Outcomes related to adverse childhood experiences in college students: Comparing latent class analysis and cumulative risk

Childhood adversity is associated with anxiety and depression in older adults: A cumulative risk and latent class analysis

BACKGROUND

The long-lasting influence of childhood adversity on mental health is well documented; however empirical research examining how this association extends into older adults is limited. This study operationalises adversity using cumulative risk and latent class analysis (LCA) models to assess how adversity exposure and typologies may predict anxiety and depression in older adults.

METHODS

Data came from the Personality and Total Health (PATH) Through Life Project (N = 2551, age 60-66). Participants retrospectively reported their childhood experiences of domestic adversity on a 17-item scale. Mental health was measured using four validated questionnaires of depression and anxiety.

RESULTS

Linear and generalised additive models (GAM) indicated a dose-response relationship, where a greater number of cumulative adversities were associated with poorer scores on all four mental health measures. LCA identified a four-class solution; with high adversity and high parental dysfunction being associated with poorer mental health outcomes while moderate parental dysfunction and low adversity groups scored at healthy levels. Women reported higher overall anxiety than men, but no notable interactions between ACEs and gender were observed. Patterns revealed by LCA were similar to patterns shown by the cumulative risk model.

LIMITATIONS

There is a large time gap from childhood to assessment, making our study susceptible to recall bias. Also, our findings were based on cross-sectional data, limiting causal inferences.

CONCLUSION

Childhood adversity had independent and additive contributions to depression and anxiety in older adulthood, and both cumulative risk and person-centred approaches captured this relationship.

Patterns of adverse childhood experiences and associations with lower mental well-being among university students

BACKGROUND

University students report high levels of adverse childhood experiences (ACEs), which can lead to severe mental health problems. Understanding how ACEs impact well-being in this population is essential, yet research to date is limited.

OBJECTIVE

To explore ACE patterns and their association with lower well-being in university students.

PARTICIPANTS AND SETTING

1023 Spanish students (71.6 % female) aged between 18 and 64 years old (M = 20.10, SD = 3.93) completed a self-report questionnaire.

METHODS

This study used a cross-sectional design. The ACE International Questionnaire (ACE-IQ) and the Short Warwick-Edinburgh Mental Well-being Scale were used to assess, respectively, childhood adversities and mental well-being. Latent Class Analysis and regression modeling were conducted to analyze the link between ACEs and lower mental well-being, considering the covariates of age, country of origin, sexual orientation, and mental illness.

RESULTS

Four ACE classes were identified: Low ACEs (49.5 %), Dysfunctional Household (12.3 %), Household and Peer Abuse (31.0 %), and High ACEs (7.2 %). The regression analysis (F(3, 1007) = 19.2, p < .001, R2adj = 0.054) successfully predicted well-being scores based on ACE classes. When compared with the Low ACE class, all other classes exhibited lower levels of well-being. Age, sexual orientation, and mental illness were also related to lower well-being, with mental illness having the strongest negative effect (β = -0.635, t(1015) = -6.49, p < .001).

CONCLUSIONS

These findings underscore the relationship between childhood adversity and mental health, offering insights for future prevention efforts and enriching our understanding of ACEs and their impact on well-being.

Adverse Childhood Experiences and Their Relationships with Perceived Stress and Self-Care Behaviors in African American Social Work Students: Insights from a Latent Class Analysis

Based on stress sensitization theory and stress proliferation theory, this study was designed to identify adverse childhood experience (ACE) classes and their relationships with perceived stress and self-care behaviors. Hypotheses were that (a) there would be diverse ACE classes among African American social work students; (b) the identified classes embedded in high/multiple ACEs would have greater levels of perceived stress than those in low ACEs; and (c) the identified classes embedded in high/multiple ACEs would have lower levels of self-care behaviors than those in low ACEs. Recruited from one of the South's historically Black colleges and universities, 186 African American social work students completed an online survey. Latent class analysis found three classes fit the data best: low ACEs, high divorce/abuse/neglect, and high/multiple ACEs. Students in the high divorce/abuse/neglect class had the greatest levels of perceived stress and significantly greater perceived stress levels than the low ACEs class. The low ACEs class had greater self-care behaviors than students in the other two ACEs classes. The study revealed diverse ACE classes and the effect of more ACEs on greater perceived stress and lower self-care behaviors, supporting the importance of using a range of approaches to support African American social work students with different ACEs.

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.

Patterns of Adverse Childhood Experiences and Problematic Health Outcomes Among US Young Adults: A Latent Class Analysis

INTRODUCTION

Adverse childhood experiences (ACEs) predict problematic health outcomes (eg, substance use, mental health) among young adults; whether specific ACEs are differentially associated with specific substance use and mental health symptoms is understudied.

METHODS

Latent class analysis (LCA) identified classes of ACEs among 2209 US young adults (Mage = 24.69, range: 18-34; 57.4% female; 30.9% sexual minority; 35.8% racial/ethnic minority) in a 2-year study (2018-2020). Multivariable logistic regressions examined ACEs (reported in 2019) in relation to 2020 reports of current (past 30-day) substance use (ie, tobacco use; cannabis use and hazardous use; alcohol use and binge drinking) and mental health (ie, ≥moderate depression and anxiety symptoms), controlling for sociodemographics (ie, age, gender, race, ethnicity, sexual orientation, education).

RESULTS

Overall, 65.4% reported ≥1 ACE (M = 2.09, SD = 2.30); 34.8%, 39.1%, and 71.1% current tobacco, cannabis, and alcohol use; 39.1% and 15.3% hazardous cannabis use and binge drinking; and 24.2% and 34.5% ≥moderate depression and anxiety symptoms, respectively. LCA yielded 4 classes: Low ACEs (referent; 55.6%), Poor family health and divorce (16.3%), Parental abuse (16.0%), and High ACEs (12.1%). High ACEs (vs Low ACEs) was associated with each adverse substance use and mental health outcome except alcohol use. Poor family health and divorce was associated with tobacco use, cannabis use, and both mental health outcomes. Parental abuse was associated with tobacco use, cannabis use, hazardous cannabis use, and both mental health outcomes.

CONCLUSIONS

Health promotion interventions for young adults must assess ACEs, given that certain types of ACEs may be associated with distinct substance use and mental health outcomes.

A Scoping Review on Adverse Childhood Experiences Studies Using Latent Class Analysis: Strengths and Challenges

Adverse childhood experiences (ACEs) studies reveal the profound impacts of experiencing trauma and hardships in childhood. However, the cumulative risk approach of treating ACEs obscures the heterogeneity of ACEs and their consequences, making actionable interventions impossible. latent class analysis (LCA) has increasingly been used to address these concerns by identifying underlying subgroups of people who experience distinctive patterns of co-occurring ACEs. Though LCA has its strengths, the existing research produces few comparable findings because LCA results are dependent on ACEs measures and indicators, which vary widely by study. Therefore, a scoping review of ACEs studies using LCA that focuses on ACEs measures, indicators, and findings is needed to inform the field. Following Arksey and O'Malley's five-stage scoping review methodological framework, we first identified 211 articles from databases of EBSCOhost, PubMed, and Scopus using "adverse childhood experiences" for title search and "latent class analysis" for abstract search. Based on the inclusion criteria of peer-reviewed articles written in English published from 2012 to 2022 and the exclusion criteria of nonempirical studies and the LCA not analyzing ACEs, we finally selected 58 articles in this scoping review. Results showed LCA has been increasingly endorsed in the ACEs research community to examine the associations between ACEs and human health and well-being across culturally diverse populations. LCA overcame the limitations of the traditional methods by revealing specific ACEs clusters that exert potent effects on certain outcomes. However, the arbitrary nature of selecting ACEs indicators, measures, and the limited use of theory impedes the field from moving forward.

Relationships between childhood adversity and life functioning in US college students: Risk and resilience

Objective: We examined the relationships between adverse childhood experiences (ACEs) and measures of mental health, academic achievement, and consequences of alcohol use, and moderators of these associations. We hypothesized that most students with high (3+) ACEs scores would be resilient on at least one measure but that few would be resilient on all measures. Additionally, we expected that greater social support and coping self-efficacy would buffer the association between ACEs and outcomes.Participants and methods: Secondary analysis of survey data from undergraduate students collected in 2015 (N = 8,997) and 2018 (N = 7,924).Results: The majority of students with high ACEs scores were resilient on each measure; 34% were resilient across all three. More students without ACEs were resilient on each measure and across all measures. Higher coping self-efficacy buffered the association between ACEs and poorer mental health.Conclusions: Research on ACEs in students should acknowledge resilience and risk.

Effects of clustering and timing of early life stress exposure on mood problems, ADHD symptoms, and problematic drinking

OBJECTIVE

Exposure to early life stress (ELS) may lead to long-term health consequences. The Early Life Stress Questionnaire (ELSQ) is a retrospective measure of multiple ELS and their timing. Latent class analysis (LCA) has not been applied to the ELSQ and questions regarding timing are rarely explored. This study examined the effects of clustering and timing of ELS exposure on internalizing and externalizing symptoms.

METHOD

Data from 1095 participants in the NIAAA Natural History Protocol were analyzed. LCA was conducted on 18 ELS items. Regression and correlational analyses examined associations of latent classes with sociodemographic variables and clinical outcomes.

RESULTS

LCA revealed three classes: Class 1: Minimal ELS (54.2%), Class 2: Moderate ELS (33.2%), and Class 3: Multiple and High ELS (12.6%). Black/African American participants were more likely to be in Class 2, and participants with low household income were more likely to be in Classes 2 and 3. Family history of problematic alcohol use and individual alcohol use disorder diagnosis were linked to Classes with higher ELS exposure. Compared with Class 1, Class 2 reported higher anxiety symptoms, depressive symptoms, ADHD symptoms, and problematic drinking, and Class 3 reported the highest levels across all these outcomes. Regarding timing, earlier exposure to ELS (e.g., sustained family conflict and witnessed domestic violence) was associated with higher psychopathological symptoms.

CONCLUSIONS

The ELSQ can effectively capture clustering and timing of exposure to multiple ELS. Greater and earlier exposure to ELS were positively associated with internalizing and externalizing symptoms, underscoring the need for early and well-timed intervention.

Comparison of Person-Centered and Cumulative Risk Approaches in Explaining the Relationship Between Adverse Childhood Experiences and Behavioral and Emotional Problems

Adverse childhood experiences (ACEs) commonly co-occur, and researchers often estimate their impact using a cumulative risk approach. The person-centered approach offers another approach to operationalize the co-occurrence of ACEs. This study aims to estimate latent classes of ACEs in a sample of U.K. children, examine their relationship with emotional and behavioral problems, and compare the explanatory value of the latent classes to cumulative risk scores. Data were collected among a general population sample of British 10-year-old children extracted from the U.K. Household Longitudinal Study (N = 601). Seven items characterized ACEs, comprising parent-report physical discipline, emotional abuse, supervisory neglect, maternal psychological distress, child-report parental educational disinterest, bullying victimization, and adverse neighborhood. Outcome measures were derived from the self-report Strengths and Difficulties Questionnaire including total difficulties, emotional symptoms, conduct problems, hyperactivity, peer problems, and prosocial behavior. Latent class analysis resulted in a three-class solution: low ACEs, household challenges, and community challenges. Compared to the other classes, the community challenges class scored substantially worse on total difficulties, emotional symptoms, and peer subscales. The cumulative risk score was associated with all outcomes except prosocial behavior. Cumulative risk models accounted for a larger proportion of variance compared with the latent class models, except for peer problems which the person-centered model explained better. This study confirms that ACEs are associated with impairment in child functioning, and that both person-centered and cumulative risk approaches can capture this relationship well. Specifically, the person-centered approach demonstrated how co-occurring risk factors in the community challenges class produced particularly poor internalizing outcomes.

Cross-time comparison of adverse childhood experience patterns among Kenyan youth: Violence Against Children and Youth Surveys, 2010 and 2019

BACKGROUND

Adverse childhood experiences (ACEs) are a global public health concern. Many children experience multiple ACEs. Patterning of multiple ACEs may change over time.

OBJECTIVE

To assess latent classes of ACEs among male and female youth in Kenya and evaluate whether ACEs latent classes changed between surveys conducted in 2010 and 2019.

PARTICIPANTS AND SETTING

We used data from Kenya Violence Against Children and Youth Survey, a repeated nationally representative survey of male and female youth aged 13-24: 2010 (nf = 1227; nm = 1456) and 2019 (nf = 1344; nm = 788).

METHODS

Latent class analysis was used to estimate clustering of seven ACEs: orphanhood, experiencing physical intimate partner violence, physical violence by a parent/caregiver, physical violence by an adult community member, forced first sex, emotional (EV) and sexual violence (SV), stratified by sex and time.

RESULTS

For females in 2010, identified classes included (1) SV only, (2) household and community physical violence (PV), EV and SV, (3) household and community PV only, (4) low ACEs, and (5) EV only. In 2019, classes included (1) SV only, (2) household and community PV only, and (3) low ACEs. Among males in 2010, the four-class model included (1) household and community PV with EV, (2) low ACEs, (3) household and community PV with SV, and (4) household and community PV only. In 2019, identified classes included (1) orphanhood and SV, (2) orphanhood and PV, (3) low ACEs, and (4) household and community PV only. For both males and females, across the two survey years, some classes demonstrated continuity (low ACEs and caregiver and community PV for both males and females, and SV for females). Orphanhood emerged as relevant to the ACEs latent class structure in 2019 compared to 2010 among males.

CONCLUSION

Prevalence and changes in latent classes between 2010 and 2019 can point toward priority areas and subgroups for violence prevention and response in Kenya.

Adverse childhood experiences and adult outcomes using a causal framework perspective: Challenges and opportunities

BACKGROUND

Research on the effect of adverse childhood experiences (ACEs) on adult outcomes has typically relied on retrospective assessment of ACEs and cumulative scores. However, this approach raises methodological challenges that can limit the validity of findings.

OBJECTIVE

The aims of this paper are 1) to present the value of directed acyclic graphs (DAGs) to identify and mitigate potential problems related to confounding and selection bias, and 2) to question the meaning of a cumulative ACE score.

RESULTS

Adjusting for variables that post-date childhood could block mediated pathways that are part of the total causal effect while conditioning on adult variables, which often serve as proxies for childhood variables, can create collider stratification bias. Because exposure to ACEs can affect the likelihood of reaching adulthood or study entry, selection bias could be introduced via restricting selection on a variable affected by ACEs in the presence of unmeasured confounding. In addition to challenges regarding causal structure, using a cumulative score of ACEs assumes that each type of adversity will have the same effect on a given outcome, which is unlikely considering differing risk across adverse experiences.

CONCLUSIONS

DAGs provide a transparent approach of the researchers' assumed causal relationships and can be used to overcome issues related to confounding and selection bias. Researchers should be explicit about their operationalization of ACEs and how it is to be interpreted in the context of the research question they are trying to answer.

Measuring adverse childhood experiences with latent class trajectories

BACKGROUND

Adverse childhood experiences (ACEs) are associated with several negative health and behavioral outcomes during adolescence, but most of the extant research has employed ACEs scores at one or two time points. Studies have not assessed whether latent class ACEs trajectories affect adolescent problem behaviors and conditions.

OBJECTIVES

We used longitudinal data from the Fragile Families and Child Wellbeing Study (FFCWS, n = 3444) to assess ACEs at several time points and empirically developed latent class trajectories. We then examined the sociodemographic characteristics of youth who belonged to each trajectory group. We next evaluated whether the ACEs trajectories during childhood were associated with delinquent behavior, substance use, and symptoms of anxiety or depression. Finally, we explored whether closeness to mother buffered the impact of ACEs on these outcomes.

METHODS

Eight types of ACEs were captured in the FFCWS data. ACE scores were assessed at year one, three, five, and nine, along with the outcomes during year 15. Trajectories were estimated with a semiparametric latent class models.

RESULTS

The analysis revealed three latent trajectories during childhood: a low/none ACEs group, a medium exposure group, and a high exposure group. Adolescents in the high exposure group manifested a heightened risk of involvement in delinquent behaviors and substance use. They also reported more symptoms of anxiety and depression than their peers in the low/none and medium exposure groups.

CONCLUSIONS

Repeated exposure to ACEs during childhood can have serious negative repercussions in the lives of adolescents, but maternal closeness may buffer their effects. Scholars should continue to examine the dynamics of ACEs exposure during childhood by using empirical approaches appropriate for identifying age-graded trajectories.

The Influence of Adverse Childhood Experiences on Suicidal Behaviors in South Korea: The Mediating Effects of Depressive Symptoms and Latent Class Analysis

This study examines the relationship between patterns of adverse childhood experiences (ACEs) and suicidal behaviors. It investigates the role of depressive symptoms as an underlying mechanism between patterns of ACEs and suicidal behaviors in South Korea. Data came from the 2012 Korean General Social Survey (KGSS), a nationally representative sample in South Korea (N = 1,048). The dependent variables included two suicidal behaviors: suicidal thoughts and a suicide plan or attempt. The independent variable was the patterns of ACEs identified using ten binary indicators of childhood adversity. The mediating variable of depressive symptoms was measured using the Korean version of the Patient Health Questionnaire-9 (PHQ-9). Covariates were also included to control for socio-demographic characteristics: age, gender, education, and household income. This study conducted a latent class analysis (LCA) to classify different patterns of ACEs and then employed path analysis to examine mediating effects of depressive symptoms in the relationship between ACEs and suicidal behavior. Among the results, three latent classes of ACEs were identified-child maltreatment, child maltreatment and family dysfunction, and low ACEs. The child maltreatment and child maltreatment and family dysfunction classes were more likely to have suicidal thoughts and to plan or attempt suicide compared to the low ACEs class. Path analysis also showed significant indirect pathways from ACEs exposure to suicidal behaviors through depressive symptoms. This evidence corroborates previous research that shows family dysfunction and child maltreatment as detrimental factors leading to depressive symptoms and suicidal behaviors. Practitioners and policy-makers should therefore consider childhood life experiences when assessing suicidal behaviors in health prevention and intervention strategies.

Youth Suicide and Self-Harm: Latent Class Profiles of Adversity and the Moderating Roles of Perceived Support and Sense of Safety

Research suggests that exposure to adversity can lead to an increased risk of experiencing suicidal and self-injurious thoughts or behaviours, but few studies have examined whether different patterns of adversity are differentially associated with youth suicide/self-harm. The current study aims to explore the relationship between exposure to adversity across various social domains and youth self-harm and suicidality, using a person centred approach, and examines whether access to social support and a sense of safety across home, peer or school settings buffer the relationship between adversity and self-harm/suicidality. Secondary data analyses were carried out on cross-sectional self-report data collected from 4848 (M_age=15.78, SD = 0.59; 50% female) adolescents who participated in the Irish Planet Youth survey. Latent Class Analyses identified four distinct profiles of adversity; low-adversity (n = 2043, 42%); peer-adversity (n = 972, 20%); parental-adversity (n = 1189, 25%); and multiple-adversity (n = 644, 13%). Findings from logistic moderated regressions indicated that there were significant differences in self-harm and suicidality across the adversity classes. Although parental support and perceived safety at school were negatively associated with suicidality and self-harm outcomes, no significant moderation effects were observed. These findings suggest that youth who experience adversity across multiple social domains are more likely to report suicidal and self-harm thoughts and behaviours, and should be key targets for intervention/prevention efforts. While parental support and school safety may act as significant compensatory factors, further work is needed to identify the social resources that can offset the risk imposed by youth's adverse experiences.

Comparison of adverse childhood experience analytic approaches and associations with emotional and behavioral problems: A nationwide study among Chinese middle school students

BACKGROUND

Adverse childhood experiences (ACEs) are demonstrated to be strongly associated with many health related problems, which have aroused extensive public attention. But the variety of analytic approaches of ACEs has limited researchers to differentiate those approaches across the outcomes.

METHODS

A total of 22,686 middle school students were surveyed, and their ACEs and health related behaviors were collected. Four different analytic approaches were used to compare the effects of ACEs on four outcomes (non-suicidal self-injury, suicidal ideation, depression and anxiety symptoms). Logistic regression models were applied to verify the associations of adversities and four outcomes. R² and the areas under the Receiver Operator Characteristic (ROC) curve were computed to compare the effects of four approaches.

RESULTS

It was suggested that four measures of ACEs were significantly associated with all the outcomes in both the unadjusted and adjusted models (Ps all <0.05). R² and areas under ROC curve showed that the contributions of four analytical approaches to different outcomes were diverse in this study. ACEs were more impactive to girls than to boys.

CONCLUSION

ACEs are profound influencing factors of emotional and behavioral problems among middle school students. The selection of analytic approaches of ACEs depends on the need of research, and our study contributes to the choice of suitable analytic methods for future research of ACEs.

The Relationship of Risky Online Behaviors and Adverse Childhood Experiences to Online Sexual Victimization Among Korean Female Adolescents

Prior research has demonstrated that online sexual victimization (OSV) is a significant social problem and is associated with adolescents' negative developmental outcomes. However, it remains unclear whether adolescents' risky online behaviors and offline victimization are related to the risk of OSV. The present study examined whether female adolescents' risky online behaviors (mood regulation through the Internet, ingratiating behavior, disclosure of personal information, harassing behavior, talking with someone met online, and sexual behavior) and offline victimization (adverse childhood experiences [ACEs]) would be associated with OSV. This study recruited female adolescents and their mothers within six metropolitan cities and provinces of residential areas of South Korea. A total of 509 female adolescents participated in the survey (aged 13-18 years). The present study employed multivariate regression to examine the relationship of risky online behaviors and offline victimization to the experience of OSV. Female adolescents' risky online behaviors (harassing behavior, talking with someone met online, and sexual behavior) were significantly associated with OSV, and those with high exposure to maltreatment and family dysfunction during childhood were more at risk of OSV than adolescents with low exposure to ACEs. The results suggest that it is important to address the effects of risky online behaviors and exposure to offline victimization on female adolescents' sexual victimization online. Identifying risky online behaviors and offline victimization related to OSV can help researchers and practitioners further understand female adolescents' online victimizations in the context of offline and online dynamics.

Patterns of Adverse Childhood Experiences and Mental Health: Evidence From College Students in Korea

Adverse childhood experiences (ACEs) are concerning exposures that may have detrimental effects on mental health. Much of the prior evidence on ACEs comes from the U.S and western developed countries. In light of the limited knowledge of ACEs in other social contexts and the interconnection among adversities, this study aims to identify distinct patterns of co-occurring ACEs and examines the associations between those adversities and mental health in South Korea. We used data from a national sample of Korean college students recruited via non-probability quota sampling in 2019 (N = 1037). The dependent variables included three measures of mental health assessed by the Brief Symptom Inventory depression symptoms, anxiety symptoms, and somatization symptoms. The independent variable was the patterns of ACEs identified using 14 indicators of childhood adversity. We conducted a Latent Class Analysis with a distal outcome, using the Bolck, Croons, and Hagenaars method. The analysis found four patterns of ACEs: extreme adversity (8%), family violence (20.3%), economic adversity (10.4%), and low adversity (61.3%). The extreme adversity group exhibited multiple exposures, including interpersonal violence in home environments, economic hardship, and bullying victimization by peers. The results suggest that the extreme adversity and family violence groups showed significantly worse mental health symptoms than the economic adversity and low adversity groups. Also, the extreme adversity group reported significantly higher levels of depression symptoms and somatization symptoms than the family violence group. This study expands the current understanding of ACEs and their harmful effects on mental health in young adulthood specific to Korea while comparing them with other social contexts. Researchers and practitioners should recognize the co-occurrence of child adversities, rather than overestimating sole adversity, to develop effective strategies for promoting mental health.

Childhood trauma and college student health: a review of the literature

The experience of childhood trauma is known to predict health-relevant outcomes across the lifespan. Previous reviews summarize existing knowledge of the implications of childhood trauma for health in young adults and adults more generally. The current theoretical review aims to integrate the existing literature on the relationship between childhood trauma and health-relevant outcomes specifically in college students, consolidating findings across specific health domains. Further, the following theoretical review highlights the need for more research in this area and discusses how college campuses may use the knowledge in this area of work to develop targeted interventions aimed at improving the health of college students who experienced trauma in childhood.

Adverse Childhood Experiences and Intimate Partner Violence Among Youth in Cambodia: A Latent Class Analysis

Adverse childhood experiences (ACEs) are a global public health problem, including in low- and middle-income country settings, and are associated with increased risk of intimate partner violence (IPV) during young adulthood. However, current measurement of ACEs may underestimate sequelae of different combinations, or classes, of ACEs and mask class-specific associations with adult exposure to IPV. We used data among ever-partnered young women and men aged 18-24 years from the Cambodia Violence Against Children Survey (N_w = 369; N_m = 298). Participants retrospectively reported on seven ACEs and lifetime physical and/or sexual IPV victimization and perpetration. Latent classes comprised of ACEs were used as predictors of physical and/or sexual IPV perpetration and victimization, controlling for household wealth. Identified latent classes for women were "Low ACEs" (60%), "Community Violence and Physical Abuse" (23%), and "Physical, Sexual and Emotional Abuse" (17%). Latent classes for men were "Low ACEs" (48%) and "Household and Community Violence" (52%). Among women, those in the Physical, Sexual and Emotional Abuse class were more likely to experience and perpetrate physical and/or sexual IPV in their romantic relationships compared to the reference group (Low ACEs). Women in the Community Violence and Physical Abuse class were more likely to perpetrate physical and/or sexual IPV, but not experience IPV, compared to women in the Low ACEs class. Among men, those in the Household and Community Violence class were more likely to perpetrate physical and/or sexual IPV against a partner, compared to men in the Low ACEs class. Overall, patterns of ACEs were differently associated with IPV outcomes among young women and men in Cambodia. National violence prevention efforts might consider how different combinations of childhood experiences shape risk of young adulthood IPV and tailor interventions accordingly to work with youth disproportionately affected by varied combinations of ACEs.

Patterns of Childhood Adversities and Their Associations With Adult Victimization Among Incarcerated Men and Women in Spanish Prisons

Adverse childhood experiences (ACEs) are prevalent and have long lasting effects. There is evidence of gender differences in exposure to different types of ACEs, with women experiencing higher levels of sexual abuse and cumulative adversity than men. Despite this, most research examining patterns of adversities have used joint samples, assuming that men and women have comparable profiles. The current study examines if distinct profiles of childhood adversities exist for men and women and analyzes their associations with multiple forms of interpersonal victimization during adulthood. Participants were 2,709 residents (91.6% men and 8.4% women) from eight prisons in Spain, who completed a self-administered survey. Latent Class Analysis revealed different patterns of childhood adversities for men and women. For both groups, higher adversity was associated with interpersonal harm during adulthood.

How adverse and benevolent childhood experiences influence depression and suicidal ideation in Chinese undergraduates: a latent class analysis

BACKGROUND

There has been minimal research on the role of benevolent childhood experiences (BCEs) and how such events may offer protection from the insidious effects of adverse childhood experiences (ACEs) or later in life.

OBJECTIVES

This research aims to learn how BCEs and ACEs interact to affect adolescents' psychological distress.

METHODS

Cross-sectional survey was conducted in three cities (Xuzhou, Nanjing, and Wuhan) in China from March 2021 to May 2021. Latent class analysis (LCA) was used to classify the patterns of ACEs and BCEs. We adopted hierarchical multivariable regression to examine the influences of ACEs and BCEs on depression and suicidal ideation.

RESULTS

To explore the relationship between childhood experience and suicidal ideation and depression, LCA revealed three patterns of ACEs: (1) emotional abuse (10.57%); (2) high ACEs (0.55%); and (3) low ACEs classes (88.88%). Adolescents with emotional abuse (depression: OR = 3.82, 95%CI = 2.80-5.22, P < 0.001; suicidal ideation: OR = 5.766, 95%CI = 3.97-8.38, P < 0.001) and high ACEs class (suicidal ideation: OR = 5.93, 95%CI = 1.19-29.66, P < 0.05) had an increased risk of psychological distress (reference: low ACEs). LCA revealed four patterns of BCEs: (1) relationship support (14.54%); (2) low BCEs (4.85%); (3) high BCEs (55.34%); and (4) high quality of life classes (25.28%). Adolescents with a high quality of life (depression: OR = 0.09, 95%CI = 0.05-0.16, P < 0.001; suicidal ideation: OR = 0.22, 95%CI = 0.12-0.40, P < 0.001) and high BCEs (depression: OR = 0.05, 95%CI = 0.03-0.09, P < 0.001; suicidal ideation: OR = 0.15, 95%CI = 0.09-0.26, P < 0.001) protected the mental health of adolescents (reference: low BCEs).

CONCLUSIONS

High ACEs and emotional abuse classes were significantly associated with poorer mental health symptoms, including suicidal ideation and depression. In contrast, high BCEs and high quality of life classes were associated with better mental health. These findings point out that it is more necessary to identify and support victims of ACEs, and it is urgent to increase BCEs in early childhood.

Childhood Adversity, Emotional Well-Being, Loneliness, and Optimism: a National Study

Optimism and loneliness, which reflect the expected inverse associations with excess morbidity and mortality, are theoretically and empirically associated with early adversities and offer potential avenues for clinical support. The current study first estimates latent classes of adverse childhood experiences and, second, assesses the role of these experiences on later reports of optimism and loneliness in late adolescence and emerging adulthood, and the role of emotional regulation and common mental disorders. Surveys were conducted in a longitudinal household sample of adolescents recruited in 2013 (average age of 20 at wave 6 follow-ups). The analytic sample included 1177 female and male respondents representative of their age group in the USA at baseline. Latent classes were estimated based on 10 indicators of childhood adversity. Respondents were assigned to classes using posterior probabilities of latent class membership, and class membership was used to predict psychological outcomes in multivariable models. Three latent classes of childhood adversity were identified in the current sample, representing low childhood adversity (81.5%), higher probability of family dysfunction with lower levels of interpersonal abuse (13.4%), and high adversity including higher probabilities of parental discord and violence as well as child abuse (5.1%). Both classes of respondents who faced greater childhood adversity were more likely to report greater loneliness and lower optimism in emerging adulthood. Results were attenuated by measures of emotional well-being. Addressing adolescent loneliness and supporting optimistic outlooks in emerging adulthood are two pathways with potential benefits to reduce mental and physical morbidities.

Adverse childhood experiences and child behavioral health trajectory from early childhood to adolescence: A latent class analysis

BACKGROUND

Adverse childhood experiences (ACEs) profoundly influence child development. Different patterns of ACEs among boys and girls may be associated with different developmental trajectories.

OBJECTIVE

This study aimed to identify patterns of ACEs at age three and tested the associations of these patterns with child behavioral health problems from age three to age fifteen.

PARTICIPANTS AND SETTING

This study used data (N = 4898) from the Fragile Families Child Wellbeing Study.

METHODS

First, this study conducted latent class analysis (LCA) across ten indicators of ACEs at age 3. LCA was conducted separately for boys and girls. Second, class membership was tested for associations with child internalizing symptoms and externalizing behaviors (ages three, five, nine, and fifteen years).

RESULTS

LCA identified five classes of ACEs for girls: low ACEs, parental separation, financial difficulty, chaotic home, and child maltreatment. LCA for boys, however, identified a six-class solution, in which there was a physical abuse-only class, while also a sixth high ACEs class that included both physical and emotional abuse. Classes with the most ACEs often had the highest symptomology (internalizing symptoms ranging from 0.24 to 0.56; externalizing ranging from 0.36 to 1.00; ps < .05). However, differences in behavioral health were detected depending on the patterns of ACES. At ages nine and fifteen, the financial difficulty group also had high symptomatology (internalizing symptoms ranging from 0.23 to 0.43; externalizing from 0.23 to 0.46; ps < .05).

CONCLUSIONS

Findings provide implications including the need to examine ACEs heterogeneity and address financial difficulty as a substantial ACE.

Patterns of Adverse Childhood Experiences, Social Problem-Solving, and Mental Health Among Latina Immigrants

Researchers have established the long-term negative impact of adverse childhood experiences (ACEs) on mental health. Evidence also shows that different types of ACEs often co-occur and that ACEs profiles have differential impact on mental health. However, this prior research has often omitted first-generation Latino immigrants-a growing segment of the population, with potentially higher risk for ACEs, decreased access to mental health services, and increased risk for remaining in poor mental health. In this study, we conducted a cluster analysis using a sample of 336 Latina immigrant to examine: (1) patterns of ACEs, and (2) the mediating role of social problem-solving in the association between ACEs and mental health (depression, anxiety, and post-traumatic stress disorder symptoms [PTSD]) and life satisfaction. We identified 5 clusters: (a) Global ACEs (n = 52, 15.5%), (b) Community Violence and Physical Abuse (n = 80, 23.8%), (c) Physical and Emotional Abuse (n = 72, 21.4%), (d) Household Dysfunction with Physical and Emotional Abuse (n = 56, 16.7%), and (e) Low ACEs (n = 76, 22.6%). The clusters differed by social problem-solving, chronic life burden, mental health, and life satisfaction. Compared to the Low Abuse cluster, the Community Violence and Physical Abuse, and Global ACEs clusters were significantly more likely to have higher depression, anxiety, and PTSD symptoms. Social problem-solving was independently associated with all mental health variables and life satisfaction, and mediated the association between ACEs and depression and anxiety for those in the Community Violence and Physical Abuse cluster. Our study sheds light on how ACEs are experienced by Latina immigrants. Social problem-solving also emerged as a significant determinant of mental health and life satisfaction, and may be a point of intervention for improving mental health in this population.

Latent Classes of Adverse and Benevolent Childhood Experiences in a Multinational Sample of Parents and Their Relation to Parent, Child, and Family Functioning during the COVID-19 Pandemic

Adverse Childhood Experiences (ACEs) are known to contribute to later mental health. Conversely, Benevolent Childhood Experiences (BCEs) may buffer against mental health difficulties. The importance of ACEs and BCEs for mental health of both parents and children may be most obvious during periods of stress, with potential consequences for functioning of the family. Subgroups of ACEs and BCEs in parents during the COVID-19 pandemic were investigated and validated in relation to indices of parent, child, and family well-being. In May 2020, ACEs/BCEs were assessed in 547 parents of 5-18-year-old children from the U.K., U.S., Canada, and Australia. Subgroups of parents with varying levels of ACEs and BCEs were identified via latent class analysis. The subgroups were validated by examining associations between class membership and indices of parent and child mental health and family well-being. Four latent classes were identified: low-ACEs/high-BCEs, moderate-ACEs/high-BCEs, moderate-ACEs/low-BCEs, and high-ACEs/moderate-BCEs. Regardless of the extent of BCEs, there was an increased risk of parent and child mental health difficulties and family dysfunction among those reporting moderate-to-high levels of ACEs. Parents' history of adversity may influence the mental health of their family. These findings highlight the importance of public health interventions for preventing early-life adversity.

Adversity effects on nonword repetition skills: A proxy measure of language and reading ability

BACKGROUND

Children exposed to adversity are at increased risk for underachievement in reading; however, how early that risk appears and the mechanisms underlying that risk are unclear.

OBJECTIVE

Identify whether individual variation in nonword repetition-a clinical indicator of language and reading ability-can be captured in early childhood (three- to five-years-old) and how various features of adversity exposure (e.g., dosage, severity) are associated with performance.

PARTICIPANTS AND SETTING

Community-based sample of children between the ages of three- and five-years-old who were exposed to significant adversity (n = 92) and living in a major Midwestern metropolitan area.

METHODS

Participants completed a nonword repetition task, and their parent completed a comprehensive adversity questionnaire to report on the child's cumulative lifetime adversity exposure.

RESULTS

Over a third of the participants (34.78 %) did not meet age expectations on the nonword repetition task; however, nonword repetition performance did not significantly associate with the features of the adverse experience (i.e., dosage, severity, frequency, chronicity).

CONCLUSIONS

Risk for underachievement in reading appears early in the preschool years for children exposed to adversity; however, the underlying mechanisms remain unclear since the features of the children's adverse experiences did not associate with their performance. Implications for prevention and early identification within the learning context are discussed.

Adverse childhood experiences and positive psychotic symptoms: A nationally representative study in Singapore

BACKGROUND

Epidemiological studies show that adverse childhood experiences (ACE) are associated with positive psychotic symptoms in Western populations; however, there is a lack of population-based data in multi-ethnic, Asian societies.

OBJECTIVE

We investigated the associations between ACE (type and dosage) and positive psychotic symptoms in a nationally representative study in Singapore.

PARTICIPANTS AND SETTING

A total of 4441 adult Singapore residents were recruited via door-to-door surveys; they were assessed for ACE and positive psychotic symptoms (i.e., hallucinations, delusions, thought insertion, thought control, and telepathic powers) on structured interviews.

METHODS

Lifetime experiences of positive psychotic symptoms were regressed on (1) the experience of any ACE; (2) cumulative ACE; and (3) the experience of either no ACE, interpersonal victimization only, dysfunctional home environments only, neglect only or multiple exposures to ACE in weighted and adjusted regression models.

RESULTS

5.2 % of the sample experienced positive psychotic symptoms during their lifetime. Individuals exposed to dysfunctional home environments (OR = 2.84, 95 % CI 1.26 to 6.37) and multiple adverse childhood experiences (OR = 3.31, 95 % CI 2.18 to 5.01) were at an elevated risk of experiencing positive psychotic symptoms. The exposure to three or more ACE was associated with a near five-fold higher risk of experiencing positive psychotic symptoms (OR = 4.51, 95 % CI 2.89 to 7.05).

CONCLUSIONS

Individuals exposed to dysfunctional home environments or multiple adverse childhood experiences are at an elevated risk of experiencing positive psychotic symptoms. Given the intrafamilial nature of these childhood adversities, dual-generation approaches and family-centered interventions are key.

How psychosocial stress profile influences the subsequent occurrence of neuropsychiatric comorbidities: A longitudinal population-based cohort study

BACKGROUND

The role of psychosocial stressors in psychiatric disorders and executive dysfunction has been reported, separately. The literature has also suggested the involvement of social support and coping strategies in these relationships. However, there is a lack of research conducted to examine the relationships among multiple stressors and neuropsychiatric comorbidities while considering the presence of social support and coping strategies. This study aims to articulate the roles of multiple psychosocial stressors, social support, and coping strategies in the subsequent occurrence of neuropsychiatric comorbidities.

METHODS

Data analyzed were from the 6th data collection of a large-scale, longitudinal population-based cohort from Southwest Montreal in Canada. The cumulative effects of multiple stressors were separately examined by a composite score and latent profile analysis. Multinomial logistic regression models were used to test the relationship between cumulative stressors and neuropsychiatric comorbidities.

RESULTS

A total of 210 participants were included in the analyses. The LPA identified a 2-class model for psychosocial stressors (low and high) and executive function (executive dysfunction and no executive dysfunction), respectively. There were 11.8% of participants with neuropsychiatric comorbidities. Both the composite stress score (RR = 1.08, 95%CI = 1.01-1.15) and latent stress groups (RR = 3.65, 95%CI = 1.15-11.57) were associated with neuropsychiatric comorbidities after adjusting for social support and coping strategies. The risk of developing neuropsychiatric comorbidities decreased when the level of social support was high (P < 0.05).

CONCLUSIONS

Exposures to multiple stressors increased the risk of subsequent neuropsychiatric comorbidities, but the risk can be modified by a higher level of social support.

Distinct Patterns of University Students Study Crafting and the Relationships to Exhaustion, Well-Being, and Engagement

Job crafting has been established as a bottom-up work design instrument for promoting health and well-being in the workplace. In recent years, the concepts of job crafting have been applied to the university student context, proving to be positively related to student well-being. Building on person-centered analyses from the employment context, we assessed approach study crafting strategy combinations and the relationships to students’ exhaustion, study engagement, and general well-being. Data from 2,882 German university students were examined, collected online during the summer term in 2020. Using latent profile analysis, we found five distinct crafting groups, which showed discriminate validity with regard to emotional exhaustion, engagement, and well-being. The results underscore the positive role of study crafting for students’ health and well-being. They further indicate a less important role of increasing social resources for emotional exhaustion when combined with a moderate increase in structural resources and a moderate increase in challenging demands. Our findings imply that interventions to promote study crafting should be considered to promote student health and well-being.

Effects of multiple adverse childhood experiences on substance use in young adults: A review of the literature

BACKGROUND

Adverse childhood experiences (ACE), including maltreatment and household dysfunction, are consistent predictors of health compromising behaviors in adulthood. While most ACE studies have focused on adults, there is an emerging body of research focusing on young adulthood.

METHODS

This review describes research focused on the relationship between ACE and substance use among young adults. Two databases were searched for studies published from 1998 to 2021 that assess the relationship between ACE and substance use among young adults. Of the 1474 articles identified in the search, 43 met the inclusion criteria.

RESULTS

Consensus across reviewed studies is that the relationship between ACE and substance use demonstrated in the general adult population is evident in young adults, although effects varied by demographic variables such as gender and ethnic background.

CONCLUSIONS

The need for standardized measures across studies, racial/ethnic considerations, and the importance of building trauma informed prevention programs targeting this age group are discussed.

Adverse childhood experiences: Examining latent classes and associations with physical, psychological, and risk-related outcomes in adulthood

BACKGROUND

Adverse childhood experiences (ACEs) are a public health crisis, affecting nearly half of children in the United States. Long-term effects of ACEs on psychological well-being, engagement in risk behaviors, and physical health have been observed. Moreover, many individuals exposed to ACEs are also affected by an accumulation of stressors due to broader structural inequities.

OBJECTIVE

The current study examined heterogeneity in patterns of ACEs, explored how these patterns varied based on race/ethnicity, biological sex, and socioeconomic status, and assessed how ACE patterns were associated with physical health, mental health, and risk-related outcomes in adulthood.

PARTICIPANTS

Drawing on the Add Health dataset, survey data from Waves I, III, IV (n = 12,288) were analyzed. Mean age of participants was 28.3 (SD = 1.9), more than half were female (54.4%), and a little less than half identified as youth of color (46.7%).

METHOD

Multigroup latent class analysis explored heterogeneity in ACE exposure and variations based on structural inequities. Latent class regression assessed associations between ACE classes and outcomes.

RESULTS

A four-class solution was identified. Class sizes and latent structures differed by biological sex. Among males and females, the low adversity class had more positive physical health, mental health, and risk-related outcomes compared to all classes, while the childhood maltreatment and high adversity/community violence classes engaged in more risk-related behaviors. Very small to medium effects were observed.

CONCLUSION

Findings highlight the importance of examining heterogeneity in ACE exposure, and how patterns of ACEs may differentially affect outcomes in adulthood.

Childhood Abuse Classes for Incarcerated Men and Women: Are There Unique Gender Patterns in Abuse Classes?

Childhood adversity is predictive of poorer health and behavioral health outcomes in adulthood. Males and females are known to experience different types of childhood adversity, with females experiencing more sexual and emotional harm in childhood. Latent class analysis (LCA) has been used to identify patterns among types of childhood adversity. These studies have constructed class structures using single gender or blended gender samples. Class structures based on blended gender samples, however, may misrepresent the nuances of gender-specific adversity histories through averaging, potentially distorting the relative need for gender-specific types of intervention. This study investigated whether latent class structures of childhood abuse are equivalent for incarcerated males and females. Our sample included 4,204 residents (3,986 males, 218 females) drawn from a single prison system. Residents completed an hour-long audio computer-assisted self-interview that included questions on 10 types of childhood abuse, depression, and anxiety symptoms, the Beck Hopelessness Scale (BHS), Buss-Perry Aggression Questionnaire, and Criminal Sentiments Scale-Modified (CSS-M). Overall, female residents were both more likely to experience childhood abuse and have more extensive victimization experiences. Small subgroups of males, however, had even more extensive victimization experiences. Abuse patterns for males and females, while optimally clustering in four classes, are rather unique, especially for higher abuse classes, in terms of distribution of membership and types of abuse. These differences may matter in terms of identifying the relative need for therapeutic intervention among incarcerated males and females and targeting those interventions in ways that reflect the gradient and density of therapeutic need. The next step is to test whether using blended or gendered latent class structures matters in terms of predicting outcomes, such as prison-based behavioral health problems, suicidality, and victimization.

Profiles of adverse childhood experiences and protective resources on high-risk behaviors and physical and mental disorders: Findings from a national survey

BACKGROUND

Adverse childhood experiences (ACE) vary across culture and their heterogenous impact on health outcomes is understudied. The present population-based study determined latent classes of adverse childhood experiences, examined socio-demographic variations between identified classes, and elucidated the interactions between class membership and protective resources (i.e., positive mental health and perceived social support) on high-risk behaviors (i.e., smoking, binge drinking, and suicidality), chronic physical disorders, and mental disorders.

METHODS

A total of 4441 adult Singapore residents were recruited from the community. Lifetime mental disorders and suicidality were assessed on structured clinical interviews by trained interviewers, while chronic physical disorders, smoking, binge drinking, ACE, perceived social support, and positive mental health were self-reported.

RESULTS

Latent class analysis identified three distinct profiles; a multiple adversities class endorsing elevated levels of abuse and violence (6.1%), an emotionally neglected and bullied class (7.6%), and a low adversities class (86.2%). The multiple adversities class was associated with younger age, female gender, lower education status, more high-risk behaviors (e.g. binge drinking and suicidality), and physical/mental disorders. A three-way interaction was observed between ACE profiles, social support, and positive mental health on suicidality; high social support and positive mental health reduced the risk of suicidality in the multiple adversities class.

LIMITATIONS

Results may not be generalizable beyond the Singapore population due to cultural factors.

CONCLUSIONS

Clinical assessment should adopt a person-centered approach to identify profiles of ACE and determine their interactions with protective resources on high-risk behaviors and physical/mental disorders; patient-tailored treatment may subsequently build upon these profiles.

The role of adverse childhood experiences (ACEs) in predicting academic problems among college students

BACKGROUND AND OBJECTIVE

The complex associations between adverse childhood experiences (ACEs) and academic performance among college students are not well understood. The following aims were examined in this longitudinal study: the direct association of ACEs on academic problems after 4 years without (1) and with accounting for other academic risk factors (2a), the possible mechanisms linking ACEs and academic problems (2b).

PARTICIPANTS AND SETTING

First-semester freshmen (N = 268; 71.3% female; M_age = 18.30; 76.9% White, 14.6% Asian, 3.7% Black, 2.6% multiracial, 1.1% Native American, and 1.1% other) were recruited from a Midwestern U.S. university.

METHODS

Participants reported their ACEs, intrinsic motivation, psychological distress, and financial status as first-semester freshmen. Administrative records (i.e., SAT/ACT scores, GPA, courses taken not counted toward degree progress, and graduation) were collected prospectively over 4 years. Structural equation modeling was used to test the research aims. Post-hoc analyses without SAT/ACT scores were conducted.

RESULTS

ACEs were associated with academic problems assessed 4 years later, when studied in isolation (β = 0.36, p < .001) but not after adjusting for other risk factors (β = 0.08, p = .278). Psychological distress and SAT/ACT scores during the first semester predicted academic problems 4 years later (β = 0.33 and - 0.38, p < .001). There was an indirect effect of ACEs on academic problems through psychological distress (β = 0.13, p < .001).

CONCLUSIONS

There is a need to expand mental health services and address barriers to utilization on college campuses.

Examining the Associations between Adverse Childhood Experiences, Health Risk Behaviours, and Psychological Well-Being in a Convenience Sample of Lithuanian University Students

This study examines the associations between adverse childhood experiences (ACEs), health risk behaviours, and psychological well-being among Lithuanian university students. A cross-sectional survey was carried out with a convenience sample of 393 students (80.7% females and 19.3% males) recruited from mostly undergraduate courses (96.4%) in Lithuanian universities. Participants, aged 18−25 years (21.07 ± 1.53), completed a web-based survey in which they were asked to retrospectively self-report on ACEs while answering questions on health risk behaviours (e.g., smoking, substance use, riding a car with a drunk driver) and psychological well-being. Only 8.7% of the study sample experienced no ACEs, and almost half of the sample (48.9%) experienced ≥4 ACEs. Findings from adjusted models showed that, compared with students with no ACEs, those who experienced ≥4 ACEs had higher odds of lifetime illicit drug use (AOR = 2.73, p < 0.05), riding with a drunk driver (AOR = 2.44, p < 0.05), suicidal ideation before age 18 (AOR = 28.49, p < 0.01) and in the past 12 months (AOR = 5.39, p < 0.01). An increased number of ACEs was also associated with lower psychological well-being (B = −3.94, p < 0.001). Findings from this study have implications for mental health professionals as well as university administrators, as students with a higher number of traumatic experiences may require greater levels of support and services.

The Clustering of Adverse Childhood Experiences in the Avon Longitudinal Study of Parents and Children: Are Gender and Poverty Important?

Previous research has demonstrated a graded relationship between the number of Adverse Childhood Experiences reported (an ACE score) and child outcomes. However, ACE scores lack specificity and ignore the patterning of adversities, which are informative for interventions. The aim of the present study was to explore the clustering of ACEs and whether this clustering differs by gender or is predicted by poverty. Data on 8,572 participants of the Avon Longitudinal Study of Parents and Children (ALSPAC) were used. ALSPAC is a regionally representative prenatal cohort of children born between 1991 and 1992 in the Avon region of South-West England. ACEs included parental divorce, death of a close family member, interparental violence, parental mental health problems, parental alcohol misuse, parental drug use, parental convictions, and sexual, emotional, and physical abuse, between birth and 19 years. Latent class analysis was used to derive ACE clusters and associations between poverty, gender, and the derived classes tested using multinomial logistic regression. Five latent classes were identified: "Low ACEs" (55%), "Parental separation and mother's mental health problems" (18%), "Parental mental health problems, convictions and separation" (15%), "Abuse and mental health problems" (6%), and "Poly adversity" (6%). Death of a close family member and sexual abuse did not cluster with other adversities. The clustering did not differ by gender. Poverty was strongly related to both individual ACEs and clusters. These findings demonstrate that ACEs cluster in specific patterns and that poverty is strongly related to this. Therefore, reducing child poverty might be one strategy for reducing ACEs.

Household dysfunction and child development: Do financial resources matter?

Children who experience household dysfunction often report more developmental problems and lower educational attainment. A question, however, is whether these lower outcomes are caused by the household dysfunction itself, or by other (pre-existing) factors, such as growing up in poverty. Based on the extended family stress model, we derived hypotheses on the consequences of household dysfunction for child development. Furthermore, we considered the mediating and moderating role of parents' financial resources in the impact of household dysfunction on children's development. We studied these relationships while rigorously accounting for differential selection into experiencing household dysfunction using data from the British Millennium Cohort Study and employing descriptive and fixed-effects analyses. We found that children who experienced household dysfunction after age 5 already had more behavioural problems prior to these experiences. This underscores the importance of accounting for differential selection into experiencing household dysfunction. We also found that household dysfunction beginning after age 5 led to more behavioural problems but did not impact children's verbal ability. Parents' financial resources declined after household dysfunction, particularly among high-income households. However, we found only weak evidence of a mediating effect of financial resources, and larger declines in financial resources did not translate into larger consequences of household dysfunction among children from high-income households. Financial resources thus mainly seemed to play an important role for selection into experiencing household dysfunction.

Cumulative risk, factor analysis, and latent class analysis of childhood adversity data in a nationally representative sample

BACKGROUND

Childhood adversity is a multifaceted construct that is in need of comprehensive operationalisation.

OBJECTIVE

The aim of this study was to explore the optimal method to operationalise a scale of adverse childhood experiences (ACEs).

PARTICIPANTS AND SETTING

Data were from Wave 1 of the Personality and Total Health (PATH) Through Life Project (N = 7485, 51% women). Participants from three age groups (20-25, 40-45, 60-65) retrospectively reported their childhood experiences of domestic adversity on a 17-item scale (e.g., physical abuse, verbal abuse, neglect, poverty).

METHODS

We compared three approaches to operationalising the 17-item scale: a cumulative risk approach, factor analysis, and latent class analysis (LCA). The cumulative risk and dimensional models were represented by a unidimensional and two-dimensional model respectively using confirmatory factor analysis (CFA).

RESULTS

The cumulative risk approach and LCA were viable approaches to operationalising ACE data in PATH. CFA of the dimensional model produced latent factors of threat and deprivation that were highly correlated, potentially leading to problems with multicollinearity when estimating associations. LCA revealed six classes of ACEs: high adversity, low adversity, low affection, authoritarian upbringing, high parental dysfunction, and moderate parental dysfunction.

CONCLUSION

Our study found multiple latent classes within a 17-item questionnaire assessing domestic adversity. Using both the cumulative method and latent class approach may be a more informative approach when examining the relationship between ACEs and later health outcomes. Future ACE studies may benefit by considering multi-dimensional approaches to operationalising adversity.

Maternal adverse childhood experiences (ACEs) and their associations with intimate partner violence and child maltreatment: Results from a Brazilian birth cohort

Adverse childhood experiences (ACEs) have been found to predict many negative life outcomes. However, very little evidence exists on Intimate Partner Violence (IPV) and Child Maltreatment (CM). We investigated the impact of maternal ACEs on IPV and CM in three different: cumulative risk, individual adversities and particular groupings of ACEs. The 2015 Pelotas Birth Cohort, Southern Brazil, has followed a population-based sample mothers and children repeatedly until children were aged 4 years, when mothers provided data on ACEs, and current IPV and CM. ACEs were examined in three different ways: (i) as a cumulative risk score; (ii) individual adversities; and (iii) patterns of ACEs (Latent Class Analysis: LCA). One quarter (25.4%) of mothers reported having 5+ ACEs in childhood. Compared to mothers with no ACEs, those who reported 5+ ACEs, had 4.9 (95%CI 3.5; 6.7) times the risk of experiencing IPV and 3.8 (95%CI 2.5; 5.6) times the risk of reporting child maltreatment. LCA results also highlighted the major influence of multiple ACEs on later IPV and CM. However, individual ACEs related to violence (exposure to abuse or domestic violence) showed some specificity for both later IPV and CM, over and above the influence of cumulative childhood adversity. This is the first large study to demonstrate a strong link between maternal ACEs and both IPV and CM. Cumulative ACE exposure and some specificity in effects of childhood violence are important for later IPV and CM. Integrated prevention is essential for reducing the intergenerational transmission of adversity and violence.

Patterns of adverse childhood experiences and depressive symptoms: self-esteem as a mediating mechanism

PURPOSE

There is a growing interest in the co-occurring natures of adverse childhood experiences (ACEs) and unmeasured types of adversity. The current body of knowledge may also lack plausible mechanisms linking ACEs to mental health in young adulthood. This study aims to identify early adversity patterns using expanded ACEs items and investigate the pathway of ACEs and self-esteem to depressive symptoms in young adulthood.

METHODS

Data were obtained from the National Longitudinal Study of Adolescent and Adult Health, including a nationally representative sample in the U.S. (N = 10,702). We identified the ACEs patterns and estimated the direct and indirect associations between ACEs and depressive symptoms through self-esteem, using a latent class analysis with a distal outcome.

RESULTS

This study identified four distinct groups of ACEs that include Child Maltreatment, Household Dysfunction, Violence, and Low Adversity. The Child Maltreatment class showed a significantly higher risk of depressive symptoms compared to other ACEs groups. Self-esteem mediated the negative association of child maltreatment with depressive symptoms. The Violence class presented a significantly higher risk of depressive symptoms than Low Adversity, but no mediation of self-esteem was found.

CONCLUSION

The study highlights the profound consequence of child abuse/neglect and identifies self-esteem as a plausible mediating mechanism. Researchers and practitioners should increase collaboration efforts to prevent early adversity exposures and detrimental effects on mental health.

Patterns of adverse childhood experiences and mental health outcomes among American Indians with type 2 diabetes

BACKGROUND

Extensive research demonstrates that Adverse Childhood Experiences (ACEs) are highly interconnected and have numerous health consequences well into adulthood. Yet, there is a dearth of focused research that examines ACEs and health inequities for American Indians (AIs).

OBJECTIVE

To assesses the prevalence of ten types of childhood adversities, explore constellations of exposures, and examine whether there are differential risks of mental health outcomes according to sub-group classification.

PARTICIPANTS AND SETTING

Adult AIs with type 2 diabetes from five reservation-based tribal communities in the Great Lakes region of the U.S.

METHODS

Prevalence was estimated using a modified version of the World Health Organization's ACE-International Questionnaire. To examine heterogeneity in ACEs exposures, latent class analysis was used. Risk of mental health outcomes was calculated by class.

RESULTS

The four most common ACEs reported were residing with someone who abused substances, witnessing household violence, incarceration of a household member, and sexual abuse. Three latent classes were identified: low risk (56.7%), family maladjustment with high probabilities of household violence, incarceration, and substance abuse (27.1%), and complex trauma (16.3%) with moderate to high probabilities of exposure to all ACEs. The most consistent differences in mental health outcomes were between the low risk and complex trauma classes.

CONCLUSIONS

Identification of a high number of participants in the low-risk class helps structure a more wholistic image of AI families, as negative stereotypes of AIs are abundant. For the minority of individuals in the complex trauma class, risk for chronic mental health challenges and co-morbidities appears to be high.

Adverse childhood experiences in relation to mood-, weight-, and eating-related outcomes in emerging adulthood: Does self-compassion play a buffering role?

BACKGROUND

Adverse childhood experiences (ACEs) are associated with a range of health problems, yet protective factors such as self-compassion may help buffer these associations.

OBJECTIVE

This study examined associations of distinct patterns of ACEs with depressive symptoms, body mass index (BMI), and disordered eating symptoms and investigated self-compassion as a potential protective factor.

PARTICIPANTS AND SETTING

Data from a diverse sample of 1440 emerging adults (M_age = 22.2 years; 53.7% female; 80.3% with race/ethnicity other than non-Hispanic white) came from the population-based EAT 2018 (Eating and Activity over Time) study.

METHODS

Seven types of ACEs were retrospectively self-reported and used as model indicators in latent class analysis to identify patterns of ACEs. Self-compassion, depressive symptoms, height and weight (to calculate BMI), and disordered eating symptoms were also assessed. Demographic-adjusted regression models were conducted.

RESULTS

Three latent classes emerged: "low ACEs" (66.5% of the sample), "household dysfunction" (24.3%), and "household dysfunction and abuse" (9.1%). Compared to participants in the "low ACEs" class, participants in either latent class involving household dysfunction demonstrated higher levels of depressive and disordered eating symptoms. Participants in the "household dysfunction and abuse" class also had higher BMI. Associations differed by self-compassion for depressive symptoms (p_interaction = 0.01), BMI (p_interaction = 0.03), and disordered eating symptoms (p_interaction = 0.005), such that associations for latent classes characterized by ACEs were weaker with higher levels of self-compassion.

CONCLUSIONS

These findings suggest self-compassion may act as a buffer against adverse mood-, weight-, and eating-related outcomes in the face of adversity and therefore may be an important intervention target.

Positive Functioning Moderates the Association between Classes of Adverse Childhood Experiences and Adolescent Depressive Symptoms

Adverse childhood experiences (ACEs) are associated with short- and long-term psychological health, but most research, to date, relies on retrospective self-reports during adulthood to test this association. Moreover, there is limited evidence on how ACEs group together and differentially influence mental health, as well as factors that promote positive outcomes in the context of ACEs. The present study used secondary data of children and their biological parents from the Fragile Families and Child Wellbeing Study (N = 3,487; M _age = 9.30, SD = .40 years; 52% male) to test if meaningful subgroups of ACE exposure existed at age 9, and if positive adolescent functioning moderated the association between ACE exposure class membership at age 9 and adolescent depressive symptoms at age 15. Results revealed three distinct classes: an impoverished and interpersonally abused class, a single-parent and impoverished class, and a low adversity class. Positive adolescent functioning moderated the association between class membership and depressive symptoms. Specifically, individuals in the impoverished and interpersonally abused and low adversity classes had the highest levels of depressive symptoms at low levels of positive functioning, and the lowest levels of depressive symptoms at high levels of positive functioning. Results support prior evidence that children experiencing interpersonal abuse group together into a latent class and provide a nuanced perspective on factors that promote positive functioning in the context of various constellations of ACEs.

Childhood adversities and mental health outcomes: Does the perception or age of the event matter?

The current study extends knowledge regarding the individual contribution of different adverse experiences to mental health symptoms in late adolescence by including the perception of how upsetting each experience was to the adolescent and the age at the first occurrence. We also sought to move beyond sum scores of adverse experiences by using a person-centered approach to classifying individuals with similar co-occurrence of adversities. The data came from a longitudinal study of maltreatment on adolescent development (N = 454). Self-reported childhood adversities were assessed at Wave 4 (average of 7 years postbaseline) and examined with respect to current mental health symptoms (depression, PTSD, anxiety, and externalizing). Although the adversity sum score was a potent predictor of all mental health outcomes, the results indicated that the use of a sum score obscures information about the importance of individual adversities. Additionally, the influence of age of occurrence varied based on the adversity and outcome, while the perception of the event did not add much unique variance. Finally, the latent class analyses provided unique information about the patterns of co-occurring adversity in this sample, and that membership in either of the multiple-adversity classes was associated with more mental health symptoms.

Age of Occurrence and Severity of Childhood Sexual Abuse: Impacts on Health Outcomes in Men Who Have Sex with Men and Transgender Women

Childhood sexual abuse (CSA) is associated with a wide range of health outcomes and is more prevalent among men who have sex with men (MSM) compared to men who have sex with women exclusively and among transgender women (TW) compared to cisgender peers; however, there is a lack of consensus regarding an explanatory theoretical model. This analysis examined these models across health outcomes using baseline data from a longitudinal study of MSM and TW in Chicago (n = 1,035) collected from 2015 to 2019. Severity of CSA was measured for two age ranges (prior to 13 and 13-17). Logistic regression and negative binomial regressions were estimated. Teenage experiences of CSA were associated with alcohol problems, cannabis problems, suicide ideation/attempt, depression, condomless anal sex partners, rectal STI, and HIV. Pre-teenage CSA was associated with alcohol use and depressive symptoms. Significant interactions across age of experience of CSA were found for alcohol problems, cannabis problems, and condomless anal sex partners. Consistent with previous literature, this analysis found CSA to be a significant influence on various health outcomes. No single explanatory framework emerged; however, adolescent exposures may be more closely linked to health outcomes and risk behaviors than pre-teenage or cumulative exposures.

Can Adverse Childhood Experiences Heighten Risk for Problematic Internet and Smartphone Use? Findings from a College Sample

Background: College students are among the heaviest users of smartphones and the Internet, and there is growing concern regarding problematic Internet (PIU) and smartphone use (PSU). A subset of adverse childhood experiences, household dysfunction [(HHD) e.g.; parental substance use, mental illness, incarceration, suicide, intimate partner violence, separation/divorce, homelessness], are robust predictors of behavioral disorders; however, few studies have investigated the link between HHD and PIU and PSU and potential protective factors, such as social support, among students. Methods: Data are from a diverse California student sample (N = 1027). The Smartphone Addiction Scale—Short Version and Internet Addiction Test assessed dimensions of addiction. Regression models tested associations between students’ level of HHD (No HHD, 1–3 HHD, ≥4 HHD) and PSU and PIU, and the role of extrafamilial social support in these relationships, adjusting for age, gender, ethnicity, SES, employment loss due to COVID-19, and depression. Results: Compared to students reporting no HHD, students with ≥4 HHD had twice the odds (AOR: 2.03, 95% CI: 1.21–3.40) of meeting criteria for PSU, while students with 1–3 HHD and ≥4 HHD had three and six times the odds of moderate to severe PIU (AORs: 2.03–2.46, CI:1.21–3.96) after adjusting for covariates. Extrafamilial social support was inversely associated with PIU and moderated the HHD–PSU association for students with 1–3 HHD. Conclusion: Students exposed to HHD may be especially vulnerable to developing behavioral addictions such as PSU and PIU. Extrafamilial social support offset the negative effects of HHD for PSU among the moderate risk group; implications for prevention efforts are discussed.

Adverse childhood experiences and problematic smartphone use among college students: Findings from a pilot study

BACKGROUND

There has been a tremendous increase in the use of smartphones among college students and alongside the benefits there is growing concern over problematic/addictive smartphone use (PSU). Among the most robust predictors of behavioral and substance use disorders are a subset of adverse childhood experiences conceptualized as household dysfunction (HHD). Despite the high prevalence of HHD and risk of PSU among college students, research investigating the link between HHD and PSU among college populations is sparse, especially in the United States.

METHODS

Students (N = 351) from a diverse, southern California university responded to an online survey. Regression models assessed the association between HHD (e.g., parent alcohol and drug use, mental health, incarceration, suicide, intimate partner violence, separation/divorce, and homelessness; categorized into 0, 1-3, and 4 or more) and PSU using Smartphone Addiction Scale short version (SAS-SV) scale, adjusted for covariates.

RESULTS

Over 50% of students reported at least one type of household dysfunction and about 25% were at high risk for PSU. Compared to students who report no household stressors, students with 1-3 had twice the odds (AOR: 2.11, 95% CI: 1.13-3.83) and students with 4 or more had four times the odds (AOR: 4.01, 95% CI: 2.35-6.82) of PSU, after adjusting for covariates. There were no sex differences in this association.

CONCLUSION

Findings suggest that household dysfunction can increase the likelihood of developing behavioral disorders such as PSU. Implications for prevention efforts are discussed.

Classifying childhood war trauma exposure: latent profile analyses of Sierra Leone's former child soldiers

BACKGROUND

Former child soldiers are at elevated risk for mental health problems (e.g., traumatic stress, emotion dysregulation, and internalizing and externalizing problems). To examine which groups of former child soldiers are more likely to have difficulties with emotion regulation, interpersonal relationships, and mental health postconflict, we explored patterns of war trauma exposure and their effects on subsequent mental health problems among former child soldiers in Sierra Leone.

METHODS

Participants were 415 (23.86% female) Sierra Leonean former child soldiers participating in a 15-year, four-wave longitudinal study. At T1 (2002), 282 former child soldiers (aged 10-17) were recruited. T2 (2004) included 186 participants from T1 and an additional cohort of self-reintegrated former child soldiers (NT2 = 132). T3 (2008) and T4 (2016/2017) participants were youth enrolled in previous waves (NT3 = 315; NT4 = 364). Latent profile analysis (LPA) was used to classify participants based on the first-time reports of eight forms of war exposure (separation and loss of assets, parental loss, loss of loved ones, witnessing violence, victimization, perpetrating violence, noncombat activities, and deprivation). ANOVA examined whether patterns of war exposure were associated with sociodemographic characteristics and mental health outcomes between T1 and T4.

RESULTS

LPA identified two profiles: higher exposure versus lower exposure, using cumulative scores of eight forms of war-related trauma exposure. The 'higher war exposure' group comprised 226 (54.5%) former child soldiers and the 'lower war exposure' group included 189 (45.5%). Significantly higher levels of violence-related and combat experiences characterized the group exposed to more traumatic events. The 'higher war exposure' group reported more PTSD symptoms at T2, more hyperarousal symptoms across all waves, and more difficulties in emotion regulation at T4.

CONCLUSIONS

Former child soldiers exposed to higher levels of war-related traumatic events and loss should be prioritized for mental health services immediately postconflict and as they transition into adulthood.

Helping students cope with adversity: the influence of a web-based intervention on students' self-efficacy and intentions to use wellness-related resources

To investigate the effects of an online wellness intervention on college students' self-efficacy, intentions to seek help, general resilience and whether adverse childhood experiences (ACEs) act as a moderating variable. Participants: Three-hundred and eighty-two undergraduate students. Method: Students were assigned to two conditions: treatment or control. The treatment group participated in an online intervention designed to enhance student wellness, the control group did not. Both groups completed an online questionnaire. Results: Students exposed to the intervention reported greater self-efficacy, a higher likelihood to engage in self-help activities and greater intention to use campus resources. Additionally, among students with more ACEs, those who were exposed to the site were more likely to recommend resources. Conclusion: The online intervention presented here may be an effective tool to reduce barriers for students seeking help for mental health and may increase student wellness.