Association of Childhood Adversity With Morbidity and Mortality in US Adults: A Systematic Review

Stability of Aging- and Cognition-Related Methylation Profile Scores Across Two Waves in Children and Adolescents

DNA-methylation profile scores (MPSs) index biology relevant for lifelong physical and cognitive health, but information on their longitudinal stability in childhood is lacking. Using two waves of data collected from 2014 to 2022 (Mlag between waves = 2.41 years) from N = 407 participants (Mage = 12.05 years, 51% female, 60% White), test-retest correlations were estimated for four salivary MPSs related to aging (PhenoAgeAccel, GrimAgeAccel, DunedinPACE), and cognitive function (Epigenetic-g). MPSs varied in longitudinal stability (test-retest rs = 0.38 to 0.76). MPSs did not differ in children exposed to the COVID-19 pandemic, but race-ethnic and sex differences were apparent. Further research is necessary to understand which environmental perturbations impact DNA-methylation trajectories and when children are most sensitive to those impacts.

Risks Associated with Recent Self-Harm in Preadolescent and Adolescent Youth: Parent-Report

OBJECTIVE

Self-harm among children and adolescents is a global public health issue, with concerning trends of increased rates of hospital presenting self-harm in younger age groups (5-12 years). Few studies have investigated risk factors of emerging self-harm in preadolescent populations (<12 years). This study aimed to identify key factors associated with recent (past 12-months) self-harm in preadolescents (5-12 years) compared to adolescents (13-18 years).

METHOD

This cross-sectional case-control study recruited 305 parents/guardians who had a child (aged 5-18 years) that had (i) recently engaged in self-harm (case group) or (ii) never engaged in self-harm (control group). Participants completed an online parent-report questionnaire that assessed demographic characteristics and self-harm, childhood adversity, child-parent relationships, peer relationships, and problematic digital media use. Data were analyzed using univariate and multivariate logistic regression analyses.

RESULTS

Poorer emotion regulation (OR = 1/0.76 = 1.32), lower parental age (OR = 1/0.83 = 1.20), lower household income (OR = 4.38), problematic peer relationships (OR = 1.38), and lifetime suicidal ideation (OR = 20.34) were associated with increased odds of self-harm among all youth ages. Higher parent education was associated with greater odds of self-harm among preadolescents (OR = 0.02). Lifetime mental health diagnosis (OR = 7.84) and lower levels of childhood adversity (OR = 0.60) were associated with greater odds of recent self-harm among adolescents.

CONCLUSIONS

Coordinated multi-agency efforts are essential for holistically addressing common, modifiable individual, social, and socioeconomic risk factors of youth self-harm that may help to prevent onset in young people.

Adolescent Disparities in Exposure to Adverse Childhood Experiences by Gender Identity

This survey study estimates the prevalence of adverse childhood experiences among adolescents according to gender identity.

Pathways from Adverse Childhood Family Environment to Lower Urinary Tract Symptoms and Impact Among Women

Background: To advance existing knowledge, this study examined mechanisms that may link retrospectively reported adverse childhood family environment (ACFE) to lower urinary tract symptoms and their impact (LUTS/impact), a composite variable with four levels (bladder health and mild, moderate, or severe LUTS/impact), among women (n = 1,026) in the Coronary Artery Risk Development in Young Adults cohort study. A prior study demonstrated that ACFE was associated with greater LUTS/impact. Materials and Methods: In 2000-01, the frequency of ACFE events was retrospectively assessed. In 2012-13, data on LUTS/impact were collected. Between 1985-86 and 2010-11, data on proposed mediators were collected at varying time points and averaged to form composite variables. A series of proportional odds ordinal logistic regression analyses were conducted. LUTS/impact was regressed on ACFE, adjusting for age, race, education, and parity. A single proposed mediator was added to the model at one time to determine whether the strength of the association between ACFE and LUTS/impact was attenuated. Results: When entered into regression models individually, life stressors, low levels of emotional support, and depressive symptoms each significantly attenuated the association between ACFE and LUTS/impact, with the association becoming nonsignificant when depressive symptoms were entered. Remaining proposed mediators (social network extensiveness, health behaviors, physiological health, cognitive function) did not mediate the association. Conclusions: ACFE may place women at risk for repeated or chronic episodes of experiencing life stressors, low support, and depressive symptoms during early and midlife adulthood, which in turn may place women at risk for more LUTS and impact during midlife adulthood.

Developmental impacts of deprivation and threat on emotion recognition

Dimensional models of early adversity propose developmental mechanisms by which threat and deprivation confer risk for psychopathology. Exposure to violent environments may influence social information processing biases, and limited access to complex learning environments might be associated with general challenges in emotion recognition. We examined associations of adversity measured early in development (6-36 months) and emotion recognition in early (72 months) and middle (96 months) childhood in a sample of 92 mother-child dyads. Low cognitive stimulation negatively predicted early childhood emotion recognition (β = -0.32, p = .01). Moreover, experiences of intimate-partner violence were associated with anger bias, but not global emotion recognition, in early (β = 0.24, p = .01), and middle (β = 0.18, p = .04) childhood. This pattern suggests that while the lack of exposure to complex learning experiences might impact children's conceptual knowledge of emotions, children who experience violence show biases that facilitate threat detection.

Inter-rater reliability of stress signatures in exfoliated primary dentition - Improving scientific rigor and reproducibility in histological data collection

Accentuated Lines (ALs) in tooth enamel can reflect metabolic disruptions from physiological or psychological stresses during development. They can therefore serve as a retrospective biomarker of generalized stress exposure in archaeological and clinical research. However, little consensus exists on when ALs are identified and inter-rater reliability is poorly quantified across studies. Here, we sought to address this gap by examining the reliability of accentuated (AL) markings across raters, in terms of both the presence versus absence of ALs and their intensity (HAL= Highly Accentuated, MAL= Mildly Accentuated, RL= Retzius Line). Ratings were made and compared across observers (with different levels of experience) and pairs of raters (who agreed on AL coding through consensus meetings) (N = 15 teeth, eight observers). Results indicated that more experience in AL assessment does not necessarily produce higher reliability between raters. Most disagreements in intensity ratings occurred in categories other than HAL. Furthermore, when AL assessment was performed by pairs of raters, reliability was significantly higher than individual assessments (Gwet's AC1 = 0.28 to 0.56 for line presence assessment; Gwet's AC1 = 0.48 to 0.64 for line intensity assessment). Based on these results, we recommend a workflow called IRRISS (Improving Reliability and Reporting In Scoring of Stress-markers) to increase rigor and reproducibility in histological analysis of dental collections. The introduction of IRRISS is well-timed, given the surge in studies of teeth occurring across anthropological, epidemiological, medical, forensic, and climate research fields.

Large-scale evidence of a general disease ('d') factor accounting for both mental and physical health disorders in different age groups

BACKGROUND

It is unknown whether there is a general factor that accounts for the propensity for both physical and mental conditions in different age groups and how it is associated with lifestyle and well-being.

METHODS

We analyzed health conditions data from the Millennium Cohort Study (MCS) (age = 17; N = 19,239), the National Child Development Study (NCDS) (age = 44; N = 9293), and the English Longitudinal Study of Ageing (ELSA) (age ≥ 50; N = 7585). The fit of three Confirmatory Factor models was used to select the optimal solution by Comparative Fit Index, Tucker-Lewis Index, and Root Mean Square Error of Approximation. The relationship among d factor, lifestyles, and well-being was further explored.

RESULTS

Supporting the existence of the d factor, the bi-factor model showed the best model fit in 17-year-olds (MCS:CFI = 0.97, TFI = 0.96, RMSEA = 0.01), 44-year-olds (NCDS:CFI = 0.96, TFI = 0.95, RMSEA = 0.02), and 50+ year-olds (ELSA:CFI = 0.97, TFI = 0.96, RMSEA = 0.02). The d factor scores significantly correlated with lifestyle and well-being, suggesting healthier lifestyles were associated with a reduced likelihood of physical and mental health comorbidities, which in turn improved well-being.

CONCLUSIONS

Contrary to the traditional dichotomy between mental and physical conditions, our study showed a general factor underlying the comorbidity across mental and physical diseases, related to lifestyle and well-being. Our results inform the conceptualization of mental and physical illness as well as future research assessing risk and pathways of disease transmission, intervention, and prevention. Our results also provide a strong rationale for a systematic screening for mental disorders in individuals with physical conditions and vice versa, and for integrated services addressing multimorbidity.

A Systematic Review and Meta-Analysis of the Association Between Childhood Maltreatment and Adult Depression

INTRODUCTION

Childhood maltreatment (CM) and depression are serious global issues with high prevalence and lifelong impacts on physical and mental health. CM has been proposed as a modifiable risk factor for depression that, if prevented, may contribute to a reduction in the global incidence of depressive disorders. Despite this, there is a paucity of reviews examining the strength of the association between these variables. The aim of this systematic review and meta-analysis was to evaluate the empirical evidence and determine if CM is supported as a preventable risk factor for depression.

METHODS

A search was performed in July 2024 for all peer-reviewed journal articles written in English examining the relationship between CM and adult depression in the electronic databases EBSCOhost, Proquest, and Embase. Studies were included in this review if they measured maltreatment before 18 years of age as the independent variable and adult depression as the dependent variable. Studies were excluded if the outcome variable was grouped with comorbidity and if they did not report primary quantitative data. A total of 77 studies with 516,302 participants met the inclusion criteria for review.

RESULTS

A random-effects meta-analysis was used to generate a pooled odds ratio from 87 effect estimates and demonstrated that individuals with a history of any CM are 2.5 times more likely to experience adult depression (OR = 2.49 [95% CI: 2.25-2.76]). This increase in odds remained regardless of how the primary studies screened for depression.

CONCLUSIONS

These findings confirmed the strong association between the experience of CM and adult depression. High heterogeneity in the meta-analytic results also suggested that further research is required that applies consistent adjustments for comorbidities and confounding factors and examines the temporal relationship between the variables to establish causality.

Adverse Childhood Experiences and Accelerated Epigenetic Aging in the Hispanic Community Health Study/Study of Latinos: Nativity as an Effect Modifier

BACKGROUND

Whether adverse childhood experiences (ACEs) are associated with accelerated epigenetic aging over time among the Hispanic/Latino population remains unknown. This study examined the longitudinal association between ACEs and epigenetic age acceleration (EAA), as well as potential effect modifiers, among a sample of Hispanic/Latino adults.

METHODS

We analyzed 960 Hispanic/Latino adults with DNA methylation (DNAm) profile data from two visits (approximately six years apart) sampled from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). We used PhenoAge, GrimAge, and DunedinPace, a biomarker for the pace of biological aging, to calculate epigenetic aging deviations. Linear mixed models were fit to estimate the association between ACEs and EAA measured by each epigenetic aging measure, adjusting for sex, age, and parental highest education level. Sex and nativity were also assessed as potential effect modifiers.

RESULTS

A one-unit increase in ACE score was associated with a 0.16-year (95 %CI: 0.06, 0.26, p = 0.002) higher GrimAge acceleration (AgeAccelGrim) at Visit 1. Among US-born individuals, a one-unit increase in ACE score was associated with a 0.35-year (95 %CI: 0.12, 0.58, p = 0.003) higher AgeAccelGrim and 0.01-biological year/calendar year (95 %CI: 0.01, 0.02, p = 0.0003) higher DunedinPACE at Visit 1, but statistically significantly weaker associations were found among foreign/US-territory born individuals (p for interaction=0.039 in AgeAccelGrim and 0.001 in DuendinPACE). No association was found between ACEs and the rate of change in EAA between two visits.

CONCLUSION

ACEs are associated with a higher EAA over time among Hispanic/Latino adults at a constant rate. Hispanic/Latino born in the US are more susceptible to the increased EAA related to ACEs compared with those born in a foreign country or US territory.

Construct validity of probable child maltreatment indicators using prospectively recorded information in a longitudinal cohort of Canadian children

BACKGROUND

Officially reported and self-reported measures of child maltreatment show poor agreement and may differentially predict psychosocial problems in adulthood. However, research remains primarily based on retrospective self-reports, warranting examination of the validity of prospective assessments of maltreatment.

OBJECTIVE

To assess the construct validity of prospective indicators of child maltreatment using a longitudinal cohort of Canadian children.

PARTICIPANTS AND SETTING

The population-based cohort comprises 2120 participants born between 1997 and 1998 in Quebec, Canada.

METHODS

Maternal and familial risk factors (maternal age, depressive symptoms, and antisocial behaviors, socioeconomic status, and single-parent home) and early adulthood functioning difficulties (depression, anxiety, suicidality, alcohol misuse, and unemployment status) were assessed across various time points (0-23 years). Associations between factors and prospective and retrospective maltreatment indicators were appraised.

RESULTS

Most maternal and familial risk factors (80 %) showed associations with indicators of prospective maltreatment (ΔM = +/-0.04 to 0.72; p < 0.05). Several early adulthood functioning difficulties (30 %) showed associations with physical (ΔM = 0.05 to 0.22; p < 0.05) and sexual abuse (ΔM = 0.33 to 0.34; p < 0.05), while emotional, supervisory, and physical neglect were only associated with educational/employment status (ΔM = 0.04 to 0.10; p < 0.05). Cumulatively assessed maltreatment also showed a dose-response relationship with maternal and familial risk factors/functioning difficulties.

CONCLUSIONS

The strong construct validity exhibited by our prospective indicators highlights the need to assess child maltreatment multi-modally. Our findings further contribute to the wider discussion surrounding the measurement of child maltreatment.

Adulthood trajectories of resilience and vulnerability: exploring gender differences in disadvantage after experience of out-of-home care

BACKGROUND

Childhood adversity places individuals in a vulnerable position, resulting in potentially enduring disadvantage across life domains like health and work. Studying the manifestation of this disadvantage is crucial for understanding which resources society can provide to mitigate or prevent it, which makes this subject a fundamental public health concern. This study investigated whether disadvantage patterns after childhood adversity differ by gender and educational level, using out-of-home care as proxy for early adversity.

METHODS

We used register data from a 1953 Swedish birth cohort. Distinct profiles of socioeconomic and health disadvantage in individuals with out-of-home care experience were identified using group-based multi-trajectory modelling. Multinomial logistic regression was then used to determine whether gender and education, individually or in interaction with each other, predict group membership.

RESULTS

In the population without history of out-of-home care, adulthood disadvantage was highly gendered, with women being more likely to experience disadvantage related to unemployment and poor health, while criminality and substance misuse was more common among men. History of out-of-home care was associated with a general increase in adulthood disadvantage, but the gender differences were largely absent. Women in this group were however less likely than men to experience disadvantage across multiple life domains (complex disadvantage OR = 0.56, p = 0.046; unemployment-related disadvantage OR = 0.51, p = 0.005). Higher level of education was associated with reduced likelihood of membership in the group marked by disabling health disadvantage (OR = 0.55, p = 0.002) and complex disadvantage (OR = 0.37, p = 0.001). An interaction term between gender and education was not significant.

CONCLUSIONS

Adulthood disadvantage was more common in the group with history of out-of-home care. The gender differences in disadvantage present in the full cohort were largely attenuated among individuals with out-of-home care history. We showed that using administrative data on outcomes across multiple life domains can provide rich descriptions of adult experiences after childhood adversity. Future research could examine gender differences in mechanisms translating into resilient or vulnerable trajectories, including the protective potential of education in relation to specific disadvantage patterns.

Community Threat, Positive Parenting, and Accelerated Epigenetic Aging: Longitudinal Links from Childhood to Adolescence

Early Life Adversity (ELA) has been linked to accelerated epigenetic aging. While positive parenting is hypothesized to buffer the detrimental effects of ELA on child development, its role in mitigating epigenetic age acceleration remains unclear. Data from 2,039 children (49.7% female) in the Future of Families and Child Wellbeing Study (FFCWS) were included in the current study (46.7% Black, 26.5% Hispanic, 19% White non-Hispanic). Home and community threat and observed parenting were measured from ages 3 to 9. Salivary epigenetic age acceleration was measured at ages 9 and 15. Positive parenting reduces the pace of epigenetic aging in low, but not high, community-threat environments. Interventions across home and community environments may be necessary to prevent ELA's biological embedding.

Childhood violence exposure and anxiety and depression of children and adolescents

BACKGROUND

Mental disorders constitute a global public health problem worldwide and occurs in childhood and lasts to adulthood. The purpose of this study was to explore the association between childhood violence exposure and currently diagnosed depression and anxiety in children and adolescents and investigate whether the association differs by sex and age.

METHODS

This cross-sectional study used data from 2017 to 2021 National Survey of Children's Health (NSCH). Childhood violence exposure and anxiety or depression of children were reported from caregivers. Logistic regression analyses and subgroup analyses were conducted to assess the association between the childhood violence exposure and anxiety and depression.

RESULTS

This study included 113,400 participants aged 6 to 17 years (weighted mean [SD] age, 11.5 [3.4] years; 54,539 females [weighted proportions, 48.9 %]). 9603 of them (weighted proportions, 9.0 %) had childhood violence exposure. Childhood violence exposure was associated with higher risks of anxiety (adjusted risk difference: 7.8 %, 95%CI: 6.3-9.3 %; adjusted OR: 2.11, 95%CI: 1.87-2.39) and depression (adjusted risk difference: 6.2 %, 95%CI: 5.1-7.4 %; adjusted OR: 2.94, 95%CI: 2.54-3.41) after full adjustment. Stratified analyses demonstrated that the association appeared to be stronger in younger children and the association between violence exposure and anxiety was stronger in females than in males.

CONCLUSION

In this cross-sectional study, childhood violence exposure was significantly associated with higher risks of anxiety and depression. The associations appeared to be stronger in younger and female children. Differences in sex and age-specific associations highlight the importance of building age-specific and sex-specific patterns of childhood violence prevention and intervention.

Editorial: The Differential Impact of Early Experiences of Threat and Deprivation on Epigenetic Aging

Far too commonly, children and adolescents are exposed to adversity. These experiences include not only abuse (ie, physical, sexual, or emotional abuse) or neglect within the immediate family, but also exposure to deprivation and violence in the wider community (ie, neighborhood violence, bullying victimization, economic hardship). According to findings from a representative study of more than 45,000 children in the United States, 22.5% were affected by economic hardship, 14.8% lived in a disrupted household (ie, incarcerated parent, drug abuse/mental illness of parent), and 6.5% were exposed to violence in their home or neighborhood.1 These numbers roughly translate to between 1 and 5 children per classroom being affected by different types of adversity.

Prevalence of Adverse Childhood Experience Exposure by Disability Status

This cross-sectional study uses a population-based dataset to examine the prevalence of adverse childhood experiences in people with many different types of disability.

Adverse Childhood Experiences: Increased Likelihood Of Socioeconomic Disadvantages For Young Adults

More than 60 percent of US adults report that they had adverse childhood experiences (ACEs). For this study of 930,000 children born during the period 1999-2003, we used linked administrative, survey, and criminal justice data to measure the association between ACEs (parental death; separation; incarceration; or criminal charge for intimate partner violence, substance use disorder, or child sexual or nonsexual abuse) and socioeconomic disadvantages at ages 18-22 during 2017-21. After childhood socioeconomic status was controlled for, young adults with ACEs were more likely to have been charged with felonies, have become teenage parents, live in a household with poverty or housing assistance, be enrolled in Medicaid, and be employed, and were less likely to be enrolled in an educational institution. These outcomes were most likely among young adults with multiple ACEs or lower childhood socioeconomic status. Using new linked data opportunities, this study provides large-scale, person-level longitudinal evidence of the long-lasting and substantial societal cost of ACEs.

Concordance in Child-Parent Reporting of Social Victimization Experiences in the Adolescent Brain Cognitive Development (ABCD) Study

OBJECTIVE

To investigate child-parent concordance in reporting social victimization experiences and whether parent concordance with child report of victimization was associated with child behavioral symptoms.

METHODS

This was an observational study with data from the Adolescent Brain Cognitive Development Social Development (ABCD-SD) substudy. The analytic sample was 2415 pre-adolescent children from the United States. We assessed parent-child concordance on six domains of child social victimization: conventional crime, peer victimization, witnessing violence, internet victimization, school victimization, and gun violence. Child behavior symptoms were measured using the parent-report Child Behavior Checklist. Interrater agreement and multiple linear and logistic regression analyses were conducted to assess parent concordance with child report of victimization and its relationship to behavioral symptoms.

RESULTS

Interrater agreement in parent-child social victimizations reports was low, with Cohen's Kappa values ranging from 0.10 to 0.23. Compared to parent-child dyads in which neither reported victimization, parent concordance with child report of victimization across multiple domains of social victimization was associated with more internalizing/externalizing behaviors, as was parent discordance with child reports that did not indicate victimization. Among children who reported victimization, parents' perceptions of greater neighborhood safety were associated with lower odds of concordant parent report of conventional crime (OR = 0.94, 95% CI = 0.90-0.98) and witnessing violence (OR = 0.94, 95% CI-0.89-0.98).

CONCLUSIONS

Parents and children do not necessarily agree in reporting social victimization experiences. Parent reports of child social victimization, whether they were concordant with positive child reports or discordant with negative child reports, were associated with parent reports of behavioral symptoms and thus may be an indicator of the severity of experiences, underscoring the need to consider multiple informants when screening for adversity.

Effectiveness, efficacy, acceptability, and feasibility of trauma-informed depression, anxiety, and substance use prevention programs for young people aged 12-25 years: A mixed-methods systematic review

BACKGROUND

Mental ill-health and substance use bear significant public health burden on young people. Prevention is key. Trauma-informed approaches to prevention of mental ill-health and substance use demonstrate significant promise, yet it is unclear how well existing approaches work for young people targeting mental ill-health and substance use. This review aimed to assess the effectiveness, feasibility, and acceptability of trauma-informed mental ill-health and/or substance use prevention programs for young people.

METHODS

We searched the PsycINFO, CINAHL, Embase, MEDLINE, and Cochrane Library reference databases for peer-reviewed studies of trauma-informed mental ill-health and/or substance use prevention programs for young people published between 2013 and 2022. Studies in any language were included and reference lists of included articles were scanned for additional studies of relevance.

RESULTS

In total, 30 studies were included in this review, comprising five randomized controlled trials (RCTs), seven non-RCTs, 10 quasi-experimental designs, and eight qualitative studies. Among the 30 studies, 27 unique trauma-informed prevention interventions were detailed. Eighteen studies reported statistically significant decreases in mental ill-health, and two studies reported significant decreases in substance use outcomes among participants, up to 6 months following the interventions. Most preventative interventions with statistically significant effects were selective (rather than universal or indicated) in their approach (n = 10, 55%). Broad acceptability and feasibility of trauma-informed prevention programs was observed among studies reporting this information though most quantitative studies were at high risk of bias and/or did not include a control group, whilst qualitative studies tended to report research conducted without a priori research aims.

DISCUSSION

This review synthesizes for the first-time evidence on the effectiveness (or efficacy), feasibility, and acceptability of trauma-informed mental ill-health and/or substance use programs for young people, especially for those exposed to traumatic or adverse experiences. While there are promising efficacy outcomes, further research conducting rigorous, well-powered RCTs is required for large-scale evaluation and scaling of the potential preventative benefits of such programs.

Validation of the Turkish version of the Chronic Stress Scale: assessing social role-related stressors and their impact on psychopathology

Introduction

Chronic social-role-related stress plays a crucial role in the development and progression of mental and medical disorders, making it an important factor to consider. This study aimed to translate and validate The Chronic Stress Scale (CSS) adapted by Turner for a Turkish population and explore its role in depression, anxiety, and perceived stress.

Methods

A total of 524 participants (mean age 31.59 years, 68% women) were recruited from Koç University and Basaksehir Cam Sakura City Hospitals, including 260 from the general population and 264 with depressive or anxiety disorders. The 51-item CSS was translated into Turkish and validated through reliability and validity analyses, including Cronbach's alpha, exploratory factor analysis, and correlations with the Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), and Perceived Stress Scale (PSS-14).

Results

The Turkish CSS showed good internal consistency (Cronbach's alpha = 0.90) and identified 13 dimensions of chronic stress (partner, children, work, loneliness, finances, workload, debt, relationship inoccupancy, family health, residence, family, ex-partner, and others). Dimensions were named based on the content of the items included. Significant correlations were found between CSS and BDI (r = 0.611, p < 0.001), BAI (r = 0.558, p < 0.001), and PSS-14 (r = 0.222, p < 0.001). Discriminant validity revealed significant score differences between clinical and general populations.

Conclusion

The Turkish CSS is a reliable and valid tool for assessing chronic social role-related stressors, supporting its use for both research and practice.

Developmental Timing of Associations Among Parenting, Brain Architecture, and Mental Health

Importance

Parenting is associated with brain development and long-term health outcomes, although whether these associations depend on the developmental timing of exposure remains understudied. Identifying these sensitive periods can inform when and how parenting is associated with neurodevelopment and risk for mental illness.

Objective

To characterize how harsh and warm parenting during early, middle, and late childhood are associated with brain architecture during adolescence and, in turn, psychiatric symptoms in early adulthood during the COVID-19 pandemic.

Design, Setting, and Participants

This population-based, 21-year observational, longitudinal birth cohort study of low-income youths and families from Detroit, Michigan; Toledo, Ohio; and Chicago, Illinois, used data from the Future of Families and Child Well-being Study. Data were collected from February 1998 to June 2021. Analyses were conducted from May to October 2023.

Exposures

Parent-reported harsh parenting (psychological aggression or physical aggression) and observer-rated warm parenting (responsiveness) at ages 3, 5, and 9 years.

Main Outcomes and Measures

The primary outcomes were brainwide (segregation, integration, and small-worldness), circuit (prefrontal cortex [PFC]-amygdala connectivity), and regional (betweenness centrality of amygdala and PFC) architecture at age 15 years, determined using functional magnetic resonance imaging, and youth-reported anxiety and depression symptoms at age 21 years. The structured life-course modeling approach was used to disentangle timing-dependent from cumulative associations between parenting and brain architecture.

Results

A total of 173 youths (mean [SD] age, 15.88 [0.53] years; 95 female [55%]) were included. Parental psychological aggression during early childhood was positively associated with brainwide segregation (β = 0.30; 95% CI, 0.14 to 0.45) and small-worldness (β = 0.17; 95% CI, 0.03 to 0.28), whereas parental psychological aggression during late childhood was negatively associated with PFC-amygdala connectivity (β = -0.37; 95% CI, -0.55 to -0.12). Warm parenting during middle childhood was positively associated with amygdala centrality (β = 0.23; 95% CI, 0.06 to 0.38) and negatively associated with PFC centrality (β = -0.18; 95% CI, -0.31 to -0.03). Warmer parenting during middle childhood was associated with reduced anxiety (β = -0.05; 95% CI -0.10 to -0.01) and depression (β = -0.05; 95% CI -0.10 to -0.003) during early adulthood via greater adolescent amygdala centrality.

Conclusions and Relevance

Neural associations with harsh parenting were widespread across the brain in early childhood but localized in late childhood. Neural associations with warm parenting were localized in middle childhood and, in turn, were associated with mental health during future stress. These developmentally contingent associations can inform the type and timing of interventions.

Resilience, Mental Health, Sleep, and Smoking Mediate Pathways Between Lifetime Stressors and Multiple Sclerosis Severity

Introduction

Lifetime stressors (e.g., poverty, violence, discrimination) have been linked to features of multiple sclerosis (MS); yet mechanistic pathways and relationships with cumulative disease severity remain nebulous. Further, protective factors like resilience, that may attenuate the effects of stressors on outcomes, are seldom evaluated.

Aim

To deconstruct pathways between lifetime stressors and cumulative severity on MS outcomes, accounting for resilience.

Methods

Adults with MS (N = 924) participated in an online survey through the National MS Society listserv. Structural equation modeling was used to examine the direct and indirect effects of lifetime stressors (count/severity) on MS severity (self-reported disability, relapse burden, fatigue, pain intensity, and interference) via resilience, mental health (anxiety and depression), sleep disturbance, and smoking.

Results

The final analytic model had an excellent fit (GFI = 0.998). Lifetime stressors had a direct relationship with MS severity (β = 0.27, p < 0.001). Resilience, mental health, sleep disturbance, and smoking significantly mediated the relationship between lifetime stressors and MS severity. The total effect of the mediation was significant (β = 0.45).

Conclusions

This work provides foundational evidence to inform the conceptualization of pathways by which stress could influence MS disease burden. Resilience may attenuate the effects of stressors, while poor mental health, smoking, and sleep disturbances may exacerbate their impact. Parallel with usual care, these mediators could be targets for early multimodal therapies to improve the disease course.

Examining the relative impact of adverse and positive childhood experiences on adolescent mental health: A strengths-based perspective

BACKGROUND

It is well-documented that Adverse Childhood Experiences (ACEs) have a negative impact on mental health outcomes across the lifespan, while Positive Childhood Experiences (PCEs) act as a protective factor. Less is known about the relative impact of ACEs and PCEs on mental health outcome for adolescents.

OBJECTIVE

The present study sought to identify the relative impact of ACEs and PCEs on mental health outcomes for youth.

PARTICIPANTS AND SETTING

Data were drawn from a state-wide, cross-sectional health survey of 12-17 year-olds (n = 1169) conducted on a continuous basis throughout 2021, following the height of the COVID-19 pandemic.

METHODS

Adolescents completed ACEs and PCEs screeners and the Kessler 6-item Psychological Distress Scale to assess current mental health symptoms. A multiple regression analysis controlling for age, gender, and poverty level, was conducted to examine the relative impacts of ACEs and PCEs on mental health outcomes.

RESULTS

Male gender, younger age, lower family poverty level (e.g., more financial hardship), absence of ACEs, and experiencing more PCEs were significantly associated with better mental health outcomes for adolescents [F(5, 1163) = 104.48, p < .001]. Notably, ACEs were found to account for only 9 % of variance in mental health outcomes (ΔR2 = 0.09), while PCEs accounted for 18 % of variance (ΔR2 = 0.18).

CONCLUSIONS

PCEs explained approximately double the variance in mental health outcomes for adolescents compared to ACEs. Results indicate promoting youths' exposure to PCEs in childhood and adolescence may offer a meaningful pathway for supporting adaptive mental health outcomes.

Intersection of adverse childhood experiences, suicide and overdose prevention

Adverse childhood experiences (ACEs), suicide and overdose are linked across the life course and across generations and share common individual-, interpersonal-, community- and societal-level risk factors. The purpose of this review is to summarise the shared aetiology of these public health issues, synthesise evidence regarding potential community- and societal-level prevention strategies and discuss future research and practice directions.Growing evidence shows the potential for community- and societal-level programmes and policies, including higher minimum wage; expanded Medicaid eligibility; increased earned income tax credits, child tax credits and temporary assistance for needy families benefits; Paid Family Leave; greater availability of affordable housing and rental assistance; and increased participation in the Supplemental Nutrition Assistance Program (SNAP), to contribute to ACEs, suicide and overdose prevention. Considerations for future prevention efforts include (1) expanding the evidence base through rigorous research and evaluation; (2) assessing the implications of prevention strategies for equity; (3) incorporating a relational health perspective; (4) enhancing community capacity to implement, scale and sustain evidenced-informed prevention strategies; and (5) acknowledging that community- and societal-level prevention strategies are longer-term strategies.

Suicide Attempts during Pregnancy and Postpartum: A Systematic Review and Meta-Analysis

PURPOSE

Suicide attempts (SA) during perinatal period have the potential to adversely affect a woman's health and her developing infant. To date, little is known about perinatal SA and their risk factors. This study aimed to synthetize the evidence on risk factors of SA in pregnant and postpartum women.

METHODS

We systematically reviewed studies retrieved from PubMed/Medline, PsycINFO, and CINAHL, following the PRISMA guidelines for reporting. A meta-analysis was conducted only for risk factors examined in at least three distinct samples.

RESULTS

A total of ten studies were eligible for inclusion. All the studies found significant associations in regression models between perinatal SA and other variables (sociodemographic, clinical factors obstetric, neonatal, and psychosocial). The meta-analysis showed that unmarried women (pooled OR = 1.87, 95% CI = 1.26-2.78), with no higher education (pooled OR = 1.89, 95% CI = 1.31-2.74) and affected by a mood disorder (pooled OR = 11.43, 95% CI = 1.56-83.87) have a higher risk of postpartum SA; women who smoke during pregnancy (pooled OR = 3.87, 95% CI = 1.35-11.11) have a higher risk of SA in pregnancy; and women with previous suicidal behavior(pooled OR = 38.04, 95% CI = 3.36-431.17) have a higher risk of perinatal SA, whether during pregnancy or in the postpartum period. The type of sample, whether community or clinical, is a relevant moderating factor.

CONCLUSION

Our study extends prior reviews about suicidal behaviors in women by studying perinatal suicide attempts independently, as well as it synthesized data on some sociodemographic, clinical, and obstetric/neonatal risk factors. Further studies about specific risk factors for perinatal SA are needed in order to improve early detection and intervention of women at risk.

Intervening After Trauma: Child-Parent Psychotherapy Treatment Is Associated With Lower Pediatric Epigenetic Age Acceleration

Early-life adversity increases the risk of health problems. Interventions supporting protective and responsive caregiving offer a promising approach to attenuating adversity-induced changes in stress-sensitive biomarkers. This study tested whether participation in an evidence-based dyadic psychosocial intervention, child-parent psychotherapy (CPP), was related to lower epigenetic age acceleration, a trauma-sensitive biomarker of accelerated biological aging that is associated with later health impairment, in a sample of children with trauma histories. Within this quasi-experimental, repeated-measures study, we examined epigenetic age acceleration at baseline and postintervention in a low-income sample of children receiving CPP treatment (n = 45; age range = 2-6 years; 76% Latino) compared with a weighted, propensity-matched community-comparison sample (n = 110; age range = 3-6 years; 40% Latino). Baseline epigenetic age acceleration was equivalent across groups. However, posttreatment, epigenetic age acceleration in the treatment group was lower than in the matched community sample. Findings highlight the potential for a dyadic psychosocial intervention to ameliorate accelerated biological aging in trauma-exposed children.

Allostatic Load, Morbidity, and Mortality Among Older Adults: A Multi-Wave Analysis From the National Health and Aging Trends Study

Although allostatic load (AL) is a key concept to reflect physiologic wear and tear from stress, older adults are underrepresented in AL-related research, especially the oldest old (≥80). Further, attenuative factors are often unaccounted for. This longitudinal analysis using data from National Health and Aging Trends Study investigated relationships of AL in 2017 and multi-wave (1) comorbidity accumulation using multilevel Poisson modeling and (2) mortality risk using survival analysis. By year five (2022), each incremental AL increase that older adults (n = 3614) experienced was associated with a 47% increase in comorbidity (p < .001), and a 33% increased mortality risk (p < .001). This research supports a shift to a more proactive, health promotion/risk mitigation paradigm through informing intervention research targeting AL, which is currently scarce. Identifying potentially modifiable and key driving factors influencing the relationship between AL and health among older adults is an important next step to inform intervention design.

Childhood sexual abuse and IL6 mediated by change in BMI over an 18-year period: A growth curve model

BACKGROUND

Childhood sexual abuse can increase both body weight and inflammation later in life. Higher weight or faster changes in weight, as measured by changes in body mass index (BMI), may mediate the relationship between childhood sexual abuse and inflammation, however, most studies to date have used a cross-sectional design limiting causal inferences.

OBJECTIVE

The current study aimed to investigate the interrelationships between childhood sexual abuse, BMI, and C-reactive protein (CRP) and interleukin-6 (IL6).

PARTICIPANTS AND SETTING

Data from 461 adults who participated in the Midlife in the United States (MIDUS) study were utilized.

METHODS

Growth curve modeling was used to test initial levels of BMI and changes of BMI over an 18-year period as mediators linking childhood sexual abuse to CRP and IL6.

RESULTS

Sexual abuse was not significantly associated with the initial level of BMI; however, sexual abuse was associated with the slope of BMI (b = 0.072, p = .006). BMI intercept (b = 0.080, p = .001) and slope (b = 0.240, p = .002) predicted IL6 values whereas the slope of BMI (b = 0.398, p = .033) but not intercept predicted CRP values. The indirect effect from sexual abuse to IL6 through BMI slope was significant (b = 0.017, 95 % [CI.001, 0.033]) while the indirect effect from sexual abuse to CRP through BMI slope was not significant (b = 0.028, 95 % [CI -0.004, 0.061]).

CONCLUSION

Childhood sexual abuse was indirectly associated with IL6 through rates of change in BMI over time.

Childhood adversity and depression of older adults: the moderating effect of social participation

Objective

Examine the effect of childhood adversity on depression in older adults and the regulatory impact that social participation has on depression.

Methods

Based on 6,704 standard-compliant research subjects, single factor analysis, multiple linear regression model, and tendency score matching were used to analyze the impact of childhood adversity on depression in older adults and the regulatory effect of social participation.

Results

The depression rate is higher among women, young age, low education, unmarried, in agricultural households, older adults with low annual income, pre-retirement work type in agriculture, non-drinking, and those with two or more chronic diseases (p < 0.05). Children who experienced adversity as children are more likely to suffer from depression as adults (β = 0.513, 0.590, 0.954, 0.983, 1.221, 0.953, 0.718; p < 0.05). Through the tendency score, the result is matched with the endogenous test. As well, older adults are more likely to suffer psychological damage from a greater number of childhood adversities in their early years (β = 1.440, 2.646, 4.122; p < 0.001). It has been shown that social participation will reduce the negative impact of low-income family economic circumstances on depression among older adults of all ages (β = -0.459,-0.567; p < 0.01), aggravate depression resulting from "neighborhood void of mutual assistance" and "no more fun to play" for older adults of all ages (β = 1.024, 0.894; p < 0.01), and exacerbate depression resulting from "loneliness because there are no friends" for the oldest old (β = 0.476, 0.779; p < 0.05).

Conclusion

Older adults who experience childhood adversity are more likely to suffer from depression. Social participation plays a regulatory role in the relationship between childhood adversity and depression in older adults. For older adults' mental health to improve, family and social adversity should be prevented, and moderate participation in society should be encouraged.

Childhood adversity and suicidal ideation in older Korean adults: unraveling the mediating mechanisms of mental health, physical health, and social relationships

BACKGROUND

Suicide rates in older adults are much higher than those in younger age groups. Given the rapid increase in the proportion of older adults in Korea and the high suicide rate of this age group, it is worth investigating the mechanism of suicidal ideation for older adults. Generally, adverse childhood experiences are positively associated with suicidal ideation; however, it is not fully understood what mediating relationships are linked to the association between these experiences and current suicidal ideation.

METHODS

The data from 685 older Korean adults were analyzed utilizing logistic regression, path analyses, and structural equation modeling. Based on our theoretical background and the empirical findings of previous research, we examined three separate models with mental health, physical health, and social relationship mediators. After that, we tested a combined model including all mediators. We also tested another combined model with mediation via mental health moderated by physical health and social relationships.

RESULTS

The univariate logistic regression results indicated that childhood adversity was positively associated with suicidal ideation in older adults. However, multivariate logistic regression results demonstrated that the direct effect of childhood adversity became nonsignificant after accounting all variables. Three path models presented significant mediation by depression and social support in the association between childhood adversity and suicidal ideation. However, combined structural equation models demonstrated that only mediation by a latent variable of mental health problems was statistically significant. Social relationships moderated the path from mental health problems to suicidal ideation.

CONCLUSIONS

Despite several limitations, this study has clinical implications for the development of effective strategies to mitigate suicidal ideation. In particular, effectively screening the exposure to adverse childhood experiences, early identification and treatment of depressive symptoms can play a crucial role in weakening the association between childhood adversity and suicidal ideation in older adults.

Telehealth Parenting Program and Salivary Epigenetic Biomarkers in Preschool Children With Developmental Delay: NIMHD Social Epigenomics Program

Importance

Children with developmental delays are at a heightened risk of experiencing mental health challenges, and this risk is exacerbated among racially minoritized children who face disproportionate adversity. Understanding the impact of parenting interventions on biological markers associated with these risks is crucial for mitigating long-term health disparities.

Objective

To examine the effect of 20 weeks of an internet-based parent-child interaction training (iPCIT) program on biomarkers associated with aging and chronic inflammation among preschoolers with developmental delay at 12-month follow-up.

Design, Setting, and Participants

An observational secondary analysis of data from a randomized clinical trial conducted from March 17, 2016, to December 15, 2020, to assess changes in salivary DNA methylation (DNAm)-derived biomarkers following iPCIT intervention. Participants were recruited from 3 Part C early intervention sites in a large southeastern US city. Eligible participants included children recruited within 3 months of their third birthday who had a Child Behavior Checklist Externalizing Problems T score greater than 60 and provided saliva in at least 1 study wave. Data analysis was conducted May 2023 to April 2024.

Intervention

Participants received either iPCIT (a telehealth therapeutic intervention focused on enhancing the parent-child relationship and addressing behavioral challenges in young children) or referrals as usual.

Main Outcomes and Measures

DNAm at the 12-month follow-up was assessed using the Infinium HumanMethylationEPIC Bead Chip Assay to derive biomarkers DunedinPACE, C-reactive protein (CRP), and interleukin-6 (IL-6). Analyses were intent-to-treat and used path analysis.

Results

A total of 71 children (mean [SD] age, 36.27 [0.61] months 51 male [71.8%] and 20 female [28.2%]) were analyzed, of whom 34 received iPCIT and 37 received referrals as usual. The iPCIT group had a slower pace of aging (β = 0.26; 95% CI, 0.06 to 0.50; P = .03) and less DNAm-derived CRP (β = 0.27; 95% CI, 0.05 to 0.49; P = .01) relative to the control condition at the 12-month follow-up. These associations remained significant after accounting for baseline DNAm score, child demographics, and symptom severity, and were independent of predicted buccal epithelial cell proportion for both DunedinPACE and CRP. There was no association with DNAm-derived IL-6 (β = 0.14; 95% CI, -0.08 to 0.36; P = .21).

Conclusions and Relevance

In this study of a parenting intervention, iPCIT, the association of intervention with decreased molecular markers of inflammation and biological aging suggests their potential to modify aspects of the biological embedding of stress. Understanding the systemic biological impact of such interventions offers insights into addressing health disparities and promoting resilience among vulnerable populations.

Trial Registration

ClinicalTrials.gov Identifier: NCT03260816.

Allostasis, health, and development in Latin America

The lifespan is influenced by adverse childhood experiences that create predispositions to poor health outcomes. Here we propose an allostatic framework of childhood experiences and their impact on health across the lifespan, focusing on Latin American and Caribbean countries. This region is marked by significant social and health inequalities nested in environmental and social stressors, such as exposure to pollution, violence, and nutritional deficiencies, which critically influence current and later-life health outcomes. We review several manifestations across cognition, behavior, and the body, observed at the psychological (e.g., cognitive, socioemotional, and behavioral dysfunctions), brain (e.g., alteration of the development, structure, and function of the brain), and physiological levels (e.g., dysregulation of the body systems and damage to organs). To address the complexity of the interactions between environmental and health-related factors, we present an allostatic framework regarding the cumulative burden of environmental stressors on physiological systems (e.g., cardiovascular, metabolic, immune, and neuroendocrine) related to health across the life course. Lastly, we explore the relevance of this allostatic integrative approach in informing regional interventions and public policy recommendations. We also propose a research agenda, potentially providing detailed profiling and personalized care by assessing the social and environmental conditions. This framework could facilitate the delivery of evidence-based interventions and informed childhood-centered policy-making.

Childhood trauma and hair cortisol response over the year following onset of a chronic life event stressor

OBJECTIVE

Childhood trauma may contribute to poor lifelong health in part through programming of the HPA-axis response to future life stressors. To date, empirical evidence shows an association of childhood trauma with dysregulation of the HPA-axis and blunted cortisol reactivity to acute stressors. Here, we conduct an initial examination of childhood trauma as a moderator of changes over time in perceived stress levels and HPA-axis response to a major chronic stressor in adulthood.

METHODS

Participants were 83 maternal caregivers of children newly diagnosed with cancer who completed the Childhood Trauma Questionnaire (CTQ), and who, over the year following their child's cancer diagnosis, had hair samples collected up to 7 times for the assessment of cortisol and completed monthly measures of perceived stress.

RESULTS

CTQ scores were in the expected range for a community sample and associated with changes in perceived stress and cortisol concentration over time (γ =.003, p =.002; γ = -.0004, p =.008, respectively) independently of age, education, treatment intensity and randomization to stress management intervention. Maternal caregivers who endorsed lower childhood trauma showed a steeper decline in perceived stress and a larger increase in cortisol levels across the year than caregivers who recalled more childhood trauma.

CONCLUSIONS

Findings extend animal models and studies that examine cortisol reactivity to acute stressors and suggest that childhood trauma may program a phenotype that is more psychologically reactive but shows a blunted HPA-axis response to chronic stress. While adaptive in the short-term, this early life programming may incur long-term costs for health. Further work is warranted to examine this possibility.

Patterns of Adverse Childhood Experiences and Neurocognitive Development

Importance

Early life adversity is associated with higher risk of many adult health problems, including mental illness, substance abuse, suicide attempt, and chronic diseases. Many previous studies investigated adversities one at a time or investigated the health toll associated with the cumulative number of adversities.

Objective

To examine the co-occurrence of adversities among children and how specific patterns of adversities are associated with neurocognitive development.

Design, Setting, and Participants

This cohort study used data from the Collaborative Perinatal Project (CPP), which enrolled a national sample of women during pregnancy and followed their offspring to ages 7 to 8 years, between 1959 and 1974. The CPP was a community-based study conducted in 12 US medical centers. The CPP sample was ascertained through prenatal clinics and is diverse with respect to race and socioeconomic status. Data analysis was performed from August 2023 to March 2024.

Exposures

A latent class analysis was conducted of 12 adverse childhood experiences that occurred between birth and 7 years to identify common patterns of childhood adversities.

Main Outcomes and Measures

Five neurocognitive tests were used to measure children's visual-motor, sensory-motor, auditory-vocal, intelligence quotient, and academic skills.

Results

The analysis sample included 49 853 offspring (25 226 boys [50.6%]); 24 436 children (49.0%) had low probability of experiencing any adversity, whereas the remaining half were classified into 5 groups reflecting distinct patterns of childhood adversities: parental harshness and neglect, 1625 children (3.3%); parental separation and poverty, 8731 children (17.5%); family instability, 3655 children (7.3%); family loss, instability, and poverty, 1505 children (3.0%); and crowded housing and poverty, 9901 children (19.9%). Children in 4 of these groups had lower neurocognitive scores than children with a low probability of experiencing adversity, with standardized mean differences ranging from -0.07 (95% CI, -0.11 to -0.03) to -0.86 (95% CI, -1.06 to -0.65).

Conclusions and Relevance

These findings suggest that adverse childhood experiences are associated with deficits in children's neurocognitive functions. It is important to understand the complexity in children's exposure to adversity and the resulting developmental consequences, as well as the underlying mechanisms, to help support children exposed to adversity and foster healthier and resilient trajectories of development.

Gender differences in the association between adverse childhood experiences and premature mortality: A prospective population study

BACKGROUND

Birth cohort studies have shown that adverse childhood experiences (ACEs) are associated with all-cause mortality. The effect of ACEs on premature mortality among working-age people is less clear and may differ between the genders.

OBJECTIVE

In this prospective population study, we investigated the association of ACEs with all-cause mortality in a working-age population.

PARTICIPANTS AND METHODS

In a representative Finnish population study, Health 2000, individuals aged 30 to 64 years were interviewed in 2000, and their deaths were registered until 2020. At baseline, the participants (n = 4981, 2624 females) completed a questionnaire that included 11 questions on ACEs and questions on tobacco smoking, alcohol abuse, self-reported health and sufficiency of income. All-cause mortality was analysed by Cox regression analysis.

RESULTS

Of the ACEs, financial difficulties, parental unemployment and individual's own chronic illness were associated with mortality. High number (4+) of ACEs was significantly associated with all-cause mortality in females (HR 2.11, p < 0.001), not in males. Poor health behaviour, self-reported health and low income were the major predictors of mortality in both genders. When the effects of these factors were controlled, childhood family conflicts associated with mortality in both genders.

CONCLUSIONS

Among working-age people, females seem to be sensitive to the effects of numerous adverse childhood experiences, exhibiting higher premature all-cause mortality. Of the individual ACEs, family conflicts may increase risk of premature mortality in both genders. The effect of ACEs on premature mortality may partly be mediated via poor adult health behaviour and low socioeconomic status.

WHAT IS ALREADY KNOWN

In birth cohort studies, adverse childhood experiences (ACEs) have been associated with all-cause mortality. In working-age people, the association of ACEs with premature mortality is less clear and may differ between the genders.

WHAT THIS STUDY ADDS

In working-age people, high number of ACEs associate with all-cause premature mortality in females, not in males. The effect of ACEs on premature mortality may partly be mediated via poor adult health behaviour, self-reported health and low socioeconomic status.

Adverse childhood experiences among doctor of pharmacy students

OBJECTIVE

Adverse Childhood Experiences (ACEs) have demonstrated negative impact on physical, emotional, and cognitive health outcomes. This study aimed to assess prevalence of ACEs among Doctor of Pharmacy (PharmD) students, and their associations with mental health, substance use, academic performance, and sleep patterns.

METHODS

A cross-sectional survey was conducted on PharmD students at a private University. ACE scores, mental health history, substance use, academic performance, and sleep habits were self-reported. Descriptive statistics and chi-square tests were used for analysis.

RESULTS

From 54 participants across all cohorts of students in the curriculum (response rate: 19%), 48% reported ≥4 ACEs. A majority of students reported having been diagnosed with or sought treatment for depression (56%) or anxiety (67%), while 42.9% reported a history of contemplating suicide. Participants with ACE scores of ≥4 were more likely to have sought treatment for depression, any mental health condition, contemplated suicide, or used alcohol for mental health purposes. No differences in academic performance based on ACE scores were found.

CONCLUSION

High numbers of ACEs were common and linked to mental illness, suicidality, and use of alcohol for mental health purposes. While no direct academic impact was found in this small sample size, adopting a trauma-informed approach is crucial to supporting student well-being. Further research in this area is needed to optimize interventions to support academic and professional success among students with ≥4 ACEs.

A future food boom rescues the negative effects of early-life adversity on adult lifespan in a small mammal

Early-life adversity, even when transient, can have lasting effects on individual phenotypes and reduce lifespan across species. If these effects can be mitigated by a high-quality later-life environment, then differences in future resources may explain variable resilience to early-life adversity. Using data from over 1000 wild North American red squirrels, we tested the hypothesis that the costs of early-life adversity for adult lifespan could be offset by later-life food abundance. We identified six adversities that reduced juvenile survival in the first year of life, though only one-birth date-had continued independent effects on adult lifespan. We then built a weighted early-life adversity (wELA) index integrating the sum of adversities and their effect sizes. Greater weighted early-life adversity predicted shorter adult lifespans in males and females, but a naturally occurring food boom in the second year of life ameliorated this effect. Experimental food supplementation did not replicate this pattern, despite increasing lifespan, indicating that the buffering effect of a future food boom may hinge on more than an increase in available calories. Our results suggest a non-deterministic role of early-life conditions for later-life phenotype, highlighting the importance of evaluating the consequences of early-life adversity in the context of an animal's entire life course.

Lifetime stressors relate to invisible symptoms of multiple sclerosis

Aim

Childhood stressors can increase adult stress perception and may accumulate over the lifespan to impact symptoms of multiple sclerosis (MS). Growing evidence links childhood stressors (e.g., abuse, neglect) to fatigue, pain, and psychiatric morbidity in adults with MS; yet literature in this area is lacking a comprehensive lifespan approach. The aim of this cross-sectional study was to examine contributions of childhood and adulthood stressor characteristics (i.e., count, severity), on three individual outcomes: fatigue, pain interference, and psychiatric morbidity in People with MS (PwMS).

Methods

An online survey was distributed through the National MS Society. Hierarchical block regression modeling was used to sequentially assess baseline demographics, childhood stressors, and adult stressors per outcome. We hypothesized that child and adult stressors would significantly contribute to fatigue, pain interference, and psychiatric morbidity.

Results

Overall, 713 PwMS informed at least one final analytic model. Both childhood and adult stressors significantly contributed to pain interference and psychiatric morbidity. Adult stressor severity independently correlated with psychiatric morbidity (P < 0.0001). Childhood stressors significantly contributed to fatigue (LR test P < 0.0001). Childhood stressor severity independently significantly correlated with both fatigue likelihood (P = 0.03) and magnitude (P < 0.001).

Conclusions

This work supports a relationship between stressors across the lifespan and fatigue, pain, and psychiatric morbidity in PwMS. Stressor severity may have an important role which may not be captured in count-based trauma measurement tools. Clinicians and researchers should consider lifetime stress when addressing fatigue, pain, and psychiatric morbidity among PwMS.

Association of adversities and mental health among first- and second-generation Arab American young adults

The prevalence of mental health problems among young adults is widely recognized. However, limited research has examined the mental health of Arab American young adults specifically. To address this gap in the literature, this study aimed to investigate the effects of multiple stressors including adverse childhood experiences (ACEs), discrimination, and bullying victimization on the mental health of first- and second-generation Arab American young adults. The participants (N = 162) were recruited from a Midwest university using online and in-person methods. They were screened and completed a demographic questionnaire and self-report measures of ACEs, discrimination, bullying victimization, and mental health. Hierarchical multiple regression analysis was conducted to examine the effect of psychosocial stressors on mental health and the moderating effect of generation (first vs. second) on that relationship. Female gender, increased perceived discrimination, and more ACEs were associated with lower mental health scores (β = -0.316, p < 0.001, β = -0.308, p < 0.001, and β = -0.230, p = 0.002, respectively). There was a significant negative relationship between victimization and mental health for first-generation Arab Americans (β = -0.356, p = 0.010). However, that association all but disappeared for second-generation participants (β = 0.006, p = 0.953). The results highlight the impact of multiple adversities on Arab American young adults' mental health and indicate important nuances related to their generation in the association between bullying victimization and mental health. Implications for practice and future research are discussed.

Do dyadic interventions impact biomarkers of child health? A state-of-the-science narrative review

BACKGROUND

Early life adversity is related to numerous poor health outcomes in childhood; however, dyadic interventions that promote sensitive and responsive caregiving may protect children from the negative consequences of such exposures. To date, quasi-experimental and randomized controlled trials (RCTs) have examined the impact of dyadic interventions on a range of individual biomarkers in children, which may elucidate the relation between early stress exposure and transdiagnostic risk factors for prospective poor health. However, the content of interventions, analytic strategies, and findings vary widely across studies, obscuring key themes in the science and hindering policy and research efforts.

METHODS

We use a narrative approach to review findings from methodologically rigorous (predominantly RCT) studies of dyadic interventions' impacts on different biomarkers in children, including indicators of the hypothalamic-pituitary-adrenal (HPA) axis, parasympathetic (PNS) and sympathetic nervous systems (SNS), brain development, inflammation, and intracellular DNA processes. We contribute to this important area of inquiry through integrating findings across biological systems and identifying contextual and mechanistic factors to depict the current state of the field.

RESULTS

Evidence suggests dyadic interventions improved PNS functioning and advanced brain maturation. Some studies indicated interventions reduced hair cortisol concentrations, systemic inflammation, and resulted in differences in DNA methylation patterns. Findings did not support main effect-level change in salivary measures of HPA axis activity, SNS activity, or telomere length. Importantly, reviewed studies indicated significant heterogeneity in effects across biological systems, underscoring the importance of contextual factors (e.g., adversity subtype and severity) as potential moderators of effects. Further, findings suggested enhanced parenting behaviors may be a mechanism through which dyadic interventions operate on biomarkers.

CONCLUSIONS

We close with future policy and research directions, emphasizing the promise of biologically-informed dyadic interventions for understanding and ameliorating the effects of early adversity on transdiagnostic biomarkers of health.

Partitioning the Composition of Adverse Childhood Experiences From Accumulated Adversity: Cross-Sectional Evidence From 2 U.S. Samples

Introduction

Adverse childhood experiences are linked to adult morbidity and mortality. However, it is unknown whether the patterning of adverse childhood experiences, individually and in combination, confer health risk distinct from that of a cumulative adversity score. This study evaluates whether individual and comorbid adverse childhood experience exposures within a cumulative risk score are equally associated with current smoking and lifetime history of depression.

Methods

Cross-sectional analysis of adverse childhood experience assessments in the Behavioral Risk Factor Surveillance System from 21 states in 2019 (n=115,183) and 23 states in 2020 (n=120,416) was performed. We modeled cumulative adverse childhood experience scores and the 5 most common distinct adverse childhood experience components that compose a given adverse childhood experience score, up to a cumulative score of 4. We compared adverse childhood experience components, adjusting for covariates.

Results

Across both samples, 23% and 57%-58% of persons reported 1 adverse childhood experience and 2 or more adverse childhood experiences, respectively. In 2019 smoking prevalence was 10.4% for persons reporting zero adverse childhood experiences and 14.2% for persons reporting 1 adverse childhood experience. When the single adverse childhood experience was experiencing parental divorce, smoking was higher (16.6%) than when the single adverse childhood experience was verbal abuse (11.8%) or living with a mentally ill household member (9.5%). Lifetime depression prevalence was 9.6% and 14.1% across zero and 1 adverse childhood experience, respectively, whereas it was 26.6% if the single adverse childhood experience was living with a mentally ill household member and 11.0% when the adverse childhood experience was experiencing parental divorce. This heterogeneity was replicated in 2020 data. Additional heterogeneity was observed for higher cumulative adverse childhood experience scores.

Conclusions

Cumulative adverse childhood experience scores mask substantial health risk heterogeneity, which can be delineated by examining distinct components of cumulative adverse childhood experience scores.

Childhood maltreatment and health in the UK Biobank: triangulation of outcome-wide and polygenic risk score analyses

BACKGROUND

Childhood maltreatment is common globally and impacts morbidity, mortality, and well-being. Our understanding of its impact is constrained by key substantive and methodological limitations of extant research, including understudied physical health outcomes and bias due to unmeasured confounding. We address these limitations through a large-scale outcome-wide triangulation study.

METHODS

We performed two outcome-wide analyses (OWAs) in the UK Biobank. First, we examined the relationship between self-reported maltreatment exposure (number of maltreatment types, via Childhood Trauma Screener) and 414 outcomes in a sub-sample of 157,316 individuals using generalized linear models ("observational OWA"). Outcomes covered a broad range of health themes including health behaviors, cardiovascular disease, digestive health, socioeconomic status, and pain. Second, we examined the relationship between a polygenic risk score for maltreatment and 298 outcomes in a non-overlapping sample of 243,006 individuals ("genetic OWA"). We triangulated results across OWAs based on differing sources of bias.

RESULTS

Overall, 23.8% of the analytic sample for the observational OWA reported at least one maltreatment type. Of 298 outcomes examined in both OWAs, 25% were significant in both OWAs and concordant in the direction of association. Most of these were considered robust in the observational OWA according to sensitivity analyses and included outcomes such as marital separation (OR from observational OWA, ORo = 1.25 (95% CI: 1.21, 1.29); OR from genetic OWA, ORg = 1.06 (1.03, 1.08)), major diet changes due to illness (ORo = 1.27 (1.24, 1.29); ORg = 1.01 (1.00, 1.03)), certain intestinal diseases (ORo = 1.14 (1.10, 1.18); ORg = 1.03 (1.01, 1.06)), hearing difficulty with background noise (ORo = 1.11 (1.11, 1.12); ORg = 1.01 (1.00, 1.01)), knee arthrosis (ORo = 1.13 (1.09, 1.18); ORg = 1.03 (1.01, 1.05)), frequent sleeplessness (ORo = 1.21 (1.20, 1.23); ORg = 1.02 (1.01, 1.03)), and low household income (ORo = 1.28 (1.26, 1.31); ORg = 1.02 (1.01, 1.03)). Approximately 62% of results were significant in the observational OWA but not the genetic OWA, including numerous cardiovascular outcomes. Only 6 outcomes were significant in the genetic OWA and null in the observational OWA; these included diastolic blood pressure and glaucoma. No outcomes were statistically significant in opposite directions in the two analyses, and 11% were not significant in either OWA.

CONCLUSIONS

Our findings underscore the far-reaching negative effects of childhood maltreatment in later life and the utility of an outcome-wide triangulation design with sensitivity analyses for improving causal inference.

A sex-specific pathway linking early life maltreatment, vagal activity, and depressive symptoms

Background: Experiences of early life maltreatment (ELM) are alarmingly common and represent a risk factor for the development of psychopathology, particularly depression. Research has focused on alterations in autonomic nervous system (ANS) functioning as a mediator of negative mental health outcomes associated with ELM. Early alterations in autonomic vagal activity (vmHRV) may moderate the relationship between ELM and depression, particularly when considering forms of emotional maltreatment. Recent evidence suggests that the relationships of both ELM and vmHRV with depression may be non-linear, particularly considering females.Objective: Building on and extending theoretical considerations and previous work, the present work aims to further the current understanding of the complex relationships between ELM exposure, vmHRV, and depression.Methods: This study uses an adaptive modelling approach, combining exploratory network-based analyses with linear and quadratic moderation analyses, drawing on a large sample of males and females across adolescence (total N = 213; outpatient at-risk sample and healthy controls) and adulthood (total N = 85; community-based convenience sample).Results: Exploratory network-based analyses reveal that exposure to emotional abuse is particularly central within a network of ELM subtypes, depressive symptoms, and concurrent vmHRV in both adolescents and adults. In adults, emotional neglect shows strong associations with both emotional abuse and vmHRV and is highly central as a network node, which is not observed in adolescents. Moderator analyses reveal significant interactions between emotional maltreatment and vmHRV predicting depressive symptoms in adult females. Significant quadratic relationships of emotional maltreatment and vmHRV with depression are observed in both adolescent and adult females.Conclusions: The present findings contribute to the understanding of the psychological and physiological mechanisms by which ELM acts as a risk factor for the development of depression. Ultimately, this will contribute to the development of targeted and effective intervention strategies to mitigate the detrimental effects of early adversity.

Resilience, mental health, sleep, and smoking mediate pathways between lifetime stressors and Multiple Sclerosis severity

Intro

Lifetime stressors (e.g., poverty, violence, discrimination) have been linked to Multiple Sclerosis (MS) features; yet mechanistic pathways and relationships with cumulative disease severity remain nebulous. Further, protective factors like resilience, that may attenuate the effects of stressors on outcomes, are seldom evaluated.

Aim

To deconstruct pathways between lifetime stressors and cumulative severity on MS outcomes, accounting for resilience.

Methods

Adults with MS (N=924) participated in an online survey through the National MS Society listserv. Structural Equation Modeling was used to examine the direct and indirect effect of lifetime stressors (count/severity) on MS severity (self-reported disability, relapse burden, fatigue, pain intensity and interference), via resilience, mental health (anxiety and depression), sleep disturbance, and smoking.

Results

The final analytic model had excellent fit (GFI=0.998). Lifetime stressors had a direct relationship with MS severity (β=0.27, p<.001). Resilience, mental health, sleep disturbance, and smoking significantly mediated the relationship between lifetime stressors and MS severity. The total effect of mediation was significant (β=0.45).

Conclusions

This work provides foundational evidence to inform conceptualization of pathways by which stress could influence MS disease burden. Resilience may attenuate effects of stressors, while poor mental health, smoking, and sleep disturbances may exacerbate their impact. Parallel with usual care, these mediators could be targets for early multimodal therapies to improve disease course.

Self-reported childhood adversity, unhealthy lifestyle and risk of new-onset chronic kidney disease in later life: A prospective cohort study

BACKGROUND

The prospective relation of childhood adversity with the risk of chronic kidney disease (CKD) remains unclear. We aimed to investigate the association of childhood adversity with new-onset CKD and examine the potential modifications by unhealthy lifestyle on this association.

METHODS

A total of 115,453 adults without prior CKD at baseline were included from UK Biobank (2006-2010). Childhood adversity was retrospectively evaluated through online Childhood Trauma Screener in 2016. Six common lifestyle factors including smoking, body mass index, sleep, diet, physical activity and alcohol consumption, were combined into an unhealthy lifestyle score. New-onset CKD was the primary outcome.

RESULT

The average age of participants in the study was 55.3 (SD, 7.7) years, and 39.3% of them were male. During a median follow-up duration of 14.1 years, 1905 participants developed new-onset CKD. Childhood adversity was significantly positively related with the risk of new-onset CKD in dose-response pattern. Each additional type of childhood adversity was associated with a 12% increment in the risk of developing CKD (adjusted hazard ratio (HR)1.12; 95% CI 1.08, 1.16). Among participants with high unhealthy lifestyle score, those with 4-5 types of childhood adversity increased the 1.73-fold risk of incident CKD (95% CI 1.17, 2.54) compared with those free of any childhood adversity. However, no statistically significant interaction was observed between unhealthy lifestyle and childhood adversity for new-onset CKD (P interaction = 0.734).

CONCLUSIONS

Childhood adversity was significantly associated with an increased risk of new-onset CKD in a dose-response pattern regardless of unhealthy lifestyle.

Adverse childhood experience is associated with an increased risk of reporting chronic pain in adulthood: a stystematic review and meta-analysis

Background: Adverse childhood experiences (ACEs) have been shown to negatively affect health in adulthood. Estimates of associations between ACEs and chronic painful conditions are lacking.Objectives: This systematic review and meta-analysis aimed to evaluate associations between exposure to ACEs and chronic pain and pain-related disability in adults.Methods: We searched 10 electronic databases from inception to February 2023. We included observational studies assessing associations between direct ACEs (childhood sexual, physical, emotional abuse, or neglect) alone or in combination with indirect ACEs (witnessing domestic violence, household mental illness), and adult chronic pain (≥3 months duration) and pain-related disability (daily activities limited by chronic pain). Pairs of reviewers independently extracted data and assessed study risks of bias. Random-effect models were used to calculate pooled adjusted odds ratios [aOR]. Tau square [T2], 95% prediction intervals [95%PI] and I2 expressed the amount of heterogeneity, and meta-regressions and subgroup meta-analyses investigated sources of heterogeneity (PROSPERO: CRD42020150230).Results: We identified 85 studies including 826,452 adults of which 57 studies were included in meta-analyses. Study quality was generally good or fair (n = 70). The odds of reporting chronic pain in adulthood were significantly higher among individuals exposed to a direct ACE (aOR, 1.45, 95%CI, 1.38-1.53). Individuals reporting childhood physical abuse were significantly more likely to report both chronic pain (aOR, 1.50, 95CI, 1.39-1.64) and pain-related disability (1.46, 95CI, 1.03-2.08) during adulthood. Exposure to any ACEs alone or combined with indirect ACEs significantly increase the odds of adult chronic painful conditions (aOR, 1.53, 95%CI, 1.42-1.65) and pain-related disability (aOR, 1.29; 95%CI, 1.01-1.66). The risk of chronic pain in adulthood significantly increased from one ACE (aOR, 1.29, 95%CI, 1.22-1.37) to four or more ACEs (1.95, 95%CI, 1.73-2.19).Conclusions: Single and cumulative ACEs are significantly associated with reporting of chronic pain and pain-related disability as an adult.

Desistance from physical abuse in a national study of Nepal: Protective informal social control and self-compassion

BACKGROUND

Research on the conditions under which perpetrators desist from child maltreatment has seen greater attention as part of the efforts to break the cycle of maltreatment. New theoretical insights suggest that informal actions (herein protective informal social control of child maltreatment) by network members which communicate warmth, empathy with victim distress, and promote the modeling of positive parenting practices are more likely to increase maltreatment desistance. Likewise, parents' desistance from maltreatment is theorized to impact on adolescents' (victim) cognition and self-compassion.

OBJECTIVE

This study examined the relationship among protective informal social control of child maltreatment (protective ISC_CM) by social networks, physical abuse desistance, and adolescent self-compassion.

PARTICIPANTS AND SETTING

A nationally representative sample of 1100 mothers and their adolescent children (aged 11-15) in Nepal was obtained.

METHODS

Questionnaires were administered to mothers and their adolescent children independently. Hypotheses were tested using regression models with standard errors corrected for clustering within wards.

RESULTS

More than 1 in 7 mothers reported perpetrating physical abuse in the past year, and 1 in every 5 adolescents reported being victims of physical abuse. Odds of abuse desistance increase by roughly 10 % for each act of protective ISC_CM reported by the mother. Also, odds of abuse desistance associated with higher adolescent self-compassion, and acts of protective ISC_CM associated with higher levels of adolescent self-compassion.

CONCLUSION

The findings suggest that interventions to boost desistance from maltreatment and break the cycle of abuse in Nepal, should focus on promoting protective informal social control actions.

Economic Burden of Health Conditions Associated With Adverse Childhood Experiences Among US Adults

Importance

Adverse childhood experiences (ACEs) are preventable, potentially traumatic events in childhood, such as experiencing abuse or neglect, witnessing violence, or living in a household with substance use disorder, mental health problems, or instability from parental separation or incarceration. Adults who had ACEs have more harmful risk behaviors and worse health outcomes; the economic burden associated with these issues is uncertain.

Objective

To estimate the economic burden of ACE-associated health conditions among US adults.

Design, Setting, and Participants

In this economic evaluation, regression models of cross-sectional survey data from the 2019-2020 Behavioral Risk Factor Surveillance System (BRFSS) and previous studies were used to estimate ACE population-attributable fractions (PAFs) (ie, the fraction of total cases associated with a specific exposure) for selected health outcomes (anxiety, arthritis, asthma, cancer, chronic obstructive pulmonary disease, depression, diabetes, heart disease, kidney disease, stroke, and violence) and risk factors (heavy drinking, illicit drug use, overweight and obesity, and smoking) among the 2019 US adult population. Adverse childhood experience PAFs were used to calculate the proportion of total condition-specific medical spending and lost healthy life-years related to ACEs using Global Burden of Disease Study data. Data analysis was performed from September 10, 2021, to November 29, 2022.

Exposure

Adverse childhood experiences (age <18 years).

Main Outcomes and Measures

Monetary valuation of ACE-associated morbidity and mortality using standard US value of statistical life methods and presented in terms of annual and lifetime per affected person and total population estimates at the national and state levels.

Results

A total of 820 673 adults, representing 255 million individuals, participated in the BRFSS in 2019 and 2020. An estimated 160 million of the total 255 million US adult population (63%) had 1 or more ACE, associated with an annual economic burden of $14.1 trillion ($183 billion in direct medical spending and $13.9 trillion in lost healthy life-years). This was $88 000 per affected adult annually and $2.4 million over their lifetimes. The lifetime economic burden per affected adult was lowest in North Dakota ($1.3 million) and highest in Arkansas ($4.3 million). Twenty-two percent of adults had 4 or more ACEs and comprised 58% of the total economic burden-the estimated per person lifetime economic burden for those adults was $4.0 million.

Conclusions and Relevance

In this cross-sectional analysis of the US adult population, the economic burden of ACE-related health conditions was substantial. The findings suggest that measuring the economic burden of ACEs can support decision-making about investing in strategies to improve population health.

The Impact of Childhood Psychological Maltreatment on Mental Health Outcomes in Adulthood: A Systematic Review and Meta-Analysis

Childhood emotional abuse (CEA) and childhood emotional neglect (CEN) are the least well-studied forms of childhood maltreatment due to challenges in their definition and in detection. However, the available evidence suggests associations with multiple adulthood mental health problems in clinical and non-clinical populations. This systematic review and meta-analysis (PROSPERO registration number CRD42020197833) explored the associations between CEA and CEN and a range of adulthood mental health problems based on systematic searches of eight databases. In total, 79 English and 11 Chinese studies met our inclusion criteria. Results suggested that CEA and CEN had positive associations with various adulthood mental health problems (d = 0.02-1.84), including depression, anxiety, substance abuse, suicidal ideation or attempts, personality disorders, eating disorders, and other psychological symptoms in the general population and across different geographic regions. Furthermore, findings suggested that compared with the non-clinical population, individuals in clinical populations were more likely to have experienced emotional abuse and neglect during childhood. The review highlights the need for more research on emotional abuse and emotional neglect. Furthermore, future research should include more populations from non-western countries and non-college populations. They further underline the importance of addressing issues related to CEA/CEN experiences in the prevention and treatment of mental health issues in adulthood.