has shown that adverse childhood experiences (ACEs) increase the risk of poor health-related outcomes in later life. Less is known about the consequences of ACEs in early adulthood or among diverse samples. Therefore, we investigated the impacts of differential exposure to ACEs on an urban, minority sample of young adults. Health, mental health, and substance use outcomes were examined alone and in aggregate. Potential moderating effects of sex were also explored. Data were derived from the Chicago Longitudinal Study, a panel investigation of individuals who were born in 1979 or 1980. Main-effect analyses were conducted with multivariate logistic and OLS regression. Sex differences were explored with stratified analysis, followed by tests of interaction effects with the full sample. Results confirmed that there was a robust association between ACEs and poor outcomes in early adulthood. Greater levels of adversity were associated with poorer self-rated health and life satisfaction, as well as more frequent depressive symptoms, anxiety, tobacco use, alcohol use, and marijuana use. Cumulative adversity also was associated with cumulative effects across domains. For instance, compared to individuals without an ACE, individuals exposed to multiple ACEs were more likely to have three or more poor outcomes (OR range=2.75-10.15) and four or more poor outcomes (OR range=3.93-15.18). No significant differences between males and females were detected. Given that the consequences of ACEs in early adulthood may lead to later morbidity and mortality, increased investment in programs and policies that prevent ACEs and ameliorate their impacts is warranted.
Article
To pilot test a tool to screen for adverse childhood experiences (ACE), and to explore the ability of this tool to distinguish early child outcomes among lower- and higher-risk children. This cross-sectional study used data collected of 102 children between the ages of 4 and 5 years presenting for well-child visits at an urban federally qualified health center. Logistic regression analyses adjusted for child sex, ethnicity, and birth weight were used to test the association between each dichotomized child outcome and risk exposure based on a 6-item (maltreatment suspected, domestic violence, substance use, mental illness, criminal behavior, single parent) and 7-item (plus maternal education) Child ACE tool. Effect sizes were generally similar for the 6-item and 7-item Child ACE tools, with the exception of 2 subscales measuring development. The adjusted odds of behavior problems was higher for children with a higher compared to a lower 7-item Child ACE score (adjusted odds ratio [aOR] 3.12, 95% confidence interval [CI] 1.34-7.22), as was the odds of developmental delay (aOR 3.66, 95% CI 1.10-12.17), and injury visits (aOR 5.65, 95% CI 1.13-28.24), but lower for obesity (aOR 0.32, 95% CI 0.11-0.92). Brief tools can be used to screen for ACE and identify specific early child outcomes associated with ACE. We suggest that follow-up studies test the incorporation of the 7-item Child ACE tool into practice and track rates of child behavior problems, developmental delays, and injuries.
Article
Context Although childhood adversities (CAs) are known to be highly co-occurring, most research examines their associations with psychiatric disorders one at a time. However, recent evidence from adult studies suggests that the associations of multiple CAs with psychiatric disorders are nonadditive, arguing for the importance of multivariate analysis of multiple CAs. To our knowledge, no attempt has been made to perform a similar kind of analysis among children or adolescents. Objective To examine the multivariate associations of 12 CAs with first onset of psychiatric disorders in a national sample of US adolescents. Design A US national survey of adolescents (age range, 13-17 years) assessing DSM-IV anxiety, mood, behavior, and substance use disorders and CAs. The CAs include parental loss (death, divorce, and other separations), maltreatment (neglect and physical, sexual, and emotional abuse), and parental maladjustment (violence, criminality, substance abuse, and psychopathology), as well as economic adversity. Setting Dual-frame household-school samples. Participants In total, 6483 adolescent-parent pairs. Main Outcome Measures Lifetime DSM-IV disorders assessed using the World Health Organization Composite International Diagnostic Interview. Results Overall, exposure to at least 1 CA was reported by 58.3% of adolescents, among whom 59.7% reported multiple CAs. The CAs reflecting maladaptive family functioning were more strongly associated than other CAs with the onset of psychiatric disorders. The best-fitting model included terms for the type and number of CAs and distinguished between maladaptive family functioning and other CAs. The CAs predicted behavior disorders most strongly and fear disorders least strongly. The joint associations of multiple CAs were subadditive. The population-attributable risk proportions across DSM-IV disorder classes ranged from 15.7% for fear disorders to 40.7% for behavior disorders. The CAs were associated with 28.2% of all onsets of psychiatric disorders. Conclusions Childhood adversities are common, highly co-occurring, and strongly associated with the onset of psychiatric disorders among US adolescents. The subadditive multivariate associations of CAs with the onset of psychiatric disorders have implications for targeting interventions to reduce exposure to CAs and to mitigate the harmful effects of CAs to improve population mental health.
Article
This study examined the relationship of emotion regulation to multiple forms of child abuse and subsequent posttraumatic stress. Particular consideration was given to emotional abuse, which has received less attention in the literature. Results from a survey of 912 female college students revealed that women who reported a history of sexual, physical, or emotional abuse endorsed greater emotion regulation difficulties compared to women without abuse histories. Notably, emotional abuse was the strongest predictor of emotion deregulation. Mediation analyses indicated that emotion dysregulation partially explained the relationship between physical and emotional abuse and symptoms of posttraumatic stress, suggesting that intervention efforts aimed at improving emotion regulation strategies might be beneficial in decreasing posttraumatic stress among women with child maltreatment histories.
Article
Based on the data obtained through Child Protective Services (CPS) case records abstraction, this study aimed to explore patterns of overlapping types of child maltreatment in a sample of urban, ethnically diverse male and female youth (n= 303) identified as maltreated by a large public child welfare agency. A cluster analysis was conducted on data for 303 maltreated youth. The overall categorization of four types of abuse (i.e., physical, sexual, emotional abuse and neglect) was used to provide a starting point for clustering of the 303 cases and then the subtypes of emotional abuse were broken down in the clusters. The different clusters of child maltreatment were compared on the multiple outcomes such as mental health, behavior problems, self-perception, and cognitive development. In this study, we identified four clusters of child maltreatment experiences. Three patterns involved emotional abuse. One cluster of children experienced all four types. Different clusters were differentially associated with multiple outcome measures. In general, multiply-maltreated youth fared worst, especially when the cluster involved sexual abuse. Also, sex differences were found in these associations. Boys who experienced multiple types of maltreatment showed more difficulties than girls. These results reiterate the importance of creating more complex models of child maltreatment. Children who have experienced various types of maltreatment are especially in need of more attention from professionals and resources should be allocated accordingly.
Article
Although significant associations of childhood adversities (CAs) with adult mental disorders have been widely documented, associations of CAs with onset and persistence of disorders have not been distinguished. This distinction is important for conceptual and practical purposes. To examine the multivariate associations of 12 retrospectively reported CAs with persistence of adult DSM-IV disorders in the National Comorbidity Survey Replication. Cross-sectional community survey. Household population in the United States. Nationally representative sample of 5692 adults. Recency of episodes was assessed separately for each of 20 lifetime DSM-IV mood, anxiety, disruptive behavior, and substance use disorders in respondents with a lifetime history of these disorders using the Composite International Diagnostic Interview. Predictors of persistence were examined using backward recurrence survival models to predict time since most recent episode controlling for age at onset and time since onset. The CAs involving maladaptive family functioning (parental mental illness, substance use disorder, criminality, family violence, physical and sexual abuse, and neglect) but not other CAs were significantly but modestly related to persistence of mood, substance abuse, and anxiety disorders. Number of maladaptive family functioning CAs had statistically significant, but again substantively modest, subadditive associations with the same outcomes. Exposure to multiple other CAs was significantly associated with persistence of mood and anxiety disorders. Associations remained statistically significant throughout the life course, although the substantive size of associations indicated by simulations showing time to most recent episode would increase by only 1.6% (from a mean of 8.3 years to a mean of 8.4 years) in the absence of CAs. The overall statistically significant associations of CAs with adult DSM-IV/Composite International Diagnostic Interview disorders are due largely to component associations with onsets rather than with persistence, indirectly suggesting that the greatest focus of public health attention on CAs should be aimed at primary rather than secondary prevention.
Article
Although significant associations of childhood adversities (CAs) with adult mental disorders have been documented consistently in epidemiological surveys, these studies generally have examined only 1 CA per study. Because CAs are highly clustered, this approach results in overestimating the importance of individual CAs. Multivariate CA studies have been based on insufficiently complex models. To examine the joint associations of 12 retrospectively reported CAs with the first onset of DSM-IV disorders in the National Comorbidity Survey Replication using substantively complex multivariate models. Cross-sectional community survey with retrospective reports of CAs and lifetime DSM-IV disorders. Household population in the United States. Nationally representative sample of 9282 adults. Lifetime prevalences of 20 DSM-IV anxiety, mood, disruptive behavior, and substance use disorders assessed using the Composite International Diagnostic Interview. The CAs studied were highly prevalent and intercorrelated. The CAs in a maladaptive family functioning (MFF) cluster (parental mental illness, substance abuse disorder, and criminality; family violence; physical abuse; sexual abuse; and neglect) were the strongest correlates of disorder onset. The best-fitting model included terms for each type of CA, number of MFF CAs, and number of other CAs. Multiple MFF CAs had significant subadditive associations with disorder onset. Little specificity was found for particular CAs with particular disorders. Associations declined in magnitude with life course stage and number of previous lifetime disorders but increased with length of recall. Simulations suggest that CAs are associated with 44.6% of all childhood-onset disorders and with 25.9% to 32.0% of later-onset disorders. The fact that associations increased with length of recall raises the possibility of recall bias inflating estimates. Even considering this, the results suggest that CAs have powerful and often subadditive associations with the onset of many types of largely primary mental disorders throughout the life course.
Article
To assess the severity of depression in school-aged children, self-report, clinician-rated and peer-rated instruments have been developed. Since these rating scales attempt to quantify an alleged clinical phenomenon, they represent a needed step toward more systematic scientific research into childhood depression. On the other hand, they are not diagnostic tools. The available instruments are promising but are still experimental. Additional data are needed to support their usefulness and accuracy as measurement devices.
Article
The relationship of health risk behavior and disease in adulthood to the breadth of exposure to childhood emotional, physical, or sexual abuse, and household dysfunction during childhood has not previously been described. A questionnaire about adverse childhood experiences was mailed to 13,494 adults who had completed a standardized medical evaluation at a large HMO; 9,508 (70.5%) responded. Seven categories of adverse childhood experiences were studied: psychological, physical, or sexual abuse; violence against mother; or living with household members who were substance abusers, mentally ill or suicidal, or ever imprisoned. The number of categories of these adverse childhood experiences was then compared to measures of adult risk behavior, health status, and disease. Logistic regression was used to adjust for effects of demographic factors on the association between the cumulative number of categories of childhood exposures (range: 0-7) and risk factors for the leading causes of death in adult life. More than half of respondents reported at least one, and one-fourth reported > or = 2 categories of childhood exposures. We found a graded relationship between the number of categories of childhood exposure and each of the adult health risk behaviors and diseases that were studied (P < .001). Persons who had experienced four or more categories of childhood exposure, compared to those who had experienced none, had 4- to 12-fold increased health risks for alcoholism, drug abuse, depression, and suicide attempt; a 2- to 4-fold increase in smoking, poor self-rated health, > or = 50 sexual intercourse partners, and sexually transmitted disease; and 1.4- to 1.6-fold increase in physical inactivity and severe obesity. The number of categories of adverse childhood exposures showed a graded relationship to the presence of adult diseases including ischemic heart disease, cancer, chronic lung disease, skeletal fractures, and liver disease. The seven categories of adverse childhood experiences were strongly interrelated and persons with multiple categories of childhood exposure were likely to have multiple health risk factors later in life. We found a strong graded relationship between the breadth of exposure to abuse or household dysfunction during childhood and multiple risk factors for several of the leading causes of death in adults.
Article
The purpose of this study was to describe the extent to which childhood abuse and neglect increase a person's risk for subsequent posttraumatic stress disorder (PTSD) and to determine whether the relationship to PTSD persists despite controls for family, individual, and lifestyle characteristics associated with both childhood victimization and PTSD. Victims of substantiated child abuse and neglect from 1967 to 1971 in a Midwestern metropolitan county area were matched on the basis of age, race, sex, and approximate family socioeconomic class with a group of nonabused and nonneglected children and followed prospectively into young adulthood. Subjects (N = 1,196) were located and administered a 2-hour interview that included the National Institute of Mental Health Diagnostic Interview Schedule to assess PTSD. Childhood victimization was associated with increased risk for lifetime and current PTSD. Slightly more than a third of the childhood victims of sexual abuse (37.5%), 32.7% of those physically abused, and 30.6% of victims of childhood neglect met DSM-III-R criteria for lifetime PTSD. The relationship between childhood victimization and number of PTSD symptoms persisted despite the introduction of covariates associated with risk for both. Victims of child abuse (sexual and physical) and neglect are at increased risk for developing PTSD, but childhood victimization is not a sufficient condition. Family, individual, and lifestyle variables also place individuals at risk and contribute to the symptoms of PTSD.