Deconstructing pathways to resilience: A systematic review of associations between psychosocial mechanisms and transdiagnostic adult mental health outcomes in the context of adverse childhood experiences

Trajectories of risk and resilience: The role of empathy and perceived social support in the context of early adversity

BACKGROUND

Evidence overwhelmingly suggests that adverse childhood experiences (ACEs) is a risk factor for poor mental health outcomes. However, the specific mechanisms via which ACEs confer an increased risk of psychopathology are less well understood.

OBJECTIVE

The study modelled the effect of empathy and perceived social support (PSS) on mental health outcomes in a mixed clinical and non-clinical population, within the context of exposure to ACEs.

PARTICIPANTS AND SETTING

A total of 575 participants (comprising a treatment-receiving and community-based sample), aged 18 to 65 completed self-report measures assessing early adversity, PSS, empathy, and mental health outcomes.

METHODS

Multiple mediation analyses were used to investigate whether empathy and PSS mediated the relationship between self-reported ACEs and mental health outcomes, and whether affective and cognitive empathy affected differentially the link between emotional neglect and psychological distress.

RESULTS

Results revealed a statistically significant indirect effect of ACEs on adult mental health through affective empathy and PSS. Emotional neglect was the only type of adversity significantly correlated with both dimensions of empathy. The indirect effect of emotional neglect on mental health outcomes via cognitive and affective empathy was also statistically significant.

CONCLUSIONS

Study results highlight the role of affective empathy and PSS as transdiagnostic mechanisms influencing the pathway between early adversity and adult mental health, and the importance of taking these into account when designing interventions aiming to promote well-being among those who have experienced childhood adversity.

The role of explicit and implicit self-esteem in the relationship between childhood trauma and adult depression and anxiety

BACKGROUND

Self-esteem is an important psychological concept that can be measured explicitly (reflective processing) and implicitly (associative processing). The current study examined 1) the association between childhood trauma (CT) and both explicit and implicit self-esteem, and 2) whether self-esteem mediated the association between CT and depression/anxiety.

METHODS

In 1479 adult participants of the Netherlands Study of Depression and Anxiety, CT was assessed with a semi-structured interview, depression/anxiety symptoms with self-report questionnaires and explicit and implicit self-esteem with the Rosenberg Self-Esteem Scale and Implicit Association Test, respectively. ANOVAs and regression analyses determined the association between CT (no/mild/severe CT), its subtypes (abuse/neglect) and self-esteem. Finally, we examined whether self-esteem mediated the relationship between CT and depression/anxiety.

RESULTS

Participants with CT reported lower explicit (but not lower implicit) self-esteem compared to those without CT (p < .001, partial η2 = 0.06). All CT types were associated with lower explicit self-esteem (p = .05 for sexual abuse, p < .001 for other CT types), while only emotional neglect significantly associated with lower implicit self-esteem after adjusting for sociodemographic characteristics (p = .03). Explicit self-esteem mediated the relationship between CT and depression/anxiety symptoms (proportion mediated = 48-77 %).

LIMITATIONS

The cross-sectional design precludes from drawing firm conclusions about the direction of the proposed relationships.

CONCLUSIONS

Our results suggested that the relationship between CT and depression/anxiety symptoms can at least partly be explained by explicit self-esteem. This is of clinical relevance as it points to explicit self-esteem as a potential relevant treatment target for people with CT.

How are adverse childhood experiences and women's mental health associated? A latent class analysis

BACKGROUND

Adverse childhood experiences (ACEs) have a cumulative effect on adult mental health; however, the effect of such combinations is less well known. The purpose of this study is to assess the association between specific combinations of early adversities and women's mental health.

METHODS

A total of 378 women (Myears = 41.4; SDyears = 13) receiving support from mental health and social services participated in this cross-sectional study. Latent class analysis was performed to classify participants based on the number of ACEs types.

RESULTS

Our results provided support for four latent classes which differed in ACEs types reported: class 1 range of maltreatment but no family disruption (16.40 %; n = 62), class 2 range of maltreatment with family disruption (24.87 %; n = 94), class 3 few ACEs (44.71 %; n = 169), class 4 high maltreatment/high family disruption (14.02 %; n = 53). Differences in psychological functioning (presence of psychopathology, attachment, emotion dysregulation, and coping strategies) were found between the classes, especially between few ACEs and high maltreatment/high family disruption classes. In addition, women who lived in a low-adversity home and those who lived in a home with maltreatment, but no family disruption, differed in their desire for closeness, problem-solving and emotional expression strategies.

CONCLUSION

This study highlights that the probability of exposure to different combinations of ACEs is associated with differences in adult psychological functioning. Deeper insight into this association may contribute to a better understanding of mental health problems and to improved prevention and intervention strategies in public support systems.

Burnout and secondary traumatic stress in staff working with people with intellectual disabilities: The role of adverse childhood experiences, resilience and trauma-informed organisational climate

BACKGROUND

There has been extensive research into adverse childhood experiences (ACEs), however, less consideration has been given to the prevalence and impact of ACEs for staff working with people with intellectual disabilities.

METHOD

Participants were staff employed by agencies that care for people with intellectual disabilities. An online survey collected demographic information and measures of ACEs, resilience, trauma-informed organisational climate, burnout and secondary traumatic stress. Correlation, regression, mediation and moderation analyses were used.

RESULTS

81.7% of 109 participants had experienced at least one ACE. Burnout, secondary traumatic stress and resilience were greater in the present study than in comparable samples. Trauma-informed organisational climate significantly predicted burnout and secondary traumatic stress. Resilience significantly predicted burnout.

CONCLUSIONS

Staff working with people with intellectual disabilities are likely to have experienced ACEs. Working in a trauma-informed organisational climate and resilience may be effective avenues for reducing burnout and secondary traumatic stress.

Childhood trauma and anger in adults with and without depressive and anxiety disorders

BACKGROUND

Childhood trauma (CT) is associated with severe sequelae, including stress-related mental health disorders that can perpetuate long into adulthood. A key mechanism in this relationship seems to be emotion regulation. We aimed to investigate (1) whether childhood trauma is associated with anger in adulthood, and, if so, (2) to explore which types of childhood trauma predominate in the prediction of anger in a cohort that included participants with and without current affective disorders.

METHODS

In the Netherlands Study of Depression and Anxiety (NESDA), childhood trauma was assessed with a semi-structured Childhood Trauma Interview (CTI) at baseline, and analyzed in relation to anger as measured at a 4-year follow-up with the Spielberger Trait Anger Subscale (STAS), the Anger Attacks Questionnaire, and cluster B personality traits (i.e., borderline, antisocial) of the Personality Disorder Questionnaire 4 (PDQ-4), using analysis of covariance (ANCOVA) and multivariable logistic regression analyses. Post hoc analyses comprised cross-sectional regression analyses, using the Childhood Trauma Questionnaire-Short Form (CTQ-SF) also obtained at a 4-year follow-up.

RESULTS

Participants (n = 2271) were on average 42.1 years (SD = 13.1), and 66.2% were female. Childhood trauma showed a dose-response association with all anger constructs. All types of childhood trauma were significantly associated with borderline personality traits, independently of depression and anxiety. Additionally, all types of childhood trauma except for sexual abuse were associated with higher levels of trait anger, and a higher prevalence of anger attacks and antisocial personality traits in adulthood. Cross-sectionally, the effect sizes were larger compared with the analyses with the childhood trauma measured 4 years prior to the anger measures.

CONCLUSIONS

Childhood trauma is linked with anger in adulthood, which could be of particular interest in the context of psychopathology. Focus on childhood traumatic experiences and adulthood anger may help to enhance the effectiveness of treatment for patients with depressive and anxiety disorders. Trauma-focused interventions should be implemented when appropriate.

Biomarkers of Neurodegeneration in Post-Traumatic Stress Disorder: An Integrative Review

Post-Traumatic Stress Disorder (PTSD) is a chronic psychiatric disorder that occurs following exposure to traumatic events. Recent evidence suggests that PTSD may be a risk factor for the development of subsequent neurodegenerative disorders, including Alzheimer's dementia and Parkinson's disease. Identification of biomarkers known to be associated with neurodegeneration in patients with PTSD would shed light on the pathophysiological mechanisms linking these disorders and would also help in the development of preventive strategies for neurodegenerative disorders in PTSD. With this background, the PubMed and Scopus databases were searched for studies designed to identify biomarkers that could be associated with an increased risk of neurodegenerative disorders in patients with PTSD. Out of a total of 342 citations retrieved, 29 studies were identified for inclusion in the review. The results of these studies suggest that biomarkers such as cerebral cortical thinning, disrupted white matter integrity, specific genetic polymorphisms, immune-inflammatory alterations, vitamin D deficiency, metabolic syndrome, and objectively documented parasomnias are significantly associated with PTSD and may predict an increased risk of subsequent neurodegenerative disorders. The biological mechanisms underlying these changes, and the interactions between them, are also explored. Though requiring replication, these findings highlight a number of biological pathways that plausibly link PTSD with neurodegenerative disorders and suggest potentially valuable avenues for prevention and early intervention.

Relationships Among Adverse and Benevolent Childhood Experiences, Emotion Dysregulation, and Psychopathology Symptoms

This cross-sectional study sought to examine adverse childhood experiences (ACEs), benevolent childhood experiences (BCEs), and emotion dysregulation as they relate to psychopathology symptoms (posttraumatic stress disorder [PTSD], anxiety, depression) in university students in emerging adulthood. Students at a United States university (N = 1,498) completed an online survey during the fall 2021 and spring 2022 semesters. Measures include the Adverse Childhood Experiences Questionnaire, Benevolent Childhood Experiences Scale, Difficulties in Emotion Regulation Scale-Short Form, PTSD Checklist for the Diagnostic and Statistical Manual of Mental Disorders 5th edition, Patient Health Questionnaire 8, and Generalized Anxiety Disorder 7 Scale. ACEs significantly related to greater symptoms and positive screens for PTSD, depression, and anxiety. BCEs significantly related to fewer symptoms and positive screens for PTSD, depression, and anxiety. Emotion dysregulation was a significant mediator of relationships between ACEs and all symptom types (direct and indirect effects were both significant, supporting partial mediation). Emotion dysregulation was a significant partial mediator of relationships between BCEs and all symptom types (direct and indirect effects were both significant, supporting partial mediation). Results showed significant small moderation effects of BCEs on the relationships of ACEs-emotion dysregulation, ACEs-depression symptoms, ACEs-anxiety symptoms, and emotion dysregulation-PTSD symptoms. Implications for colleges and universities are discussed.

Adverse Childhood Experiences and Health in Rural Areas of Riyadh Province in Saudi Arabia: A Cross-Sectional Study

Adverse childhood experiences (ACEs) and their consequences are a worldwide problem. ACEs are primary stressors that have a long-term impact on the body and mind during development. They are linked to a variety of chronic illnesses in adults. Information about ACEs and health and risk behaviors is scarce among rural populations. The study aimed to examine ACEs, chronic diseases, and risk behaviors, as well as to explore the relationship between them and number of sociodemographic factors among adults living in rural areas in Riyadh Province, Saudi Arabia. A cross-sectional design and a convenience sampling method were utilized to collect information. A self-reported questionnaire, including an ACEs questionnaire as well as direct health and risk behaviors questions, was used. In total, 68.2% of the respondents reported at least one ACE, and 34.2% reported four or more ACEs. Emotional and physical abuse were the most reported forms. Hypertension and chronic respiratory disease were the most reported chronic diseases. Depression and anxiety were associated with ACEs, indicating that those who reported four or more ACEs were more likely to develop depression and anxiety. ACEs contribute to many negative health outcomes; thus, identifying the prevalence of ACEs among the rural population is essential for future health-related actions. It is also important that chronic diseases and risk behaviors be specifically identified among the rural population in order to prioritize these actions. Future research should further investigate ACEs and other determinants of health among the rural population, taking into consideration the inclusion of more diverse people, such as older adults and those from other rural areas.

The impact of experiencing severe physical abuse in childhood on adolescent refugees' emotional distress and integration during the COVID-19 pandemic

Background

Accumulating evidence highlights the importance of pre- and post- migration stressors on refugees' mental health and integration. In addition to migration-associated stressors, experiences earlier in life such as physical abuse in childhood as well as current life stress as produced by the COVID-19-pandemic may impair mental health and successful integration - yet evidence on these further risks is still limited. The present study explicitly focused on the impact of severe physical abuse in childhood during the COVID-19 pandemic and evaluated the impact of these additional stressors on emotional distress and integration of refugees in Germany.

Methods

The sample included 80 refugees, 88.8% male, mean age 19.7 years. In a semi-structured interview, trained psychologists screened for emotional distress, using the Refugee Health Screener, and integration status, using the Integration Index. The experience of severe physical abuse in childhood was quantified as a yes/no response to the question: "Have you been hit so badly before the age of 15 that you had to go to hospital or needed medical attention?" Multiple hierarchical regression analyses further included gender, age, residence status, months since the start of the COVID-19 pandemic and length of stay in Germany to predict emotional distress and integration.

Results

Two regression analyses determined significant predictors of (1) emotional distress (adjusted R ² = 0.23): duration of being in the pandemic (ß = 0.38, p < 0.001) and severe physical abuse in childhood (ß = 0.31, p = 0.005), and significant predictors of (2) integration (adjusted R ² = 0.53): length of stay in Germany (ß = 0.62, p < 0.001), severe physical abuse in childhood (ß = 0.21, p = 0.019) and emotional distress (ß = -0.28, p = 0.002).

Conclusion

In addition to migration-associated stressors, severe physical abuse in childhood constitutes a pre-migration risk, which crucially affects the well-being, emotional distress and integration of refugees in Germany.