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Background: Depression is a concern during pregnancy, but it is especially prevalent for pregnant adolescents. Because prenatal depression is a strong predictor of postpartum depression and other forms of psychopathology in both mothers and children, it is important to understand potential risk and protective factors for prenatal depression.Objectives: The present study examined whether social support buffered the impact of childhood trauma on prenatal depression, and whether social support exerted a stronger buffering effect for adolescents compared to adults.Method: Self-reported levels of childhood trauma, social support, and prenatal depression were collected in a racially and ethnically diverse sample of 682 first-time mothers, 58% were adolescents (n = 396; Mage = 17.38 years) and 42% were adults (n = 286; Mage = 26.29 years).Results: Using multi-group moderation analyses, we found that pregnant adolescents with more social support were buffered from the effects of childhood trauma on prenatal depression symptoms, but pregnant adults with more social support were not.Conclusion: Findings support the stress-buffering model in that those with more stressors may benefit more from social support than those with fewer stressors. These results highlight the importance of social support and inform prenatal depression prevention/intervention strategies particularly with pregnant adolescents.

Purpose: Adverse childhood experiences (ACEs) are a global public health concern. Little research exists on the prevalence and health consequences of ACEs in Zambia. The current study examined associations between individual and cumulative ACEs, mental distress, and suicide risk among Zambian youth. Methods: Data from Zambia Violence Against Children and Youth Survey were used (18-24 years old, n=1034). Bivariate and adjusted logistic models were performed with independent variables (i.e., experienced physical violence (PV), sexual violence (SV), and emotional violence (EV); witnessed intimate partner violence (IPV) and community violence (CV); orphan status; cumulative ACE exposure) and dependent variables (i.e., mental distress and suicide risk). Adjusted models controlled for demographic and social characteristics. Results: 76.8% of Zambian youth experienced one or more ACEs, and more than 30% witnessed CV (38.4%) or IPV (30.2%), or experienced PV (35.1%), prior to age 18. 27.5% were orphans, and less than 20% experienced EV (17.3%) or SV (15.4%) in childhood. 42.4% experienced mental distress in the past 30 days, and 12.5% reported lifetime suicidal thoughts or suicide attempts. PV, EV, cumulative ACE exposure, older age, being single, and stronger friendships were significantly related to experiencing mental distress. Cumulative ACEs exposure was associated with significantly higher suicide risk. Conclusions: Preventing ACEs can reduce mental distress and suicide risk among Zambian youth. Youth with cumulative ACE exposure can be prioritized for mental health intervention. More research is warranted to investigate the broad-based prevention of ACEs, especially PV and EV, and protective factors that can promote resilience among youth who have experienced ACEs.

We examined racial/ethnic inequities in the prevalence of adverse childhood experiences (ACEs) and examined the association between ACEs and selected health-related behaviors and problems. Data for this cross-sectional study come from the 2018 Maryland Youth Risk Behavior Survey/Youth Tobacco Survey, a statewide survey of high school students (n = 40,188). ACEs included caregiver verbal abuse and household food insecurity, substance use or gambling, mental illness, and involvement with the criminal justice system. We estimated the prevalence of ACEs overall and by race/ethnicity, and then used multiple logistic regression to determine associations between ACEs and emotional/behavioral problems, adjusting for race/ethnicity. Outcome variables included emotional distress, poor school performance, suicidal ideation, fighting, alcohol use, and marijuana use. More than one fifth of students reported each individual ACE. Differences in the prevalence of ACEs by race/ethnicity were statistically significant (p < .001). More than one fourth (25.8%) reported one of the five ACEs, 15.1% reported two, and 15.4% reported three or more. For each ACE, reporting having experienced it (vs. not) was associated with a >30% higher prevalence for each of the outcome variables. Among students who reported three or more ACEs (relative to none), the odds of emotional distress and suicidal ideation were more than 8 times greater. Among Maryland adolescents, ACEs are common, are inequitably distributed by race/ethnicity, and are strongly linked to behavioral health. Findings suggest the need to monitor ACEs as a routine component of adolescent health surveillance and to refocus assessment and intervention toward “upstream” factors that shape adolescent health.

Adverse childhood experiences (ACEs) have been associated with poor mental health outcomes in adulthood. Childhood maltreatment is related to both depressive and anxiety symptoms. Our objective was to investigate these associations among low-income, mostly Black and Latino men who have sex with men (MSM), as these may be a particularly vulnerable population group. Data come from a longitudinal study of MSM with varied substance use behaviors (n = 321) collected between August 2014 and April 2022. Cumulative, childhood maltreatment ACEs, and the single ACE of childhood sexual abuse were investigated as potential predictors of self-reported depressive and anxiety symptoms in mixed-effects logistic and ordinal regression models. There was no evidence of a dose-response relationship between the number of ACEs and the predicted probability of depressive and anxiety symptoms. Compared to MSM reporting fewer than five ACEs, those with five or more ACEs had approximately double the odds ratio of reporting depressive (OR = 1.93; 95% CI: 1.04–3.60) and anxiety symptoms (OR = 2.21; 95% CI: 1.05–4.68). The dimension of childhood maltreatment had a more robust prediction of depressive symptoms than the dimension of household dysfunction across all models. The association between childhood sexual abuse history and depressive symptoms remained after adjustment for the other nine ACEs (OR = 2.27; 95% CI: 1.11–4.68). The ordinal logistic model suggested that cumulative ACEs more than triple the odds of being in a higher anxiety category (OR = 3.12; 95% CI: 1.58–6.14), with associations reported for childhood maltreatment ACEs (OR = 1.31; 95% CI: 1.06–1.66) and childhood sexual abuse (OR = 1.93; 95% CI: 0.89–4.21). Childhood maltreatment ACEs, particularly childhood sexual abuse, are salient predictors of depressive and anxiety symptoms among adult urban MSM. Mitigating the impact of childhood maltreatment requires understanding the additional burden of social distress often faced by MSM throughout the life course.

History of adverse childhood experiences (ACEs) is associated with poorer treatment outcomes in depression. How ACEs affect outcomes from repetitive transcranial magnetic stimulation (rTMS) is not well-defined. The primary aim was to investigate whether ACEs affect depression outcomes in patients receiving high frequency rTMS, either deep TMS (dTMS) or intermittent theta burst stimulation (iTBS), to the left dorsolateral prefrontal cortex.The Hamilton Depression Rating Scale (HAMD-17) was collected at baseline and every 2 weeks for 4-6 weeks. Outcomes included improvement in HAMD-17 and remission. The ACE-10 questionnaire was used to quantify categories of ACEs. Data from 99 patients with MDD receiving an acute rTMS course were analyzed.Patients had a mean of 2.4 ACEs (SD 2.5). No significant differences in outcomes were found between dTMS or iTBS so these data were pooled. Using a continuous ACE variable showed no significant impact on outcomes. Using a categorical ACE variable (0, 1, 2, 3, 4 or more) did not reveal significant effects of ACEs on outcomes. Higher ACE was associated with steeper decrease in HAMD-17 only from baseline to week 2 but not at other times.This was an open-label study. The well-validated ACE questionnaire does not measure severity or frequency of adversities.Patients with depression receiving rTMS reported on average 2.4 ACEs. ACE scores may lead to a steeper early decline in HAMD-17 but did not otherwise impact depression outcomes. Presence of high levels of ACEs should not preclude consideration of rTMS for depression.

Early life stress (ELS), such as abuse and neglect during childhood, can lead to psychiatric disorders in later life. Previous studies have suggested that ELS can cause profound changes in gene expression through epigenetic mechanisms, which can lead to psychiatric disorders in adulthood; however, studies on epigenetic modifications associated with ELS and psychiatric disorders in adolescents are limited. Moreover, how these epigenetic modifications can lead to psychiatric disorders in adolescents is not fully understood. Commonly, DNA methylation, histone modification, and the regulation of noncoding RNAs have been attributed to the reprogramming of epigenetic profiling associated with ELS. Although only a few studies have attempted to examine epigenetic modifications in adolescents with ELS, existing evidence suggests that there are commonalities and differences in epigenetic profiling between adolescents and adults. In addition, epigenetic modifications are sex-dependent and are influenced by the type of ELS. In this review, we have critically evaluated the current evidence on epigenetic modifications in adolescents with ELS, particularly DNA methylation and the expression of microRNAs in both preclinical models and humans. We have also clarified the impact of ELS on psychiatric disorders in adolescents to predict the development of neuropsychiatric disorders and to prevent and recover these disorders through personalized medicine.

Women’s social experiences can have long-term implications for their offspring’s health, but little is known about the potential independent contributions of multiple periods of stress exposures over time. This study examined associations of maternal exposure to adversity in childhood and pregnancy with children’s anxiety and depression symptoms in a large, sociodemographically diverse sample. Participants were 1389 mother-child dyads (child age M = 8.83 years; SD = 0.66; 42% Black, 42% White; 6% Hispanic) in the ECHO-PATHWAYS Consortium’s three U.S. pregnancy cohorts. Women reported their exposure to childhood traumatic events (CTE) and pregnancy stressful life events (PSLE). Children self-reported on their symptoms of anxiety and depression at age 8–9 years. Regression analyses estimated associations between maternal stressors and children’s internalizing problems, adjusting for confounders, and examined child sex as a modifier. Exploratory interaction analyses examined whether geospatially-linked postnatal neighborhood quality buffered effects. In adjusted models, PSLE counts positively predicted levels of children’s anxiety and depression symptoms ([ßAnxiety=0.08, 95%CI [0.02, 0.13]; ßDepression=0.09, 95%CI [0.03, 0.14]); no significant associations were observed with CTE. Each additional PSLE increased odds of clinically significant anxiety symptoms by 9% (95%CI [0.02, 0.17]). Neither sex nor neighborhood quality moderated relations. Maternal stressors during pregnancy appear to have associations with middle childhood anxiety and depression across diverse sociodemographic contexts, whereas maternal history of childhood adversity may not. Effects appear comparable for boys and girls. Policies and programs addressing prevention of childhood internalizing symptoms may benefit from considering prenatal origins and the potential two-generation impact of pregnancy stress prevention and intervention.

To estimate the effect of childhood trauma on postpartum visit attendance and explore mediation by posttraumatic stress disorder (PTSD) and depressive symptoms.We analyzed data from Grady Trauma Project surveys linked to electronic medical records. We measured childhood trauma using the Childhood Trauma Questionnaire and 4-12 week postpartum visit attendance using outpatient records. We fit log binomial causal mediation models to estimate risk ratios (RR) and 95% confidence intervals (CIs) for the total effect of childhood trauma (categorized as any moderate to severe trauma or not) on postpartum visit attendance and the controlled direct effect, eliminating PTSD or depressive symptoms, controlling for age, parity, income, education, and relationship status.Among 493 birthing people, 54.3% (268) attended the postpartum visit. Individuals without childhood trauma were more likely to attend the visit than those with childhood trauma (56.9% [173/304] v. 50.3% [95/189]). In mediation models, childhood trauma remained associated with reduced likelihood of attendance (adjusted RR: 0.83 [0.68, 1.38]) with possible mediation by PTSD symptoms (controlled direct effect: 0.98 [0.70,1.42]) but not depressive symptoms (controlled direct effect: RR: 0.86 [0.56, 1.38]).Screening and treating PTSD symptoms during pregnancy may slightly increase postpartum care engagement.

Introduction: Early recognition of adverse childhood experiences (ACEs) and adequate interventions are required to prevent negative effects on the child's mental and physical health later in life caused by toxic stress. This study aimed to assess how familiar the concepts of ACEs and toxic stress are among Dutch pediatric health care providers (PHCPs) and whether screening for ACEs is standard practice in the Netherlands.Methods: From October 2018 until March 2019, a nation-wide questionnaire survey was held.Results: Of 548 participating PHCPs, 29% were familiar with toxic stress, 67% were familiar with ACEs, and 63% knew of the relationship between multiple ACEs and somatic diseases. Routine inquiries about ACEs were done always by 17% of the participants and sometimes by 65%. The ACEs which PHCPs asked about the most included divorce (n=288; 76.8%), bullying (n=265; 70.7%), physical domestic violence (n=184; 49.1%), parental psychiatric diseases (n=205; 54.7%) and sexual abuse (n=164; 43.7%). The ACEs asked about the least included deportation of a family member (n=22; 5.9%), gender discrimination (n=9; 2.4%) and racism (n=17; 4.5%).Conclusion: Even in 2019, there is limited awareness among Dutch PHCPs of ACEs and toxic stress. While most acknowledged to be aware of the role that toxic stress plays in the physical and mental health consequences of ACEs later in life, only 17% of the respondents performed standard ACE screening. Our findings underscore the need for standard ACE screening guidelines to support early recognition and adequate treatment of children suffering with toxic stress.

The aim of this study is to investigate the relationship of childhood trauma with cyberbullying and cyber victimization levels among health sciences and medical faculty students.This study was conducted with 350 students studying at the health sciences and medical faculty of a university in Istanbul. The data were collected using an information form, the Childhood Trauma Questionnaire, the Cyber Bullying Scale, and the Cyber Victimization Scale.A significant positive correlation was found between the childhood trauma and cyberbullying and cyber victimization levels of the students. A significant positive correlation was also found between cyber victimization and cyberbullying levels.Students at risk of cyber bullying and cyber victimization should be identified, and awareness and coping programs should be planned.

To date, few studies have focused on examining either the direct or indirect effect of adverse childhood experiences (ACEs) on cardiovascular diseases (CVD). This study aimed to investigate the mediation effect of depressive symptoms as a mediator between ACEs and CVD.This study included a total of 12,981 participants from the 2011 to 2018 wave of the China Health and Retirement Longitudinal Study (CHARLS). Depressive symptoms were examined using the 10-item short form of the Center for Epidemiologic Studies Depression Scale (CESD-10). The mediation effect analysis adjusted for potential confounding factors was conducted.6635 (51.11 %) of the participants reported 4 and more ACEs count. Participants with certain ACEs were significantly associated with later-life incident depressive symptoms and CVD. Depressive symptoms partially mediated [20.72 %, 95 % CI: (13.02 %-38.12 %)] of the association between self-reported health status and CVD, [0.72 %, 95 % CI: (13.02 %-38.12 %)] of the association between health limitation and CVD, and [22.24 %, 95 % CI: (14.35 %-59.29 %)] of the association between hunger and CVD. In addition, as ACEs count increased by 1 unit, participants had the increased risk of incident depressive symptoms [5.01 %, 95 % CI: (4.53 %-5.50 %)] and CVD [0.61 %, 95 % CI: (0.23 %-0.99 %)].Not all potential confounding factors were measured and adjusted in the analysis, and ACEs were collected retrospectively.ACEs are significantly associated with both onset and increased depressive symptoms and CVD, and depressive symptoms mediated the association between ACEs and incident CVD. Our results suggested that target mental health intervention programs should be delivered to ACEs populations.

Adverse childhood experiences (ACEs) including physical, emotional, or sexual abuse; neglect; and/or exposure to household instability have been associated with adult emergency department utilization, but the impact of parental ACEs on pediatric emergency department (PED) utilization has not been studied. The primary aim was to determine if parental ACEs impact resource utilization as measured by (1) frequency of PED utilization, (2) acuity of PED visits, and (3) 72-hour PED return rates. The secondary aim was to determine if resilience interacts with the impact of parental ACEs on PED utilization.This study is a cross-sectional survey using previously validated measures of ACEs, resiliency, and social determinants of health screening. Surveys were administered from October 17, 2019, to November 27, 2019, via iPad by research assistants in our institution's PEDs. Survey responses were linked to data abstracted from the electronic health record. Descriptive statistics were used to characterize our study population. Pearson correlation was used to identify correlation between ACEs, social determinants of health, and PED utilization measures.A total of 251 parents had complete data. Parental ACEs were positively associated with frequency of PED visits (incidence rate ratio, 1.013). In addition, high levels of parental resilience attenuated the association between parental ACEs and the number of severe acuity visits and were associated with fewer 72-hour return visits (incidence rate ratio, 0.49).Parental ACEs appear to be positively associated with frequency of PED utilization and inversely associated with higher-acuity PED visits and parental resiliency.

This study characterized the prevalence of transphobic adverse childhood experiences (ACEs) among young trans women (YTW) and assessed its relationship with poor mental health and sexual risk. A survey was administered between 2012 and 2014 to 300 YTW aged 16-24 living in the San Francisco Bay Area. Transphobic childhood verbal abuse, physical abuse, and high transphobic childhood adversity were endemic, and we found strong associations with depression, posttraumatic stress disorder, and any and receptive anal intercourse. ACEs may be critical social determinants of mental and sexual health for YTW and validated measures to screen for ACEs are needed, along with interventions that provide gender-affirmative support for parents.

Background: Threading content on the social determinants of health into the nursing curricula is a best practice recommended by certifying bodies; however, introducing content on social determinants of health can overwhelm learners, who may have difficulty relating the information to their nursing practice. Method: A learning strategy was developed that used film and an experiential activity to introduce content on adverse childhood experiences, a social determinant of health, and resilience into nursing course-work. A total of 130 first-semester nursing students viewed a film in class and participated in a focused debriefing and subsequent clinical exercise. Results: The majority of participants (97%) believed the film appropriately introduced the content. Learners reported the debriefing was helpful in relieving distress, and 95% found the content relevant to their future nursing practice. Conclusion: Early introduction of key concepts related to adverse childhood experiences may assist prelicensure nursing students in developing a trauma-informed professional practice. [ J Nurs Educ . 2022;61(11):650–653.]

Background: Childhood trauma is a common and potent risk factor for developing major depressive disorder in adulthood, associated with earlier onset, more chronic or recurrent symptoms, and greater probability of having comorbidities. Some studies indicate that evidence-based pharmacotherapies and psychotherapies for adult depression might be less efficacious in patients with a history of childhood trauma than patients without childhood trauma, but findings are inconsistent. Therefore, we examined whether individuals with major depressive disorder, including chronic forms of depression, and a reported history of childhood trauma, had more severe depressive symptoms before treatment, had more unfavourable treatment outcomes following active treatments, and were less likely to benefit from active treatments relative to a control condition, compared with individuals with depression without childhood trauma. Methods: We did a comprehensive meta-analysis (PROSPERO CRD42020220139). Study selection combined the search of bibliographical databases (PubMed, PsycINFO, and Embase) from Nov 21, 2013, to March 16, 2020, and full-text randomised clinical trials (RCTs) identified from several sources (1966 up to 2016–19) to identify articles in English. RCTs and open trials comparing the efficacy or effectiveness of evidence-based pharmacotherapy, psychotherapy, or combination intervention for adult patients with depressive disorders and the presence or absence of childhood trauma were included. Two independent researchers extracted study characteristics. Group data for effect-size calculations were requested from study authors. The primary outcome was depression severity change from baseline to the end of the acute treatment phase, expressed as standardised effect size (Hedges' g). Meta-analyses were done using random-effects models. Findings: From 10 505 publications, 54 trials met the inclusion criteria, of which 29 (20 RCTs and nine open trials) contributed data of a maximum of 6830 participants (age range 18–85 years, male and female individuals and specific ethnicity data unavailable). More than half (4268 [62%] of 6830) of patients with major depressive disorder reported a history of childhood trauma. Despite having more severe depression at baseline (g=0·202, 95% CI 0·145 to 0·258, I2=0%), patients with childhood trauma benefitted from active treatment similarly to patients without childhood trauma history (treatment effect difference between groups g=0·016, –0·094 to 0·125, I2=44·3%), with no significant difference in active treatment effects (vs control condition) between individuals with and without childhood trauma (childhood trauma g=0·605, 0·294 to 0·916, I2=58·0%; no childhood trauma g=0·178, –0·195 to 0·552, I2=67·5%; between-group difference p=0·051), and similar dropout rates (risk ratio 1·063, 0·945 to 1·195, I2=0%). Findings did not significantly differ by childhood trauma type, study design, depression diagnosis, assessment method of childhood trauma, study quality, year, or treatment type or length, but differed by country (North American studies showed larger treatment effects for patients with childhood trauma; false discovery rate corrected p=0·0080). Most studies had a moderate to high risk of bias (21 [72%] of 29), but the sensitivity analysis in low-bias studies yielded similar findings to when all studies were included. Interpretation: Contrary to previous studies, we found evidence that the symptoms of patients with major depressive disorder and childhood trauma significantly improve after pharmacological and psychotherapeutic treatments, notwithstanding their higher severity of depressive symptoms. Evidence-based psychotherapy and pharmacotherapy should be offered to patients with major depressive disorder regardless of childhood trauma status. Funding: None.

Despite the well-established relationship between Adverse Childhood Experiences (ACEs) and health and well-being across the life course, there is a limited understanding of ACEs among diverse populations. The purpose of this study was to develop a new measure, the ACE-I, which consists of adversities that may be more relevant among immigrant populations, and to compare these rates to those of traditionally studied ACEs.Data for this study comes from a community sample of 338 Latino immigrant adolescents who completed an 11-item measure of traditional ACEs and a novel 13-item measure of immigrant-specific ACEs (ACE-I) as part of the intake process for a positive youth development program.While the scores of the two ACEs measure were correlated (These findings suggest that there are essential early adverse experiences for immigrants that have not previously been considered in ACEs research. Broadening our conceptualization and measurement of ACEs among immigrant populations could provide valuable insight into social determinants of health and avenues for intervention for immigrant youth and families. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

To examine the acceptability of routine screening for adverse childhood experiences (ACEs) and resilience during prenatal care.This study examined pregnant women's perspectives (The sample (Results indicate that women value ACEs screening during prenatal care and provide actionable recommendations to improve future screenings and discussions. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

ObjectiveTo determine the associations between Adverse Childhood Experiences (ACEs), adolescent screen time, and physical activity during the early COVID-19 pandemic.MethodsData (2016-2020) from the Adolescent Brain Cognitive Development (ABCD) study were analyzed. Linear regression analyses estimated associations between ACE score and screen time and physical activity in May 2020, adjusting for potential confounders.ResultsOf the 6749 adolescent respondents primarily aged 12-13, 81.6% reported a history of one ACE or more. In adjusted models, a higher ACE score was significantly associated with greater hours per day of screen time, with youth with ≥4 ACEs associated with 2.3 more hours of screen time per day compared to youth with 0 ACEs. In addition, the adjusted models found that a higher ACE score was associated with lower physical activity; youth with ≥4 ACEs averaged 0.8 fewer hours per week of physical activity and 0.5 fewer days per week of 60 minutes of physical activity compared to youth with 0 ACEs. Gender and race were also significantly associated with changes in screen time and physical activity.ConclusionsACEs are associated with higher adolescent sedentary behaviors, particularly greater screen time, during the early COVID-19 pandemic (May 2020). Clinicians caring for youth exposed to trauma in the postpandemic environment should explore screen time and physical activity behaviors.

OBJECTIVE Early life adversity is associated with somatic symptoms (SS) in adulthood, but the psychological mechanisms involved need to be further investigated. The aim of this study was to investigate whether disturbances in self-organization (DSO), consisting of affective dysregulation, negative self-concept, and disturbances in relationships, mediate the relationship between exposure to adverse childhood experiences (ACEs) and SS in adulthood. In addition, we investigated whether resilient coping buffers the direct and indirect effect of ACEs on SS. METHOD The study sample comprised 4,847 Slovenian adults aged 18 to 75 years and was broadly representative of the general population. RESULTS Results of the mediation analysis showed that DSO had a notable, significant mediating effect on the relationship between ACEs and SS, with the indirect effect (a × b = .386, p < .001) accounting for 53.3% of the total effect. A moderated mediation analysis revealed a significant interaction between ACEs and resilient coping in predicting DSO (B = -.074, p = .020), suggesting that resilient coping moderated the indirect effect of ACEs on SS. The flexible use of coping strategies to solve problems in stressful circumstances reduced the negative effect of ACEs on DSO, and hence the frequency of SS in adults with a history of ACEs. CONCLUSIONS Health care professionals should be aware of the role that DSO may have in maintaining or exacerbating SS in victims of early trauma. Strengthening the individual's capacities for resilient coping can alleviate the negative effects of early trauma on psychological functioning and health in later life. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

To understand the relationship between adverse childhood experiences (ACEs) and diet, sleep, and exercise in pre-adolescents.Baseline and 1-year follow-up data from the adolescent brain and cognitive development (ABCD) study were analyzed (age 10-11, n = 11,875). ACEs were measured by parent report at baseline. Three levels of ACEs were created: none, exposure to one ACE, and exposure to two or more ACEs. Health-promoting behaviors were assessed at 1 year. Diet quality was measured from parent report; sleep problems were measured by parent report, with higher scores indicating worse sleep; and amount of exercise was measured by youth report. Linear regression analyses were used to assess the relationship between ACEs and each health-promoting behavior, adjusting for family income and sex.Compared to children with no adversity, ACEs were associated with worse diet - one ACE (β = -0.30 [95% CI, -0.49 to -0.12], P = .002) and 2 or more ACEs (β = -0.56 [-0.78 to -0.34, P.001). Similarly, ACEs were associated with poor sleep - one ACE (β = 1.51 [1.00-2.03], P.001) and 2 or more ACEs (β = 2.96 [2.38-3.53], P.001). Finally, amount of exercise was not different in children with ACEs - 2 or more ACEs (β = -0.24, 95% CI, -0.51 to 0.04, P = .08).ACEs in pre-adolescents show a dose-response relationship with unhealthy diet and sleep disruption. These findings suggest potential behaviors to target to mitigate the negative impact of childhood adversity on adult health.

The Identity Disruption Model posits that early adversity is associated with lower self-concept clarity, which in turn increases vulnerability to sociocultural appearance factors and body dissatisfaction, but this model has not previously been tested among adolescents. Testing the model during adolescence is critical because this is a key point of development of both identity and body dissatisfaction. This paper presents two studies with adolescents recruited through social media (Study 1: n = 213; 78% female; mean age = 15.7 years, SD = 1.14) and from high schools (Study 2; n = 228; 43% female; mean age = 13.8 years, SD = 1.15). In both studies, self-reported early adversity was associated with lower self-concept clarity; lower self-concept clarity was associated with greater internalization of appearance ideals and more frequent appearance comparisons; and internalization and appearance comparisons were associated with greater body dissatisfaction. This research builds on previous sociocultural models of body dissatisfaction by pointing to processes that occur early in life that could be potential targets of intervention and prevention efforts.

Social and educational disruptions during the COVID-19 pandemic have exacerbated concerns about adolescents' mental health and suicidal behavior. Data from the 2021 Adolescent Behaviors and Experiences Survey (ABES) indicate that 37.1% of U.S. high school students reported poor mental health during the COVID-19 pandemic, with 19.9% considering and 9.0% attempting suicide in the preceding year (1). Adverse childhood experiences (ACEs)* are associated with poor mental health and suicidal behaviors (2,3), and high prevalence of some ACEs have been documented during the pandemic (4). ACEs are preventable, potentially traumatic events that occur in childhood (ages 0-17 years) such as neglect, experiencing or witnessing violence, or having a family member attempt or die by suicide. Also included are aspects of a child's environment that can undermine their sense of safety, stability, and bonding. Associations between ACEs occurring during the pandemic and mental health or suicidal behaviors among U.S. high school students were examined using ABES data. Experience of one to two ACEs was associated with poorer mental health and increased suicidal behaviors, and these deleterious outcomes increased with additional ACE exposure. After adjusting for demographic characteristics, adolescents who reported four or more ACEs during the pandemic had a prevalence of poor current mental health four times as high as, and a prevalence of past-year suicide attempts 25 times as high as, those without ACEs during the pandemic. Experience of specific ACE types (e.g., emotional abuse) was associated with higher prevalences of poor mental health and suicidal behaviors. Prevention and intervention strategies (5), including early identification and trauma-informed mental health service and support provision, for ACEs and their acute and long-term impacts could help address the U.S. child and adolescent mental health and suicide crisis.

BACKGROUND: Children in families who are refugees might experience more adversities than their peers. Adverse childhood experiences (ACEs) are well known risk factors for poorer adulthood health and adjustment. The risk of ACEs for children with a parent who is a refugee affected by trauma is unknown. We aimed to estimate the hazard of individual and cumulative ACEs using a unique sample of children with parents who are refugees affected by and seeking treatment for trauma and population level data.METHODS: This was a register-based cohort study carried out in Denmark. All children aged 0-15 years, residing in Denmark between Jan 1, 1990, and Dec 31, 2016, were followed up from birth or migration into the country to their 15th birthday. We linked data from the Danish Civil Registration System, the Danish National Patient Register, the Danish Psychiatric Central Research Register, the Employment Classification Module, the Register of Causes of Death, and the Income Statistics Register to investigate ten ACE categories (parental: natural and unnatural death, serious mental illness, substance use disorder, somatic illness, and disability; child: residential instability, family disruption, poverty, and stressors) and the cumulative number of ACE categories for children with a parent from a refugee-sending country and children with a parent who is a refugee in treatment for trauma. The main outcome was the hazard ratio (HR) of the individual and cumulative ACEs among children with a parent from a refugee-sending country and children with a parent who is a refugee affected by trauma, compared with the general population of children in Denmark, both adjusted and unadjusted for parental country of origin.FINDINGS: 2 688 794 children were included in the study, 252 310 of whom had parents from refugee-sending countries. 11 603 children had parents affected by trauma and seeking treatment, of whom 1163 (10%) migrated to Denmark before their second birthday and 10 440 (90%) were born in Denmark. Compared with the general population of children in Denmark, the hazard for most ACEs was significantly higher for both children with parents from a refugee-sending country and children with parents who are refugees affected by trauma. For children with a parent from a refugee-sending country, the highest HR was related to the child living in relative poverty for 3 years (3·62 [95% CI 3·52-3·73]). After adjusting for parental country of origin, the hazards for five ACEs were significantly greater for children of parents who are refugees affected by trauma compared with the remaining children of parents from the same countries. The highest HR for this child group was for parental serious mental illness (1·98 [1·85-2·12]). The hazard for experiencing multiple ACEs was significantly higher for both child groups compared with the general population.INTERPRETATION: Our findings suggest that children with parents from refugee-sending countries have a higher rate of several ACEs compared with the general population. Furthermore, having a parent who is a refugee affected by trauma and seeking treatment seems to be an independent risk factor for poorer health and adjustment in adulthood. This study informs decision makers and caregivers that there might be much added value in addressing needs within the whole family, as opposed to only attending to the parent who is seeking treatment.FUNDING: The Lundbeck Foundation.

Deficits in inhibitory control are common with advancing age and may underlie declines in other complex cognitive functions. The inhibitory P300 event-related potential (ERP) generally decreases in amplitude with age, reflecting deficits in inhibitory performance evaluation and adaptation, with possible generators including precentral and inferior frontal gyri and midcingulate and parietal cortex. Exposure to early-life stress (ELS) is also associated with deficits in inhibitory control, smaller P300 amplitudes, and dysfunction in regions associated with P300 generation. Although biopsychosocial effects of ELS are evident in older adulthood, the influence of ELS on neural processes in later life is unknown. In the current study, 13 young adults and 21 healthy older adults completed a high-accuracy go/no-go task and the Juvenile Victimization Questionnaire (JVQ), an indicator of ELS. Regression analyses revealed significant central-parietal models, with smaller P300 amplitudes predicted by both older age and greater exposure to ELS. Age group*ELS interactions moderated P300 prediction at central and centro-parietal electrodes, such that older age predicted smaller P300 amplitudes only in those with lower to moderate ELS. Amplitudes did not significantly differ by age in those with higher ELS. Post-hoc within-age group correlations showed that greater ELS was associated with smaller P300 amplitudes in young adults. However, greater ELS was modestly associated with larger central amplitudes in older adults, potentially suggestive of anterior age-related compensatory recruitment to maintain high task performance. These findings suggest long-lasting neural implications of ELS that interact with normative neuro-cognitive aging processes, such that ELS may be an important risk factor for age-related cognitive decline.

OBJECTIVES: To examine whether gender moderates the effects of childhood trauma on subjective and objective sleep measures. DESIGN: Secondary data analysis, exploratory SETTINGS: Sleep research lab PARTICIPANTS: A total of 213 men and 278 women aged 18–30 completed subjective measures. A subsample of 172 participants without any psychiatric, medical, or sleep disorders completed objective polysomnography for 1 night at baseline, before sleep manipulation. MEASUREMENTS: Subjective measures: Childhood Trauma Questionnaire (CTQ), Pittsburgh Sleep Quality Index, Insomnia Severity Index, and Epworth Sleepiness Scale. Objective measures: Standard polysomnography measures. Multiple regressions determined whether gender moderated CTQ score on any objective or subjective sleep measures. If gender was not a moderator, we examined additive effects of gender and CTQ score. Models were adjusted for race and age. RESULTS: Gender and CTQ score interactions were non-significant for both subjective (p > .675) and objective (p > .110) sleep. Women demonstrated better subjective sleep quality (Pittsburgh Sleep Quality Index, B = −0.264, p = .041) and more delta sleep than men (B = 3.032, p =.005). Greater CTQ score was associated with increased sleepiness (Epworth Sleepiness Scale, B = 0.029, p = .042), increased insomnia severity (Insomnia Severity Index, B = 0.027, p = .005), and lower REM density (B = −0.132, p = .045). CONCLUSION: Our finding of greater delta sleep and better subjective overall sleep quality in women suggests that, among people without comorbidities, women may experience better sleep. Childhood trauma is associated with objective and subjective sleep measures, but this association is non-specific to gender. Clear links between childhood trauma and sleep are detectable in a sample of healthy sleepers with no comorbidities.

Childhood maltreatment affects approximately 25% of the world's population. Importantly, the children of mothers who have been maltreated are at increased risk of behavioral problems. Thus, one important priority is to identify child neurobiological processes associated with maternal childhood maltreatment (MCM) that might contribute to such intergenerational transmission. This study assessed the impact of MCM on infant gray and white matter volumes and infant amygdala and hippocampal volumes during the first 2 years of life.Fifty-seven mothers with 4-month-old infants were assessed for MCM, using both the brief Adverse Childhood Experiences screening questionnaire and the more detailed Maltreatment and Abuse Chronology of Exposure scale. A total of 58% had experienced childhood maltreatment. Between 4 and 24 months (age in months: mean = 12.28, SD = 5.99), under natural sleep, infants completed a magnetic resonance imaging scan using a 3T Siemens scanner. Total brain volume, gray matter volume, white matter volume, and amygdala and hippocampal volumes were extracted via automated segmentation.MCM on the Adverse Childhood Experiences and Maltreatment and Abuse Chronology of Exposure scales were associated with lower infant total brain volume and gray matter volume, with no moderation by infant age. However, infant age moderated the association between MCM and right amygdala volume, such that MCM was associated with lower volume at older ages.MCM is associated with alterations in infant brain volumes, calling for further identification of the prenatal and postnatal mechanisms contributing to such intergenerational transmission. Furthermore, the brief Adverse Childhood Experiences questionnaire predicted these alterations, suggesting the potential utility of early screening for infant risk.

Adverse Childhood Experiences (ACEs) have been linked to a host of negative outcomes in adolescence. However, research on the impact of ACEs on adolescent mental health has produced mixed results, leaving it unclear how ACEs may relate to depression and anxiety during adolescence. Moreover, this body of work has neglected how gender, risk and protective factors may influence these relationships, despite research demonstrating gender differences in both responses to adversity and in the impact of risk and protective factors on maladaptive outcomes in adolescence. Drawing on a sample of at-risk youth from the Fragile Families and Child Wellbeing Study (N = 2455; age 14-18; 48 % female, 50 % Black, 23 % Hispanic), the current study examines the association between ACEs during early childhood (i.e., ages 1 to 5) and anxious and depressive tendencies reported during adolescence. Models are stratified by gender and incorporate six types of teenage risk and protective factors (peer bullying, delinquent peers, low self-control, parental attachment, collective efficacy, and school connectedness). Results showed support for gender differences in the associations between ACEs and boys' and girls' mental health symptoms. Initially, ACEs were associated with an increased risk of both depressive and anxious tendencies in boys, but the total ACEs score was only significantly associated with an increased risk for depressive symptoms in girls. After accounting for teenage protective factors, ACEs were related to a decreased risk of depressive and anxious symptoms among girls only. Findings have important implications for refining intervention and prevention strategies focusing on mitigating the harms of ACEs.

Social determinants of health and adverse childhood experiences have been implicated as driving causes of maternal mortality but the empirical evidence to substantiate those relationships is lacking. We aimed to understand the prevalence and intersection of social determinants of health and adverse childhood experiences among maternal deaths in Colorado based on a review of records obtained for our state's maternal mortality review committee.A 5-member interdisciplinary team adapted the Protocol for Responding to and Assessing Patients' Assets, Risk, and Experiences and the Adverse Childhood Experiences tools to create a data collection tool. The team reviewed records collected for the purpose of maternal mortality review for pregnancy-associated deaths that occurred in Colorado between 2014 and 2016 (N = 94).The review identified an overwhelming lack of information regarding social determinants of health or adverse childhood experiences in the records used to review maternal deaths. The most common finding of the social determinants of health was a lack of conclusive evidence in the record (35.1-94.7%). Similarly, the reviewers were unable to make a determination from the available records for 92.1% of adverse childhood experience indicators.The lack of social and contextual information in the records points to challenges of relying on medical records for identification of non-medical causes of maternal mortality. Maternal mortality review committees would be well served to invest in alternative data sources, such as community dashboards and informant interviews, to inform a more comprehensive understanding of causes of maternal mortality.

Adverse childhood experiences have been robustly associated with poor sexual health in later life. In low-income countries, there is growing evidence that children experience greater adversity than those in higher income countries. Research suggests this may contribute to later sexual risk taking and HIV infection, though most studies to date have been cross-sectional.We use longitudinal data on adolescents to examine the temporal relationship between adversity and HIV-related behavioral and biological outcomes.We interviewed 1878 adolescents living in Malawi in 2017-2018 (age 10-16) and again in 2021 (age 13-20). Adolescents completed the Adverse Childhood Experience - International Questionnaire. HIV-risk was assessed through both behavioral (e.g. condom use) and biological (HIV and herpes simplex virus 2 [HSV2] infection) outcomes. ordinary least squares (OLS) and logistic multivariate regression models are used to explore associations between adversity and HIV risk.In longitudinal analyses, adverse childhood experiences (ACEs) were significantly associated with intimate partner violence and girls' behavioral risk scores only. HIV incidence was too low to model; there were no significant associations with HSV2. In cross-sectional analyses, ACEs were additionally associated with an early sexual debut, lack of condom use, a greater number of sexual partnerships, and sexually transmitted infection symptoms.Our findings emphasize the importance of collecting prospective data: results from longitudinal and cross-sectional analyses drew qualitatively different conclusions. Cross-sectional analyses may not be accurate representations of longitudinal processes. However, they suggest that recent adversity and distress drives HIV-related behavior, perhaps more than early adversity. Interventions that combat emotional abuse or peer violence during adolescence could potentially reduce HIV risk.

The Adverse Childhood Experiences (ACEs) study was conducted to advance understanding of psychological trauma in early life as a possible determinant of adult health. In the past decade, there has been a movement to use the ACEs research questionnaire in a variety of clinical settings to screen individuals and assess their trauma score. But critics argue that the ACEs questionnaire was never intended to be used for individual-level screening, and even that harm can be done by using the questionnaire for this purpose. In the meantime, researchers have developed a protective factor questionnaire that they call the “Positive Childhood Experiences” (PCEs) survey that captures experiences that predict trauma resilience. The objective of this article is to explain the history of the ACEs questionnaire, the current controversy about its use for screening, the emergence of the concept of PCEs, and implications for occupational therapy practitioners and researchers.

Background: Breastfeeding is the biological norm and is associated with numerous superior health outcomes for children and mothers when compared to human milk substitutes. Yet, breastfeeding difficulties and the inability to meet one’s breastfeeding goals are common in the United States and maybe more common among mothers who have experienced trauma. Research Questions: (1) Are mothers’ adverse childhood experiences, and current experiences of discrimination, material hardship, and decreased social support associated with breastfeeding challenges; and (2) are these experiences associated with the number of breastfeeding challenges reported? Methods: A prospective, non-probability, cross-sectional study design with a diverse sample who had delivered a live baby within the previous year ( N = 306) was conducted. Results: Over 70% of participants reported breastfeeding challenges and 45.2% reported material hardship. Among those who attempted breastfeeding ( n = 286), 74.1% had at least one adverse childhood experience; 30.3% had four or more. Logistic and negative binomial regression models determined that adverse childhood experiences, experiences of discrimination, material hardship, and decreased social support were not associated with experiencing any breastfeeding challenges. However, adverse childhood experiences were associated with the number of breastfeeding challenges reported. (The adjusted rate ratio was 1.05; 95% CI [1.00, 1.09], p = .034). Conclusion: We recommend further research on adverse childhood experiences and potential relationships with discrimination, material hardship, and social support to prevent and intervene in cases of breastfeeding challenges to maximize infant, maternal, and public health.

Background: Childhood trauma (CT) is a risk factor for depressive and anxiety disorders. However, whether CT is more strongly linked to specific clinical features of these disorders remains inconclusive. The current study comprehensively examined cross-sectional and longitudinal associations between CT and depressive/anxiety symptomatology in a large adult sample with current and remitted depressive and/or anxiety disorders. Methods: Baseline (n = 1803), 2-year (n = 1735), 4-year (n = 1585), and 6-year follow-up (n = 1475) data from the Netherlands Study of Depression and Anxiety were used. CT (emotional neglect, emotional/physical/sexual abuse) was assessed at baseline, while depressive/anxiety symptomatology with relevant dimensions (e.g., mood/cognitive, melancholic, general distress, and somatic depression) was assessed at each wave using self-reported questionnaires. Linear regressions and linear mixed models determined cross-sectional and longitudinal associations. Results: Individuals with CT, especially, severe CT, compared to those without CT, had significantly higher scores in overall depressive symptomatology (Cohen's d = 0.674), mood/cognitive depression (d = 0.691), melancholic depression (d = 0.587), general distress (d = 0.561), and somatic depression severity (d = 0.549). Differences were lower, but still highly significant for anxiety (d = 0.418), worry (d = 0.362), and fear/phobic symptomatology (d = 0.359). Effects were consistent across CT types and maintained over six years. Limitations: Retrospectively-reported CT. Conclusions: CT is a risk factor for depressive and anxiety symptomatology across all dimensions and enduring over multiple years. Screening for CT is essential to identify individuals at risk for more severe and chronic manifestations of affective disorders.

Adverse childhood experiences (ACEs) are associated with many negative health outcomes. Despite this well-documented association, most research on how health conditions affect women's preconception and perinatal health overlooks ACEs.This study analyzes self-reported ACE history and health outcomes among young adults (ages 18-39) using data from the 2019 Behavioral Risk Factor Surveillance System. Our aims were to 1) assess differences by gender in overall ACE scores and specific ACEs; 2) identify trends in women's ACE scores by birth cohort; and 3) estimate the association of ACE scores with health conditions that increase risk for adverse perinatal outcomes.Findings include that women had higher overall ACE scores than men and that women were more likely to report experiencing seven of the eight ACEs queried. More than 23% of women respondents reported an ACE score of 4+, with a 3-percentage point difference between the youngest and oldest women in our sample. Compared with those reporting zero ACEs, women with four or more ACEs were almost four times as likely to report a history of depression and more than twice as likely to report fair or poor health, even after accounting for sociodemographic characteristics. Women with four or more ACEs were 62% more likely to have obesity, 41% more likely to report a hypertension diagnosis, and 36% more likely to report a diabetes diagnosis than those with zero ACEs.ACEs are a root cause in the development of adverse health conditions in young women, and their prevention should be central to policies aimed at improving women and children's well-being.

Traumatic injury is the leading cause of pediatric mortality and morbidity in the United States. Pediatric trauma survivors requiring inpatient rehabilitation (IPR) require coordinated, multispecialty follow-up. Knowledge of the nature and level of disability is necessary for planning this continued care that is specific to the needs of pediatric trauma patients. This study aims to describe the outcomes of pediatric and adolescent trauma patients using measures of functional progression.A retrospective review of trauma patients aged ≤18 y admitted to IPR between January 2018 and December 2020 at the only certified pediatric rehabilitation center in the region was performed.Ninety five children and adolescents were admitted to IPR after traumatic injury with diagnoses of multitrauma (MT, N = 18), traumatic brain injury (TBI, N = 59), and spinal cord injury (SCI, N = 18). School aged children returned to school at high rates for all injury types (MT: 86.7%, TBI: 97.4%, SCI: 93.8%, P = ns). All groups had similar hospital and rehabilitation length of stay, and most patients required a durable medical equipment at discharge (79%). Using pediatric functional independence measure scoring progression from admission to discharge from IPR, SCI patients made significant improvement in bladder function and the least improvement in stair function. Patients sustaining a TBI made significant improvement in memory and comprehension tasks.Pediatric and adolescent trauma patients admitted to IPR had a positive progression during their therapy but required variable ongoing care depending on the mechanism of injury. Excellent rates of returning to school were seen across the three injury types.

Adverse childhood experiences (ACEs) have been linked to common mental disorders (CMDs) such as anxiety and depressive thoughts. We examined the prevalence of ACEs and their association with CMDs among pregnant women living with HIV (PWLHIV) in Malawi-an HIV endemic resource-limited setting.This is a cross-sectional study of 798 PWLHIV enrolled in the VITAL Start trial in Malawi (10/2018 to 06/2021) (NCT03654898). ACE histories were assessed using WHO's Adverse Childhood Experiences International Questionnaire (ACE-IQ) tool. Depressive symptoms (somatic complaints, reduced vital energy, anxiety, and depressive thoughts) were assessed using WHO's Self Reporting Questionnaire 20-Item (SRQ-20) tool. Log-binomial regressions were used to examine the association between cumulative ACEs and each depressive symptom, as well as identify ACEs driving this association.The mean age of our sample was 27.5 years. Over 95 % reported having experienced ≥1 ACE. On average, each participant reported four ACEs; 11 % reported sexual abuse. About 52 % and 44 % reported anxiety and depressive thoughts, respectively. In regressions, cumulative ACE scores were significantly associated with depressive symptoms-even after adjusting for multiple testing. This association was primarily driven by reports of sexual abuse.Data on maternal ACEs were self-reported and could suffer from measurement error because of recall bias.ACEs are widespread and have a graded relationship with depressive symptoms in motherhood. Sexual abuse was found to be a primary driver of this association. Earlier recognition of ACEs and provision of trauma-informed interventions to improve care in PWLHIV may reduce negative mental health sequelae.

Adverse childhood experiences, which include child maltreatment, are a major public health issue nationally. Child maltreatment has been linked to poorer cognitive functioning, which can start in childhood and persist into adulthood. However, studies examining the potential disparities by gender and race/ethnicity are lacking. The aim of this study was to assess the gender and racial/ethnic disparities in the association between child maltreatment and memory performance. Data were obtained from Waves III and IV of the National Longitudinal Study of Adolescent to Adult Health ( N = 11,624). Weighted multiple linear regression models were used to assess the associations between sexual abuse, physical abuse, neglect, and child maltreatment score and memory. Models were stratified by gender, race, and ethnicity. Men who were exposed to sexual abuse, neglect and two or three child maltreatment types scored one to three points lower (β = –1.44; 95% CI: –2.83, –0.06; β = –2.41; 95% CI: –3.75, –1.08; β = –3.35; 95% CI: –5.33, –1.37; β = –2.31; 95% CI: –3.75, –0.86) in memory performance compared to men who did not report sexual abuse, neglect, or child maltreatment, respectively. Black respondents who were exposed to sexual abuse scored two points lower (β = –1.62; 95% CI: –2.80, –0.44) in memory performance compared to Black respondents who did not report sexual abuse. Among Other race and Hispanic respondents, those who reported neglect scored four points lower (β = –4.06; 95% CI: –6.47, –1.66; β = –4.15; 95% CI: –5.99, –2.30) in memory performance, respectively, compared to their counterparts who did not report neglect. Gender- and racial/ethnic-responsive memory performance interventions addressing child maltreatment may be beneficial for affected populations.

Adverse childhood experiences (ACEs) have been linked to risky health behaviors, as well as the development of chronic health conditions such as both type 1 and type 2 diabetes mellitus. A connection between ACEs and diabetes self-management has not yet been established. The current study aims to investigate the relationships among ACEs, delay discounting, impulsivity, and diabetes self-management.A total of 227 adults aged 18 to 77 with type 1 diabetes, type 2 diabetes, and prediabetes were recruited to complete an online survey via Amazon's mechanical Turk. Participants completed validated measures of diabetes self-care, delay discounting, and impulsivity, as well as questions regarding diabetes history and financial strain.In the overall sample and controlling for financial strain, increased number of ACEs was significantly associated with poorer diabetes management (r = -.15, p.05). Higher delay discounting was associated with fewer ACEs (r = -.31, p.05) and better diabetes care (r = .42, p.01), as well as increased number of diabetes-related complications (r = .33, p.01), controlling for financial strain. Participants who use insulin to manage their diabetes had significantly better diabetes self-care scores (t(225) = 8.19, p.01), higher levels of delay discounting (t(101) = 3.15, p.01), and fewer reported ACEs (t(224) = -2.19, p.05).ACEs are associated with poorer diabetes self-management later in life. This may be an important consideration for clinicians treating patients with diabetes and prediabetes. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Adverse childhood events (ACEs) are associated with poor health outcomes and behaviors. Research has shown that physical activity (PA) can have a protective effect on the relationship between ACEs and health outcomes. This study aimed to explore the moderating effects of PA on the relationships between ACEs (physical and emotional abuse) and physical and psychological health (depression and self-esteem) among South Korean middle school students. The data used in this study were from the 2020 Korean Children and Youth Rights Survey (KCYRS), which had 2640 participants. The results indicated that PA could lessen the negative effects of emotional abuse on physical health and self-esteem. However, there was no significant moderating effect of PA in the relationship between physical abuse and health outcomes. The findings suggest that, while PA might be a protective factor for individuals exposed to emotional abuse, the effects of abuse on engaging in PA and the benefits of PA can be complex. Further research is needed to understand how different types of ACEs affect individuals and how PA can mitigate negative impacts. Health professionals, educators, and stakeholders should provide more opportunities for PA to support healthy behaviors and prevent negative health outcomes in adulthood for youth exposed to ACEs.

Adverse childhood experiences (ACEs) are common and increase the risk of poor health outcomes. Resilience may offer protection against the impacts of ACEs. This study examined the association between maternal ACEs and mental/behavioral health outcomes during pregnancy overall and by resilience. The sample comprised pregnant patients in two pilot studies screened for eight ACEs and resilience during standard prenatal care in Kaiser Permanente Northern California from 1 March 2016 to 30 July 2016 (Study 1, medical centers A, B) and from 1 April 2018 to 31 March 2019 (Study 2, medical centers A, C). Early pregnancy outcomes included anxiety and depressive disorders, depression symptoms, intimate partner violence (IPV), and substance use. Multivariable logistic regression was used in this cross-sectional study to examine associations between maternal ACEs (0, 1–2, ≥3) and mental/behavioral health outcomes overall and among those with low and high resilience. Patients (n = 1084) averaged 30.8 years (SD 5.1); 41.7% were non-Hispanic White; 41.7% experienced ≥1 ACE, and 40.3% had low resilience. Patients with 1–2 ACEs or ≥3 ACEs (versus 0 ACEs) had higher odds of anxiety and depressive disorders, depressive symptoms, IPV, and any prenatal substance use (OR 1.44–4.40, p < 0.05). Each individual ACE was associated with ≥2 mental/behavioral health outcomes. In stratified analyses, having ≥1 ACE (vs. 0) was associated with a greater number of mental/behavioral health outcomes among patients with low versus high resilience. ACEs were associated with prenatal mental/behavioral health conditions, particularly in the context of low resilience, highlighting the importance of trauma-informed prenatal care and the need to study resilience-building interventions during pregnancy.

Οι αντίξοες εμπειρίες κατά την παιδική ηλικία (ΑΕΠΗ) περιλαμβάνουν μια ομάδα δυσμενών εμπειριών, όπως η παραμέληση, που αφορούν μεγάλο αριθμό παιδιών σε μια τάξη σήμερα. Συνδέονται με δυσκολίες σε όλους τους τομείς της ανάπτυξης και της σχολικής επίδοσης, καθώς και με προβλήματα στη σωματική και στην ψυχολογική υγεία στην παιδική και ενήλικη ζωή. Σε αυτό το άρθρο παρουσιάζονται, μέσα από βιβλιογραφική ανασκόπηση, οι διαφορετικές θεωρητικές προσεγγίσεις των ΑΕΠΗ καθώς και οι απόψεις ή/ και εμπειρικά δεδομένα για τη σύνδεσή τους αθροιστικά και ξεχωριστά με διάφορα ζητήματα στην ανάπτυξη, τη μάθηση και την (ψυχική) υγεία. Τέλος, γίνεται συζήτηση για τη σχολική κοινότητα ως ένα ευαισθητοποιημένο και υποστηρικτικό πλαίσιο στις ψυχοκοινωνικές και μαθησιακές ανάγκες παιδιών με αντίξοες εμπειρίες οι οποίες μπορεί να είναι στρεσογόνες ή/και τραυματικές., Adverse childhood experiences (ACEs) incorporate a group of adverse life events such as neglect that affect a significant number of students in classrooms today. ACEs link with difficulties across development and problems in physical and psychological health during childhood and adult life. In this paper, the different approaches to ACEs conceptualization are presented through employing a narrative review methodology. Moreover, the link between the various theoretical approaches to ACEs and their collective and independent effect on development, learning and mental health is highlighted. Finally, the role of the school is discussed as a trauma-sensitive community and a supportive context that caters to the psychosocial and learning needs of students with ACEs that can be stressful and traumatic.

Objectives. To assess police contact as a potential adverse childhood experience by measuring its prevalence, nature, and distribution among urban adolescents. Methods. Detailed US population-based data on youth‒police contact were collected in the Fragile Families and Child Wellbeing Study (n = 2478) from 2014 to 2017. Using regression modeling, I assessed adolescents’ police exposure and the magnitude and robustness of racial disparities in police contact. Sensitivity analyses examined disparities by behavior and socioeconomic context. Results. Urban youths are heavily policed, beginning in preadolescence. Exposure to policing is unevenly distributed, with non-White adolescents—particularly Black boys—reporting more, and more aggressive, contact than their White counterparts. Hispanic‒White differences and disparities in girls’ experiences were less pronounced but present, particularly in how intrusive stops were. Intrusion disparities were robust to most behavioral controls, but not observed among youths with higher socioeconomic status. Conclusions. Given extant literature documenting adverse health consequences of police encounters, findings implicate policing as a driver of health disparities in adolescence and throughout the life course. Public health infrastructure dedicated to the prevention and treatment of adverse childhood experiences is well suited for mitigating these harms and inequities.

Previous research has investigated the prevalence and impact of secondary traumatic stress (STS) among those working as helping professionals. However, limited studies have provided clear and coherent information about STS among clergy, pastors, and other religious leaders, despite their status as helping professionals who are implicated in times of crisis. STS is particularly salient to African American religious leaders due to cultural factors that position African American churches as trusted institutions linking local communities of color with various social services. Results from a sample of African American religious leaders confirmed the prevalence of STS along with other mental health challenges. Moreover, STS was associated with negative interactions within the church. Finally, negative religious coping and medical mistrust significantly moderated the relationship between adverse childhood experiences and PTSD. These findings bear significant implications, emphasizing the need for greater collaboration and trust-building between mental health professionals and clergy.

Human service organizations (HSO) have increasingly recognized the value of employing trauma-informed care (TIC) in a variety of practice settings. Evidence suggests that effectively adopting TIC has shown client improvements. Organizational barriers to TIC implementation, however, exist. To improve TIC practice, the attitudes related to trauma-informed care (ARTIC) scale was developed to measure staff attitudes and beliefs towards TIC. The ARTIC has been widely adopted by researchers without evaluating its psychometric performance in diverse practice settings. The purpose of this study was to independently validate the ARTIC scale drawn from a sample of staff (n = 373) who provide services to substance-using parents. Psychometric tests were conducted to evaluate how the ARTIC performs with our HSO population. Results from a confirmatory factor analysis showed poor fit (X2 = 2761.62, df = 2.96; RMSEA = 0.07 [0.07, 0.08]; CFI = 0.72). An exploratory factor analysis was conducted to analyze how the data fit with our specific population, yielding 10 factors. Finally, a qualitative inter-item analysis of these factors was conducted, resulting in nine factors. Our findings suggest that measuring TIC attitudes and beliefs may vary according to field of practice and ethno-racially diverse workers. Further refinement of the ARTIC may be necessary for various services domains.

Connecting patients to treatment for a substance use disorder (SUD) that satisfies their needs is often complicated by confounding factors. A reliable measurement of patients' underlying stress level may be helpful because it often reflects many of the same confounders as their SUD. Whereas cortisol levels reflect physiological responses to stress, patients' cortisol levels during recovery from an SUD may serve as biomarkers for stressors that result in poor treatment outcomes, including early discontinuation of treatment. However, further exploration of the relationship between patients' cortisol levels and their treatment outcomes is needed for this approach to be clinically useful.We enrolled participants from an abstinence-based, male-only, residential alcohol and drug recovery program to examine the relationship between salivary cortisol, stress exposure, ACEs, and treatment retention.Participants who remained in the program90 days had significantly higher initial cortisol levels than those who remained ≥90 days (0.62 ± 0.074 μg/dl vs. 0.36 ± 0.037 μg/dl). Kaplan-Meier curves differed significantly when we grouped participants according to whether their cortisol level was below or above the overall average of 0.49 ± 0.044 μg/dl, with the median numbers of days before discontinuing being 110 and 60, respectively. A Cox proportional hazards model indicated that elevated salivary cortisol (with increases in μg/dl), marital/relationship status, and adverse childhood experiences (ACEs) score correlated significantly with hazards of discontinuing the program (hazard ratios for the three factors were 3.49, 2.39, and 1.50, respectively).Cortisol level may predict, at least partially, SUD treatment program retention regardless of individuals' numerous confounding factors or the substance used. If this approach is validated, it could enable providers to consider patients' cortisol levels at the time of admission to treatment to facilitate their retention in treatment and thereby enhance their recovery.

Suicide in college students is a major public health concern. Suicidal ideation (SI) is associated with childhood trauma, personality, dysfunctional attitudes and depressive symptoms, but how they interact to predict SI remains unclear.Using cross-sectional design and convenience sampling method, a survey was conducted among 565 college students having major depressive disorder (MDD). The Childhood Trauma Questionnaire, Eysenck Personality Questionnaire, Dysfunctional Attitudes Scale and Hamilton Depression Scale assessed participants' psychosocial factors. Chi-square test, t-test, Pearson correlation, and Structural Equation Model were used in data analysis.Overall, 66.02% of participants with MDD had SI. Those with SI showed significant differences in physical abuse, emotional abuse, physical neglect, emotional neglect, psychoticism, neuroticism, extroversion, dysfunctional attitudes and depressive symptoms compared with those without SI. Childhood trauma, psychoticism, neuroticism, extroversion and dysfunctional attitudes affected SI through chain mediation. In addition, depressive symptoms, psychoticism, neuroticism and extroversion directly affected SI.The convenience sampling method may limit the generalizability of the findings. Results may be biased due to the self-report nature of the data collection procedure, the number of research subjects and differences in suicide risk assessment. The cross-sectional study cannot be used to infer causality.The factors of childhood trauma, personality and dysfunctional attitudes affect SI through chain mediation. In addition, depressive symptoms and personality independently predict the occurrence of SI.

To examine associations between adverse childhood experiences (ACEs) and age-specific insufficient sleep duration (ISD) in American youth.Data from the 2016-2017 National Survey of Children's Health, a sample of 46,209 youth ages 6 to 17 were analyzed. The main outcome was sleep duration that did not meet the recent recommendations of the American Academy of Sleep Medicine. Nine types of ACEs, as well as a cumulative count of ACEs, were examined as independent variables in unadjusted and adjusted logistic regression models.Approximately half of U.S. children and adolescents (ages 6-17) experienced at least one ACE and a third did not get sufficient sleep. Among those exposed to any ACE, 40.3% had ISD. Seven of the 9 ACEs examined were significantly associated with a 20% to 60% increase in odds of not getting sufficient sleep (adjusted ORs between 1.2 and 1.6). Children exposed to 2 or more ACEs were nearly twice as likely as those exposed to no ACE to have ISD (adjusted OR = 1.7, 95% CI: 1.5-1.9). Moreover, each individual ACE, except parental death was significantly associated with more than 1 hour less sleep than recommended.This study reports the association of specific and cumulative ACEs with ISD in a nationally representative sample of American youth. The study findings underscore the importance of screening for both ACEs and insufficient sleep during primary care encounters and addressing potential sleep problems in those exposed to ACEs.