Examining Associations between Adverse Childhood Experiences and Posttraumatic Stress Disorder Symptoms among Young Survivors of Urban Violence

Abnormal interbrain coupling in individuals with childhood adversity may underlie their difficulties in benefiting from social interactions

BACKGROUND

While adverse childhood experiences (ACEs) such as abuse or neglect are linked to lifelong interpersonal challenges, it's uncertain whether individuals with ACEs can effectively draw on others for distress relief and whether neural dyadic processes in these exchanges are compromised.

METHOD

To address this gap, here we examined interbrain coupling between 'targets' (adults with a varying history of ACEs) and 'regulators' (unacquainted individuals without a history of ACEs) during two conditions: (i) distressing condition: where the target shares with the regulator a distressing biographical event; (ii) neutral condition: where the target shares with the regulator a neutral biographical event. After screening 534 participants, 58 dyads were simultaneously scanned with functional near-infrared spectroscopy (fNIRS), during the distress/neutral conditions to investigate interbrain coupling in the dorsolateral pre-frontal cortex (DLPFC), a core region of the emotion regulation network.

RESULTS

Consistent with our hypothesis that individuals with high ACEs have difficulty relying on social support, we observed a significant negative relationship between targets' cumulative ACEs and distress relief during the distressing condition. Neuroimaging revealed that higher ACEs scores were significantly linked to differential interbrain coupling patterns in the DLPFC: increased coupling during the distressing condition and decreased coupling during the neutral condition.

CONCLUSIONS

Among higher ACEs dyads, hyper interbrain coupling during distress may suggest heightened yet unsuccessful efforts to regulate distress, while hypo interbrain coupling in non-distressing situations may indicate poor connectedness in neutral social interactions. Therefore, abnormal interbrain coupling may underlie the difficulties high ACEs individuals face in benefiting from supportive interactions.

Five hypothesized biological mechanisms linking adverse childhood experiences with anxiety, depression, and PTSD: A scoping review

Adults with symptoms of anxiety, depression, or PTSD and a history of adverse childhood experiences (ACEs) may experience more severe symptoms than those without ACEs. The identification of mechanisms linking ACEs to later mental health problems may provide salient treatment targets to improve outcomes. Several biological markers (cortisol, inflammation, allostatic load, DNA methylation, and telomere length) that are indicative of functional variation in stress response systems, have been hypothesized as potential mechanisms linking ACEs to later mental health outcomes. Much of the evidence supporting this hypothesis examines isolated pairwise associations between variables and it is unclear whether statistical tests of mediation support these conclusions. It is also unclear how much of the extant research has used theory to guide mediation analyses, which may be a salient factor in the recognition of a mechanism. This scoping review surveyed research conducting mediation analysis examining the indirect effect of any of these five biological markers on the relationship between ACEs and anxiety, depression, or PTSD. It further surveyed the use of theory in these analyses. Pubmed and seven electronic databases were searched: (1) APA PsychInfo (2) CINAHL Plus (3) Health Source: Nursing/Academic Edition (4) MEDLINE (5) Psychology and Behavioral Sciences Collection (6) Science and Technology Collection, and (7) SocINDEX. A total of 16 articles were identified. The majority of studies examined depression as an outcome and the statistical significance of indirect effects were mixed across mediators. Common theoretical models and frameworks were consistent with life course theory and evolutionary or developmental perspectives.

Mental health sequelae of violent injury in children: a review

In the last decade, increasing attention has been paid to the magnitude and characterization of the relationship between violent injury and mental health, with trauma centers progressively focusing on screening and intervention strategies. This review aims to characterize the mental health sequelae of violent injury on children, highlighting effective screening and intervention tools. Violent injury compared to non-violent injury incurs a greater risk for poor mental health outcomes. Risk of acute stress disorder and post-traumatic stress disorder are among the best characterized, but anxiety, depression, and substance use disorders are also correlated to violent injury in children. Mental health sequelae are pervasive, and have lasting, significant physical and psychosocial consequences. Globally, the impact of mental health sequelae of violent injury is underrecognized and undertreated. Provider awareness, and early and efficacious screening can facilitate tailored intervention strategies.

The Contribution of Adverse Childhood Experiences and Neighborhood Characteristics on Outcomes Experienced by Urban Dwelling Black Men After Serious Traumatic Injury

Depression and post-traumatic stress disorder (PTSD) are serious consequences of physical injuries. Stress associated with living in urban neighborhoods with socioecological disadvantages and the cumulative burdens of adverse childhood experiences (ACEs) can lead to poorer psychological outcomes. Limited research has explored how ACEs and socioecological environmental exposures in childhood and adulthood, together, impact post-injury outcomes. This study assessed the relative contributions of ACEs and neighborhood exposures during childhood and adulthood on post-injury outcomes among Black men in Philadelphia. We used data from a prospective cohort of 414 Black men from the Philadelphia region, aged ≥ 18 years, who sustained acute physical injuries requiring hospitalization. Primary outcomes were post-injury PTSD and depression. Secondary outcomes were sleep quality, self-reported health status, changes in substance use, and return to work. The study used perceived and objective measures of neighborhood characteristics and self-reported ACEs to model their relative impact on outcomes 3 months after hospital discharge. Higher levels of ACEs and higher perceived neighborhood disorder during childhood and adulthood were significant predictors of PTSD and depression symptom severity. Perceived neighborhood disorder contributed to sleep disturbances and decline in post-injury health. Census/administrative objective measures of neighborhood disadvantage did not show consistent associations with post-injury outcomes. Findings suggest that both ACEs and subjective perception of neighborhood environments are critical factors influencing post-injury recovery in urban Black men. Interventions to improve post-injury outcomes should consider preventing ACEs and addressing the tangible conditions of neighborhoods and residents' perceptions of their surroundings to promote health equity and injury recovery.

Adverse childhood experiences and post-traumatic stress impacts on brain connectivity and alcohol use in adolescence

The current study investigated the relationship between adverse childhood experiences (ACEs), post-traumatic stress disorder (PTSD) symptoms, within-network resting-state functional connectivity (rs-FC), and alcohol use during adolescence using functional magnetic resonance imaging (fMRI) data from the National Consortium on Alcohol and Neurodevelopment in Adolescence study (NCANDA; N = 687). Significant rs-FC differences emerged that linked participant ACEs, PTSD symptoms, and alcohol use problems. Participants with ACEs compared to those without had diminished rs-FC within the default mode, salience, and medial frontoparietal networks (p ≤ 0.005). Further reduction in rs-FC within the default mode and medial frontoparietal networks (p ≤ 0.005) was found when PTSD symptoms were present in addition to ACEs. Findings suggest that PTSD symptoms are associated with lower within network rs-FC beyond exposure to ACEs, and some of these rs-FC changes were associated with worsened alcohol use problems (i.e. withdrawal symptoms). These findings highlight the importance of addressing PTSD symptoms in adolescents with a history of ACEs as it may mitigate problematic changes in brain connectivity and reduce the risk of developing alcohol use problems.

Psychiatric disorders endorsed by trauma-exposed premenopausal women enrolled in a cardiovascular research study: a 2-year report

INTRODUCTION

Women are more likely than men to experience interpersonal trauma, with 1 in 3 women affected globally. This paper aims to give a 2-year report of the demographics, trauma history [i.e., non-interpersonal and interpersonal including adverse childhood event (ACEs)] and psychiatric disorders endorsed by premenopausal women screened for our cardiovascular research study.

METHODS

Premenopausal women were recruited from the Twin-Cities area using flyers. Interested participants were screened for this study via REDCap. Age, race, history of psychiatric disorders, menopausal status, contraceptives, and current medications were collected. Participants who met the eligibility criteria were enrolled and completed additional questionnaires focusing on trauma exposure and mental health.

RESULTS

The first 2 years our study was open to accrual, a total of 447 premenopausal women were screened. The majority (~ 71%) of our participants were between 18 and 30 years old. Among the 447 women, 35% reported a diagnosis of posttraumatic stress disorder (PTSD), while 46% reported depression and 53% an anxiety disorder, according to DSM-5. Further, we found that women between the ages of 21-25 years reported the most (23%) psychiatric disorders, mainly PTSD. The main type of trauma reported was interpersonal trauma (~ 62%), of which 76% were ACEs.

CONCLUSION

Among the trauma-exposed women enrolled in our study, the age group between 21 and 25 years old endorsed the most psychiatric disorders, possibly stemming from ACEs. Our findings shed the light on the rising rate of psychiatric disorders in premenopausal women and support the growing public health burden of trauma exposure, particularly in childhood.

Exploring Factors Affecting Parental Psychological Vulnerability During Their Child's PICU Admission: A Prospective Pilot Cohort Study

INTRODUCTION

Parental psychological responses during their child's pediatric intensive care unit (PICU) admission are often overlooked. This study aimed to identify pre-existing and peri-traumatic factors explaining parental stress and anxiety during their child's PICU admission and one-month follow-up.

METHOD

A prospective pilot study included 60 PICU parents. Parental Stressors Scale and State-trait Anxiety Inventory measured stress and anxiety during PICU admission, and the State-trait Anxiety Inventory and Perceived Stress Scale at a one-month follow-up.

RESULTS

During PICU admission, parental stress correlated with age, race, and adverse childhood experiences (ACEs), anxiety was linked to income. At one-month follow-up, anxiety related to child's health worries, perceived stress was linked to parental ACEs and education. Parental ACEs predicted perceived stress (b = 0.83, p = .028). Children's diagnoses explained anxiety, particularly respiratory and cardiac diagnoses (b = -13.44, p = .023; -10.03, p = .045).

DISCUSSION

Identifying factors helps teams understand parental vulnerability and provide appropriate support.

Mental health symptoms and engagement in a stepped-care mental health service among patients with a violent versus nonviolent injury

BACKGROUND

Few studies have examined mental health symptom trajectories and engagement in mental health follow-up in relation to mechanism of injury. This study examined differences in engagement between survivors of nonviolent and violent injury in the Trauma Resilience and Recovery Program (TRRP), a stepped-care, technology-enhanced model that provides evidence-based mental health screening and treatment to patients admitted to our Level I trauma service.

METHODS

This study analyzed data from 2,527 adults enrolled in TRRP at hospital bedside between 2018 and 2022, including 398 patients (16%) with a violent injury and 2,129 patients (84%) with a nonviolent injury. Bivariate and hierarchical logistic regression analyses examined relations between injury type (violent vs. nonviolent) engagement in TRRP and mental health symptoms at 30 day follow-up.

RESULTS

Engagement in services at bedside was similar across survivors of violent and nonviolent traumatic injury. Patients with violent injury had higher levels of posttraumatic stress disorder and depressive symptoms 30 days postinjury but were less likely to engage in mental health screening. Among patients who screened positive for posttraumatic stress disorder and depression, patients with violent injury were more likely to accept treatment referrals.

CONCLUSION

Patients with a violent traumatic injury have higher levels of mental health needs yet face greater barriers to accessing mental health services following their injury relative to those with a nonviolent injury. Effective strategies are needed to ensure continuity of care and access to mental health care to promote resilience and emotional and functional recovery.

LEVEL OF EVIDENCE

Therapeutic/Care Management; Level IV.

Childhood mental health difficulties mediate the long-term association between early-life adversity at age 3 and poorer cognitive functioning at ages 11 and 14

BACKGROUND

Early-life adversity is associated with adverse mental health outcomes and poorer cognitive functioning in later development. However, little is known about how early-life adversity, mental health, and cognition affect one another or how the effects unfold over time. Here, we test the hypothesis that early-life adversity may lead to mental health challenges which in turn have adverse consequences for the development of cognitive abilities.

METHODS

In a large (N = 13,287) longitudinal (5 wave) sample assessed at ages 3, 5, 7, 11 and 14, we use both path analysis approach and latent growth curve mediation model to study whether poorer mental health in childhood may mediate the effects of early-life adversity on later working memory and vocabulary outcomes.

RESULTS

We found a significant total association between early-life adversity and poorer performance on working memory (β = .123, p < .001, [95% CI 0.106, 0.141]) and vocabulary scores (β = -.111, p < .001, [95% CI -0.129, -0.093]). Notably, current and previous mental health mediated a substantial proportion (working memory: 59%; vocabulary: 70%) of these effects. Further longitudinal modeling showed that early-life adversity has an enduring adverse effect on mental health, and that poorer mental health is associated with poorer cognitive performance later on in development. In a complementary analysis using latent growth curve mediation model, we found indirect associations between early-life adversity and working memory through baseline mental health at age 3 (intercept: β = .083, p < .001, [95% CI 0.072, 0.094]) and change in mental health across ages 3-11 (slope: β = -.012, p = .001, [95% CI -0.019, -0.005]). Likewise, baseline mental health at age 3 (intercept: β = -.095, p < .001, [95% CI -0.107, -0.083]) and change in mental health across ages 3-14 (slope: β = .007, p = .001, [95% CI 0.003, 0.011]) significantly and completely mediated the relation between early-life adversity and vocabulary outcome.

CONCLUSIONS

These findings have important potential clinical and educational implications, because they suggest that academic and cognitive resilience may be supported through early mental health interventions in vulnerable children.