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Links of Adversity in Childhood With Mental and Physical Health Outcomes: A Systematic Review of Longitudinal Mediating and Moderating Mechanisms
Abstract and Figures
Adverse childhood experiences (ACEs) have been associated with causes of early death, addiction, mental illness, and poor health. However, studies investigating underlying mechanisms often rely on cross-sectional data or inappropriate study designs. To prevent the negative sequelae associated with ACEs, it is imperative to understand the mechanisms underlying the prospective relationship. The aim of this present review was to provide a synthesis and critical evaluation of the literature regarding the mechanisms underlying this relationship. A search in SCOPUS, MedLine via Ovid, PsycINFO via Ovid, and Web of Science was performed. Studies that utilised a prospective design assessing ACEs in childhood or adolescence, outcomes in adulthood, and analysed either a mediating or moderating relationship were included, unless the study relied on informant report or official records to assess childhood maltreatment types of ACEs. Twenty-two studies examining a longitudinal mediation or moderation were included in a systematic review. A review of the studies found links to psychopathology, delinquent and problem behaviours, poor physical health, and poor socioeconomic outcomes. A clear image of underlying mechanisms is not forthcoming due to (a) poor study design in relation to assessing longitudinal mechanisms, and (b) heterogeneity in the adversities, mechanisms, and outcomes assessed. Based on the review, several gaps and limitations are highlighted and discussed.
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... Early life adversity has been shown to have long-lasting detrimental effects on a variety of biopsychosocial outcomes (i.e., physical health, mental health, lifestyles, cognition, and brain atrophy) [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16]. Multiple lines of evidence also show that early life adversity may directly or indirectly affect cognition and thus increase the risk of dementia (e.g., [17][18][19][20][21][22][23]). ...
... These results are in line with the literature showing a negative effect of early adversity on mental health, and cognition (e.g., [2,3,5,[10][11][12][13]15]). However, the findings do not support previous research showing a negative effect of early adversity on physical health and lifestyle (e.g., [3,9,11,12,16]). The role of a mediator may be hypothesized as underlying the association between physical neglect and physical health, as well as smoking status. ...
... Education was associated with numerous outcomes in both cohorts, therefore education may (fully and partially) mediate the effects of early adversity on the outcomes of interest in both cohorts [9]. Importantly, education has been found to be important for resilience [75]. ...
Background
Early life adversity has been shown to have long-lasting detrimental effects on a variety of biopsychosocial outcomes. Early adversity and its consequences may directly or indirectly affect cognitive aging and increase the risk of developing dementia in older age. Investigating the biopsychosocial outcomes associated with early adverse experiences is essential to inform health policies and promote healthy cognitive development across the life course.
Methods
The aim of this study is to investigate the effect of early adversity (i.e., abuse and deprivation) on selected outcomes (i.e., physical and mental health, lifestyle, and cognition) in two UK cohorts (the English Longitudinal Study of Ageing (ELSA), N = 12,653, Mdnage = 66, SDage = 9.58; UK Biobank, N = 502,360, Mdnage = 58, SDage = 8.09). In both cohorts, adversities were self-reported retrospectively, and only those adversity types assessed in both cohorts were utilized. A post-hoc analysis was performed to examine the role of education as a mediator of the association between early adversity and the selected outcomes.
Results
Most of the results show that early adversity is negatively associated with health (both physical and mental), lifestyle, and cognition while also highlighting the important mediating role of education. However, differences exist according to the specific adversity experienced and the cohort studied.
Conclusions
The results found bring into attention the complex associations between early adversity and multiple later life outcomes, and suggest that various mechanisms might be at play. Furthermore, the findings highlight the importance of multi-cohort comparisons for the generalization of the results.
... All analyses were conducted with Stata 18 (StataCorp LLC, College Station, TX, USA). We performed the analyses separately for women and men based on the literature 30 and several statistically significant gender interactions found between the measures of childhood disadvantage and psychological distress, and the measures of behavioral risk factors and psychological distress. We first tabulated descriptive statistics (numbers, percentages, and p-values from the Pearson Chi 2 tests) concerning all measures. ...
... On the contrary, adaptation to healthy behaviors after disadvantaged childhood may indicate higher levels of resilience and further better psychological well-being 57 . It is also notable that behavioral risk factors do not operate separately from other factors in the pathway, such as psychosocial, biological, and cognitive factors (e.g., stress, self-esteem, social support, and coping strategies) and individual's own socioeconomic position 30,53,54,57 . Additionally, the mediation mechanisms may differ between genders-for instance, due to different coping mechanisms in handling stressful circumstances- 30,58 , suggested also by our findings. ...
... It is also notable that behavioral risk factors do not operate separately from other factors in the pathway, such as psychosocial, biological, and cognitive factors (e.g., stress, self-esteem, social support, and coping strategies) and individual's own socioeconomic position 30,53,54,57 . Additionally, the mediation mechanisms may differ between genders-for instance, due to different coping mechanisms in handling stressful circumstances- 30,58 , suggested also by our findings. Given that the study settings (cross-sectional, prospective, retrospective) and the measures used widely vary between studies 30,53-55 , the comparisons are challenging. ...
Childhood disadvantage is associated with increased adult psychological distress, but the role of behavioral risk factors in the pathway remains unclear. We examined whether behavioral risk factors mediate the effects of childhood disadvantage on adult psychological distress. We used the Helsinki Health Study data of employees of the City of Helsinki, Finland, aged 19–39 (mean age 32.0) years at baseline (2017). We included women (n = 2397) and men (n = 586) who responded to both baseline and follow-up (2022) surveys. At baseline, eight types of childhood disadvantage were asked retrospectively, and six adult behavioral risk factors were included. Psychological distress was measured by the DASS-21 at follow-up. We conducted mediation analyses using generalized structural equation modeling. Among women, we found indirect path effects of childhood disadvantage on adult psychological distress through behavioral risk factors (symptoms of depression: β = 0.68, 95% CI 0.20–1.17; anxiety: β = 0.54, 95% CI 0.13–0.95; and stress: β = 0.69, 95% CI 0.20–1.09). Among men, childhood disadvantage contributed only directly to adult depressive (β = 0.71, 95% CI 0.16–1.26) and stress (β = 0.61, 95% CI 0.10–1.13) symptoms. Our findings suggest that behavioral risk factors can mediate some of the adverse effects of childhood disadvantage on adult psychological distress among women.
... ACEs were found to be associated with physiological changes in the immune, endocrine, cardiovascular, and nervous systems and to affect inflammatory and metabolic functioning, as well as brain structure and functioning (see meta-analysis in Cooke et al., 2023). As such, ACEs take a toll not only on health but also on the ability to function at cognitive, social, and emotional levels (Hales et al., 2022;Hughes et al., 2017). Studies consistently show that exposure to a higher number of ACEs is predictive of health-harming behaviors (e.g., Bellis et al., 2014), physical diseases, higher rates of mortality, increased psychological distress and psychopathology, lower educational attainment, and poorer socioeconomic outcomes (see meta-analyses in Hales et al., 2022;Hughes et al., 2017). ...
... As such, ACEs take a toll not only on health but also on the ability to function at cognitive, social, and emotional levels (Hales et al., 2022;Hughes et al., 2017). Studies consistently show that exposure to a higher number of ACEs is predictive of health-harming behaviors (e.g., Bellis et al., 2014), physical diseases, higher rates of mortality, increased psychological distress and psychopathology, lower educational attainment, and poorer socioeconomic outcomes (see meta-analyses in Hales et al., 2022;Hughes et al., 2017). ...
... A higher number of experiences of witnessing or experiencing abuse and a lack of emotional support from parents due to neglect or family dysfunction might lead to more negative and disorganized mental representations; parents may not be aware of these, but they are likely to color their interpretations of their child's signals and their behavioral responses to the child (Crowell et al., 2010;Murphy et al., 2014;Thomson & Jaque, 2017). The increased risk of psychological distress associated with ACEs (Hales et al., 2022) may also impede parents' ability to self-regulate and remain emotionally available to their child, particularly when the child is distressed. This, in turn, may hamper the development of the child's self-regulation skills and lead to increased behavior problems (Cooke et al., 2019). ...
Research points to the substantial impact of parents' exposure to adverse childhood experiences (ACEs) on parents and their children. However, most studies have been conducted in North America, and research on ACEs effects on observed parenting or on intergenerational transmission of ACE effects is limited. We therefore studied families from diverse ethnocultural backgrounds in Israel and examined whether mothers’ ACEs hampered maternal sensitivity and the quality of the home environment and whether mothers’ psychological distress mediated these links. We also explored whether mothers’ ACEs predicted children’s behavior problems indirectly through maternal psychological distress and whether maternal sensitivity and the home environment attenuated this mediating path. Participants were 232 mothers ( M child age = 18.40 months, SD = 1.76; 63.36% non-ultra-Orthodox Jewish, 17.24% ultra-Orthodox Jewish, 19.40% Arab Muslim). Results showed mothers’ ACEs were directly associated with decreased maternal sensitivity. Mothers’ ACEs were indirectly associated with more behavior problems in children through mothers’ higher psychological distress, and maternal sensitivity moderated this indirect link; it was significant only for mothers who showed lower sensitivity. Findings emphasize the significant role ACEs play in early mother-child relationships. The importance of including ACE assessment in research and practice with families of infants and toddlers is discussed.
... Among the few studies in this area, there have been mixed findings regarding the moderating effects of sex/gender (C. Cavanaugh et al., 2023;Hales et al., 2023;Iverson et al., 2013;Lee & Chen, 2017). Sex/gender was found to moderate most associations between ACEs (i.e., child abuse, child neglect, and child household dysfunction) and IPV with mental disorders, particularly substance use disorders (C. ...
Objective: This cross-sectional study explored sex/gender differences in the associations between adverse childhood experiences (ACEs) and intimate partner violence (IPV) with mental health problems (i.e., attempted suicide and mental disorders), including whether sex/gender differences varied by race/ethnicity. Method: Data were used from participants in the National Epidemiologic Survey on Alcohol and Related Conditions in the United States of America (Wave II: 2004–2005). Logistic regressions tested associations between ACEs (i.e., child abuse, child neglect, and child household dysfunction) and IPV or cumulative trauma with mental health problems along with sex/gender and race/ethnicity interactions. Results: Females who experienced child abuse or three to four cumulative traumas had greater odds of attempted suicide than males with the same experiences. Males who experienced IPV had greater odds of attempted suicide than females who experienced IPV. There were significant sex/gender differences in the associations between cumulative trauma and mental disorders (i.e., mood disorder, anxiety disorder, alcohol use disorder, and nicotine dependence), except posttraumatic stress disorder. For example, females with cumulative trauma had greater odds of substance use disorders. Many sex/gender differences in associations between ACEs and IPV or cumulative trauma with mental health problems varied by race/ethnicity. For example, child neglect was associated with greater odds of attempted suicide for non-Hispanic Black males (adjusted odds ratio [AOR] = 3.53 vs. AOR = 1.29 for females), whereas no sex/gender differences in this association were revealed for non-Hispanic White or Hispanic adults. Conclusions: Findings show sex/gender differences in associations between trauma and mental health problems that vary by race/ethnicity and warrant further study.
... The concept of adverse childhood experiences or ACEs became prominent with the seminal article by Felitti and colleagues (1998) who found a linear relationship between the number of ACEs experienced and many of the leading chronic health conditions among adults. ACE research has flourished in Western countries focusing on biological and psychological mechanisms (Berens et al., 2017;Lang et al., 2020;Su et al., 2015); mediators and buffering effects of ACE exposure (Boyce et al., 2021;Brody et al., 2017;Hales et al., 2023); and the cost of disease burden attributable to ACEs (Bellis et al., 2019). The original concept of ACEs focused primarily on intra-familial experiences, and several researchers have discussed expanding ACE definitions to include additional adverse experiences (e.g., food insecurity, community violence) including those relevant to particular populations such as racism, and especially for adversities common in international settings (Afifi, 2020;Cronholm et al., 2015;Finkelhor et al., 2015;Massetti et al., 2020;Mersky et al., 2017;Ports et al., 2020). ...
... Childhood adversity sets individuals on different trajectories of life course health by shaping the development of health behaviors, coping mechanisms, and access to resources and opportunities (Campbell, Walker, and Egede 2016;Felitti et al. 1998;Ferraro et al. 2016). ACES have been linked to many health outcomes, including poor mental health (Felitti et al. 1998;Hales et al. 2023;Juwariah et al. 2022). A fairly linear relationship exists between the number of ACES and mental health challenges such as depression, suicide attempts, and anxiety disorders (McLaughlin et al. 2010;Merrick et al. 2017). ...
Seminary students have been found to be at a higher risk of experiencing abuse in childhood compared with the general U.S. population, as well as demonstrate mental health struggles. This study aims to understand how R/S struggles might explain the relationship between childhood abuse (emotional, physical, and sexual) among a sample of seminary students, a group that is at a higher risk of experiencing emotional and physical abuse in childhood compared to the general U.S. population. Drawing on a unique sample of seminary students at a Mainline Protestant seminary, ( N = 535), regression results suggest that among seminary students, all forms of childhood abuse studied (emotional, physical, and sexual) were associated with greater depressive and anxiety symptoms. We also found consistent evidence that R/S struggles were a mediator of this pathway, explaining anywhere between 20 percent and 35 percent of the overall association between each form of childhood abuse and depressive and anxiety symptoms. This study adds to the growing body of literature describing the associations between childhood trauma and mental health, as well as the role of R/S struggles. We also discuss how seminaries and divinity schools should implement targeted programs for students with a history of childhood abuse.
Introduction
Adults with early life adversity (ELA) often exhibit stress system dysregulation and are prone to smoke for stress relief. This study, conducted as part of a larger project examining psychobiological stress responses in smokers, specifically focuses on the a priori research question of how ELA influences the cortisol awakening response (CAR) during acute tobacco withdrawal.
Aims and Methods
Using quasi-experimental design, adult daily (heavy) smokers were randomly assigned to either regular smoking (ad-lib) (N = 37) or 24-hour withdrawal (N = 55), and categorized into low or high ELA. Carbon monoxide levels verified smoking status, and CAR was assessed through salivary cortisol upon awakening and at 30 and 60 post-wakening. CAR was evaluated using mean cortisol levels, peak reactivity, and area under the curve with respect to increase (AUCi) and area under the curve with respect to ground while controlling for possible covariates. Self-reported measures of mood, craving, and withdrawal were also analyzed.
Results
Smoking status X ELA interaction on peak cortisol and AUCi. High ELA ad-lib smokers (versus high ELA withdrawal) had elevated peak and AUCi levels and were higher than low ELA ad-lib smokers with respect to peak (ps < .05). Withdrawal (versus ad-lib smokers) had lower positive affect and higher negative affect, craving, and withdrawal (ps < .05). Adult smokers with a history of ELA exhibit heightened stress response dysregulation, as evidenced by altered CAR, compared to those without ELA or in smoking withdrawal.
Conclusions
These findings demonstrate that ELA significantly exacerbates stress system dysregulation among adult smokers, as evidenced by alterations in the CAR.
Implications
Findings from this study suggest ELA not only leads to an earlier initiation of smoking but also worsens stress system dysregulation in adult smokers. These insights highlight the importance of developing early prevention strategies aimed at adolescents with ELA to prevent smoking initiation and reduce its impact on stress regulation. Additionally, the findings support the need for customized, trauma-informed smoking cessation programs for adults with ELA, emphasizing the necessity to address the distinct challenges related to stress regulation and nicotine withdrawal they face.
Childhood maltreatment (CM) increases the risk of psychopathology. Besides CM types and severity, the timing of exposure is an important modulating factor in this association, as childhood and adolescence comprise sensitive developmental periods for brain maturation and socio-emotional development. Nevertheless, previously reported associations between the severity of subtypes and timing of CM and psychopathology have been heterogeneous and have hardly considered vulnerable groups broadly exposed to CM, such as out-of-home-placed youth. Thus, we investigated the association between CM types and timing and psychopathology in a sample of formerly out-of-home placed young adults (N = 185; 32% women, age mean = 26.38, SD = 3.49 years). CM was assessed using the Maltreatment and Abuse Chronology of Exposure Scale and general, internalizing, and externalizing problems were assessed using the Achenbach System of Empirically Based Assessment. We employed conditional random forest regression to estimate the importance of CM types (abuse, neglect, peer victimization, and sexual abuse), timings (ages 3-18) as well as CM severity, multiplicity, and duration on adult general, internalizing, and externalizing problems. We validated the results using diagnoses of mental disorders assessed in clinical interviews, which were classified under general, internalizing, and externalizing clusters based on the Hierarchical Taxonomy of Psychopathology model. We found that CM severity and multiplicity were stronger predictors of internalizing problems than timing-specific effects of CM types. Abuse in early childhood and peer violence in late adolescence were stronger predictors of externalizing problems compared to global CM measures. Our findings highlight the importance of considering CM type and timing when testing CM-associated risks for psychopathology. This might further be valuable in therapeutic settings to guide maltreatment-informed interventions. Reducing violent caregiving environments in early childhood and preventing peer victimization in adolescence may be especially important in counteracting CM-associated risks of externalizing behaviors.
Objetivos: Identificar las complicaciones dermatológicas y los
cuidados locales de los tatuajes temporales y permanentes a través
de una revisión sistemática. Metodología: Se realizó una revisión
sistemática aplicando la Declaración PRISMA. La búsqueda se llevó
a cabo en 6 bases de datos (PubMed, Cochrane Library, CUIDEN,
CINHAL, DARE y LILACS) y dos bases no indexadas (Dermatología
Elsevier y Dermatology Online Journal). Se delimitó la búsqueda
por idioma (inglés/español) y por año (últimos 10 años). Una vez
depurada la base de datos se procedió a la evaluación de la calidad
por pares. Resultados: Se obtuvieron un total de 583 artículos, de
los cuales se eliminaron 86 por duplicado y 379 tras la revisión por
título y resumen. Se seleccionaron 118 artículos a texto completo,
y una vez evaluada la calidad a través de los criterios propuestos por
la Red EQUATOR, 30 artículos presentaron una calidad media alta. Finalmente, para su análisis cualitativo se incluyeron un total
22 casos clínicos (informe CARE), 5 estudios observacionales (informe
STROBE), 2 ensayos clínicos (informe CONSORT) y una revisión
sistemática (informe PRISMA). Conclusiones: Se ha evidenciado la
necesidad de actualizar conocimientos orientados al abordaje de los
tratamientos y la identificación de las complicaciones relacionadas
con los tatuajes basados en evidencias sólidas. El desarrollo de guías de práctica clínica que aborden la detección y la aplicación de tratamientos adecuados a este problema de salud puede ser el primer paso para integrar el manejo de los tatuajes en la cartera de servicios del sistema sanitario, permitiendo conocer la dimensión epidemiológica y los recursos necesarios en atención primaria.
Importance
The current focus on the association of negative experiences in early childhood with adverse outcomes later in life is based on limited empirical evidence.
Objective
To evaluate whether age at exposure to negative experiences in childhood and adolescence is associated with outcomes in early adulthood.
Design, Setting, and Participants
This cohort study used population data from administrative sources for all Danish individuals born between 1987 and 1995 who were living in Denmark at 19 years of age. Data were analyzed in July 2020.
Exposures
Exposure to 6 household dysfunction items (HDIs) from birth to 17 years of age by age group. Age groups were as follows: 0 to 2 years (early childhood), 3 to 5 years (preschool), 6 to 12 years (mid-childhood), and 13 to 17 years (early adolescence). The 6 items were parents’ unemployment, incarceration, mental disorders, death, and divorce and the child’s foster care experiences.
Main Outcomes and Measures
Mental disorders, low educational attainment, disconnection from education and the labor market, and criminal charges. A fixed-effects model was used to estimate the dose-response and age-specific associations between HDI exposure and the collated outcome measure.
Results
The study sample included 605 344 individuals observed from birth to 19 years of age (mean [SD] birth year, 1991 [2.56] years; range, 1987-1995; 335 725 [55%] male). Overall, 278 115 individuals (45.94%) were exposed to 1 or more of the 6 HDIs from birth to 17 years of age. Exposure was most prevalent at 1 year of age (exposure rate, 11.3%), and parental unemployment was the most common HDI (15.5% observed in mid-childhood). The risk of experiencing the 4 outcomes was monotonically associated with the number of HDIs. For example, experiencing 1 HDI between birth and 17 years of age was associated with an increased risk of experiencing an adverse outcome by approximately 1.0 percentage point (β = 0.011; 95% CI, 0.010-0.012; P < .001). Similarly, the risk of experiencing adverse outcomes varied significantly in association with age at exposure. Exposure during early adolescence was more strongly associated with adverse outcomes than was exposure during early childhood (increased risk of 5.8 percentage points [β = 0.058; 95% CI, 0.052-0.063; P < .001] vs 1.0 [β = 0.010; 95% CI, 0.004-0.015; P = .001]).
Conclusions and Relevance
In this cohort study, exposure to negative experiences in early adolescence was more strongly associated with later adverse outcomes than was exposure at other points in childhood. Knowledge of age-specific associations is important information for policy makers who need to prioritize resources targeting disadvantaged children and youths.
Background
Since 2013, the number of violent crimes and offences by sharp instruments have increased continually, following a previous decrease, with majority of cases occurring among young people and in London. There is limited understanding surrounding the drivers influencing this change in trends, with mostly American-based research identifying risk factors.
Methods
The aim of this review is to identify and synthesise evidence from a range of literature to identify risk factors associated with weapon-related crime, for young people (aged 10–24 years) within the UK.
A search strategy was generated to conduct a systematic search of published and grey literature within four databases (EMBASE, Medline, PsycINFO, and OpenGrey), identifying papers within a UK-context. Abstracts and full texts were screened by two independent reviewers to assess eligibility for inclusion, namely study focus in line with the objectives of the review. Weight of Evidence approach was utilised to assess paper quality, resulting in inclusion of 16 papers. Thematic analysis was conducted for studies to identity and categorise risk factors according to the WHO ecological model.
Results
No association was found between gender or ethnicity and youth violence, contrasting current understanding shown within media. Multiple research papers identified adverse childhood experiences and poor mental health as positively associated with youth and gang violence. It was suggested that community and societal risk factors, such as discrimination and economic inequality, were frequently linked to youth violence.
A small number of studies were included within the review as this is a growing field of research, which may have led to a constrained number of risk factors identified. Due to heterogeneity of studies, a meta-analysis could not be conducted. As many studies displayed positive results, publication bias may be present.
Conclusions
Several risk factors were identified, with evidence currently heterogeneous with minimal high-quality studies. However, findings highlight key areas for future research, including the link between poor mental health and knife-crime, and the trajectory into gangs. Risk factors should help identify high-risk individuals, targeting them within mitigation strategies to prevent involvement within crime. This should contribute to efforts aimed at reducing the rising crime rates within UK.
A wide range of child and caregiver characteristics, including parental psychopathology, parents’ childhood experiences of abuse, parenting stress, child age, parent age, child disabilities, socio-cultural background, and caregiver’s relationship to the child, have been reported to contribute to increased risk of violence directed against children. Although there is a dearth of research into violence against children in stepfamilies, some studies have indicated that stepparents are more likely to abuse children compared with genetic parents. Stepparents also have been found to pose a significantly greater risk of using excessive violence, which can subsequently lead to the death of a child. The risk of violence against stepchildren has also been found to be significantly elevated with the presence of stepparent’s genetic offspring. One possible explanation for increased violence in stepfamilies is that stepparents do not want to invest feelings and resources in children who do not carry copies of their genes. Sexual violence by stepparents, on the other hand, can be explained by the lack of exposure to a learning mechanism termed ‘incest aversion’, which refers to negative sexual imprinting during a critical period of early childhood to avoid inbreeding. Yet another possibility is that people who divorce are more likely to do so due to aggressive impulses which can play a part in relationship termination. When they remarry, those aggressive impulses can be directed against stepchildren. However, stepfamilies are also reported to experience more stressors associated with family violence, including alcohol abuse, child’s behavioral problems, adverse contextual backgrounds, and weaker social networks. This suggests that the stepfamily structure may not be a risk factor of violence against children per se. The purpose of this chapter is to provide a description of the problem of violence against children by stepparents, discuss the extent of the phenomenon and its possible theoretical explanations, critically review empirical research assessing violence against children by stepmothers and stepfathers, as well as suggest directions for future research.
Background:
Despite increased understanding of Adverse Childhood Experiences (ACEs), very little advancement has been made in how ACEs are defined and conceptualized. The current objectives were to determine: 1) how well a theoretically-derived ACEs model fit the data, and 2) the association of all ACEs and the ACEs factors with poor self-rated mental and physical health.
Methods:
Data were obtained from the Well-Being and Experiences Study, survey data of adolescents aged 14 to 17 years (n = 1002) and their parents (n = 1000) in Manitoba, Canada collected from 2017 to 2018. Statistical methods included confirmatory factor analysis (CFA) and logistic regression models.
Results:
The study findings indicated a two-factor solution for both the adolescent and parent sample as follows: a) child maltreatment and peer victimization and b) household challenges factors, provided the best fit to the data. All original and expanded ACEs loaded on one of these two factors and all individual ACEs were associated with either poor self-rated mental health, physical health or both in unadjusted models and with the majority of findings remaining statistically significant in adjusted models (Adjusted Odds Ratios ranged from 1.16-3.25 among parents and 1.12-8.02 among adolescents). Additionally, both factors were associated with poor mental and physical health.
Conclusions:
Findings confirm a two-factor structure (i.e., 1) child maltreatment and peer victimization and 2) household challenges) and indicate that the ACEs list should include original ACEs (i.e., physical abuse, sexual abuse, emotional abuse, emotional neglect, physical neglect, exposure to intimate partner violence (IPV), household substance use, household mental health problems, parental separation or divorce, parental problems with police) and expanded ACEs (i.e., spanking, peer victimization, household gambling problems, foster care placement or child protective organization (CPO) contact, poverty, and neighborhood safety).
In virtually all areas of psychology, the question of whether a particular construct has a prospective effect on another is of fundamental importance. For decades, the cross-lagged panel model (CLPM) has been the model of choice for addressing this question. However, CLPMs have recently been critiqued, and numerous alternative models have been proposed. Using the association between low self-esteem and depression as a case study, we examined the behavior of seven competing longitudinal models in 10 samples, each with at least four waves of data and sample sizes ranging from 326 to 8,259. The models were compared in terms of convergence, fit statistics, and consistency of parameter estimates. The traditional CLPM and the random intercepts cross-lagged panel model (RI-CLPM) converged in every sample, whereas the other models frequently failed to converge or did not converge properly. The RI-CLPM exhibited better model fit than the CLPM, whereas the CLPM produced more consistent cross-lagged effects (both across and within samples) than the RI-CLPM. We discuss the models from a conceptual perspective, emphasizing that the models test conceptually distinct psychological and developmental processes, and we address the implications of the empirical findings with regard to model selection. Moreover, we provide practical recommendations for researchers interested in testing prospective associations between constructs and suggest using the CLPM when focused on between-person effects and the RI-CLPM when focused on within-person effects.
The purpose of the current study was to examine the potential mediating effects of internalizing and externalizing problems at ages 14, 16 and 18 between types of childhood maltreatment and alcohol and marijuana use problems and disorders in young adulthood. Data were from 473 young adults who participated in the Longitudinal Studies of Child Abuse and Neglect (LONGSCAN). Path analysis was conducted to examine pathways between maltreatment type (birth through age 12), internalizing and externalizing problems at three time points during adolescence, and alcohol and marijuana problem use in young adulthood. Findings indicated significant pathways between physical abuse and internalizing problems at 14, which was associated with alcohol-related substance use disorder in adulthood. Externalizing problems and internalizing problems at age 14 mediated the relationship between physical abuse and marijuana-related symptoms in young adulthood. Emotional and sexual abuse were not associated with substance use problems. Implications for practice are discussed.
Adverse childhood experiences (ACEs) can become biologically embedded leaving a lasting signature on multiple body systems. ACE scores have been used to associate childhood adversity to a wide range of adverse health conditions over the life course, most notably substance-related disorders. Multiple studies have shown that the presence of elevated ACE scores predicts obesity in adulthood. However, a gap exists in the literature elucidating the pathways from childhood adversity to increased BMI in adulthood. We systematically reviewed these mechanisms as well as discuss novel plausible pathways. We searched PubMed, PsycInfo, Embase, and Web of Science and after applying exclusion criteria identified 18 articles for qualitative analysis. The most commonly cited mechanisms linking ACEs to obesity are social disruption, health behaviors, and chronic stress response. Ten observational studies (n=118,691) were quantitatively summarized and demonstrated a positive association between ACE and adult obesity with a pooled odds ratio of 1.46 (CI=1.28, 1.64) with moderate heterogeneity (I²=70.8%). Our results found a 46% increase in the odds of adult obesity following exposure to multiple ACEs. Based on our qualitative synthesis and review of the most recent relevant literature, we propose biologically plausible explanations for the significant positive relationship between ACEs and adult obesity. Reducing exposure to ACEs, improved screening and detection of trauma, better access to trauma-informed care, and improvements to the food environment are likely to improve downstream health outcomes related to eating behavior.
Background: Abuse of psychoactive substances may lead to physical and/or physiological dependence on said substances. While a great deal of research has focused on risk factors predicting onset, there has been little research focused on risk factors influencing continued dependence on substances in adulthood following onset early in life. Purpose/Objectives: The present study examined poly-victimization and developmental patterns of anxiety as predictors of continued substance dependence problems. Methods: The Pathways to Desistance data were used in the present study. A subset of this sample was used in analyses comprising 261 juvenile offenders who reported lifetime drug and/or alcohol dependence at baseline. Firth logistic regression was used to estimate the impact that covariates had on the odds that individuals in this subsample had continued substance dependence in adulthood. Results: Results indicated that increased poly-victimization score pertaining to direct victimization at baseline was associated with increased odds of continued substance dependence problems in adulthood. Further, presentation of high and chronic anxiety symptomatology during adolescence was associated with increased risk for continued dependence. Conclusions/Importance: Drug dependent adolescents who demonstrate chronic anxiety and/or have experienced polyvictimization are at-risk for continuity of dependent in adulthood. Youth should be screened for these issues and targeted with treatment.
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.