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

Associations Between Adverse Childhood Experiences and Prenatal Mental Health in the French EDEN Cohort: Cumulative, Person-Centered, and Dimensional Approaches

Background: Adverse childhood experiences (ACEs) may negatively affect prenatal mental health. However, the use of a cumulative ACEs score may obscure the identification of which specific types of adversity are most strongly associated with unfavorable mental health outcomes. Aim: This study aims to evaluate the association between ACEs and prenatal symptoms of depression and anxiety using a cumulative score, a person-centered approach, and the dimensional model of adversity and psychopathology (DMAP). Methods: Data were collected from 1887 pregnant women in the French Etude des Déterminants du développement et de la santé de l'ENfant (EDEN) cohort. To operationalize our exposure, we calculated a cumulative ACE score, threat and deprivation scores, and conducted latent class analysis (LCA). Depressive and anxious symptoms were assessed with the Center for Epidemiologic Studies-Depression Scale (CES-D) and the State-Trait Anxiety Inventory state subscale (STAI-S) questionnaires, using cutoffs of 16 and 38 indicating high symptoms. Participants were categorized into four outcome groups: (1) no symptoms, (2) high depressive symptoms only, (3) high anxious symptoms only, and (4) comorbid high symptoms. Multinomial regressions were performed. Results: LCA identified three ACE classes: low-risk, family discordance, and multidimensional adversity. Women reporting two or more ACEs had higher odds of depressive and comorbid symptoms, compared to those with zero ACEs. Compared to the low-risk class, women in the family discordance class had increased odds of high depressive symptoms (adjusted odds ratios [aOR] 95% confidence interval [CI] = 1.80 [1.33, 2.56]) and comorbid high symptoms (aOR [95% CI] = 2.04 [1.43, 2.89]). Threat experiences were significantly linked to high depressive symptoms (aOR [95% CI] = 1.48 [1.22, 1.79]) and comorbid high symptoms (aOR [95% CI] = 1.53 [1.25, 1.87]). Conclusion: Using the DMAP and LCA approaches, we found that ACEs related to the familial environment and relationships during childhood were most strongly associated with prenatal high depressive and comorbid symptoms. This highlights the importance of operationalizing ACEs beyond a cumulative score to better capture their role in the development of prenatal mental health difficulties.

Interpreting evidence on the association between multiple adverse childhood experiences and mental and physical health outcomes in adulthood: protocol for a systematic review assessing causality

INTRODUCTION

Research suggests that adverse childhood experiences can have a lasting influence on children's development that result in poorer health outcomes in adulthood. Like other exposure-outcome relationships, however, there is uncertainty about the extent to which the relationship between adverse childhood experiences and health is causal or attributable to other factors. The aim of this systematic review is to better understand the nature and extent of the evidence available to infer a causal relationship between adverse childhood experiences and health outcomes in adulthood.

METHODS AND ANALYSIS

A systematic review of evidence from cross-sectional and longitudinal studies will be conducted to examine the association between multiple adverse childhood experiences and mental and physical health outcomes in adulthood. A comprehensive search for articles will be conducted in four databases (Medline, CINAHL, PsycInfo and Web of Science) and Google Scholar. We will include studies published since 2014: (1) of adults aged 16 years or over with exposure to adverse childhood experiences before age 16 years from general population samples; (2) that report measures across multiple categories of childhood adversity, including both direct and indirect types and (3) report outcomes related to disease morbidity and mortality. Two reviewers will independently screen all titles and abstracts and full texts of potentially relevant studies. Included studies will be evaluated for risk of bias with the Risk Of Bias In Non-randomised Studies of Exposures tool. Data extraction will include extraction of study characteristics; measurement of adverse childhood experiences, outcome assessment and measurement of outcomes; details about confounding variables and contextual variables; methods of statistical analysis; and methods for assessing causal inference. We will carry out a meta-analysis and incorporate causal assessment with reference to the Bradford Hill criteria and the Grading of Recommendations Assessment, Development and Evaluation framework.

ETHICS AND DISSEMINATION

This study is a systematic review protocol collecting data from published literature and does not require approval from an institutional review board. The findings from this systematic review will be disseminated via a peer-reviewed journal publication, professional networks and social media.

PROSPERO REGISTRATION NUMBER

CRD42024554563.

Association of Early-life Trauma With Gestational Diabetes and Hypertensive Disorders of Pregnancy

BACKGROUND

Early-life trauma (before age of 18 years) is hypothesized to increase the risk for adverse pregnancy outcomes through stress pathways, yet epidemiologic findings are mixed.

METHODS

Sister Study participants (US women aged 35-74 years enrolled 2003-2009) completed an adapted Brief Betrayal Trauma Survey at the first follow-up visit. Lifetime history of gestational diabetes mellitus (GDM) or hypertensive disorders of pregnancy (HDP: pregnancy-related high blood pressure, pre-eclampsia/toxemia, or eclampsia) in pregnancies lasting ≥20 weeks was self-reported. We used log-binomial regression to estimate relative risks (RR) and 95% confidence intervals (CIs) for the association between early-life trauma (modeled using conventional measures [e.g., any experience, substantive domains, individual types] and latent classes of co-occurring traumas) and GDM or HDP among 34,879 parous women.

RESULTS

Approximately, 4% of participants reported GDM and 11% reported HDP. Relative to no early-life trauma, the RRs for any were 1.1 (95% CI = 1.0, 1.3) for GDM and 1.2 (95% CI = 1.2, 1.3) for HDP. Women reporting physical trauma had the highest risk of GDM and HDP in comparison to other substantive domains. In analyses using latent classes of early-life trauma, high trauma was associated with an elevated risk of both GDM (RR = 1.9, 95% CI = 1.5, 2.6) and HDP (RR = 1.7, 95% CI = 1.4, 2.0) compared with low trauma.

CONCLUSIONS

Women experiencing high levels of trauma in early life were at higher risk of GDM and HDP, adding to a growing evidence base for this association.

Timing of adverse childhood experiences and depressive, anxiety, comorbid symptoms among Chinese female nurses: A life course perspective

BACKGROUND

Nurses demonstrate a greater vulnerability to developing depressive and anxiety symptoms compared to the general population. Adverse Childhood Experiences (ACEs) are known risk factors for mental health issues, but impact of timing of these experiences remains unclear.

OBJECTIVE

To investigate associations between timing of ACEs and depressive, anxiety, comorbid symptoms.

PARTICIPANTS AND SETTING

Using convenience sampling, a cross-sectional study was conducted. The sample was 1966 female nurses from seven hospitals in Zhejiang Province, China.

METHODS

Nurses completed a questionnaire assessing sociodemographic characteristics, ACEs, depressive and anxiety symptoms. Timing of ACEs was categorized as childhood, adolescence, and both periods. Comorbid symptoms referred to simultaneous presence of both depressive and anxiety symptoms. Multivariable logistic regression was used to examine associations between ACEs timing and mental health outcomes, presented as Odds Ratios (ORs) with 95 % Confidence Intervals (CIs).

RESULTS

A total of 429 (21.82 %) participants experienced ACEs in both periods. ACEs occurring only in childhood, only in adolescence, and in both periods were all associated with increased depressive, anxiety, and comorbid symptoms. An increasing trend in number of ACEs from childhood to adolescence was linked to higher symptoms in adulthood. Familial ACEs in both periods were strongly linked to higher depressive (OR = 1.85, 95 % CI [1.14, 3.01]), anxiety (OR = 2.55, 95 % CI [1.41, 4.60]), and comorbid symptoms (OR = 2.92, 95 % CI [1.50, 5.70]).

CONCLUSIONS

The timing of ACEs influenced the development of mental health issues. It is imperative to provide targeted psychological support based on timing of ACEs to improve mental health in this population.

Daily health and well-being in adulthood and old age: The role of adverse childhood experiences

How susceptible our daily affect is to fluctuations in physical health indicates how well we adapt to everyday health challenges. Adverse childhood experiences (ACEs) are known to have a lasting impact on everyday emotion regulation and adaptation across the lifespan, but less is known about whether and how such adversity is linked to the susceptibility of affect to everyday health challenges. This study therefore tested whether ACEs were associated with daily reports of positive and negative affect and examined weather they moderated emotional reactions to daily physical symptoms in adulthood and old age. We used data from the National Study of Daily Experiences 2 (NSDE-2) in which middle-aged and older adults (N = 2,022; Mage = 56 years; range: 33-84) reported symptoms and affect on eight consecutive evenings. Multi-level models indicated that cumulative ACEs as well as two individual childhood adversities (i.e. physical and sexual abuse by a parent) were independently associated with exacerbated increases in negative affect on days with more symptoms. Findings add to literature on the role of early adversity for the maintenance of everyday well-being and highlight the potential importance of such experiences for coping and adaption in the face of daily health challenges across adulthood and old age.

Childhood adversity and time to pregnancy in a preconception cohort

We examined the association between childhood adversity and fecundability (the per-cycle probability of conception), and the extent to which childhood social support modified this association. We used data from 6318 female participants aged 21-45 years in Pregnancy Study Online (PRESTO), a North American prospective preconception cohort study (2013-2022). Participants completed a baseline questionnaire, bimonthly follow-up questionnaires (until pregnancy or a censoring event), and a supplemental questionnaire on experiences across the life course including adverse childhood experiences (ACEs) and social support (using the modified Berkman-Syme Social Network Index [SNI]). We used proportional probabilities regression models to compute fecundability ratios (FRs) and 95% CIs, adjusting for potential confounders and precision variables. Adjusted FRs for ACE scores 1-3 and ≥4 vs 0 were 0.91 (95% CI, 0.85-0.97) and 0.84 (95% CI, 0.77-0.91), respectively. The FRs for ACE scores ≥4 vs 0 were 0.86 (95% CI, 0.78-0.94) among participants reporting high childhood social support (SNI ≥4) and 0.78 (95% CI, 0.56-1.07) among participants reporting low childhood social support (SNI <4). Our findings confirm results from 2 previous studies and indicate that high childhood social support slightly buffered the effects of childhood adversity on fecundability.

Perceived control ameliorates the impact of adverse childhood experiences on downstream mental health

BACKGROUND

Previous scholarship has illustrated the pernicious role of adverse childhood experiences (ACEs) in self-reported mental health, namely depressive and anxiety-related symptoms. Given these insights, highlighting protective factors that may diminish the magnitude of this relationship is important. The present study explored the moderating role of perceived control on the relationship between ACEs and depressive and anxiety symptoms, respectively.

METHODS

Participants consisted of a US-based non-clinical sample of 567 undergraduate students who completed a battery of surveys related to psychological wellbeing and individual differences. A series of hierarchical linear regression analyses were utilized for hypothesis testing.

RESULTS

Consistent with our main hypotheses, perceived control moderated the relationship between ACEs and both anxiety and depressive symptoms, respectively. Namely, at low levels of perceived control, ACEs were associated with significantly greater levels of anxiety and depressive symptoms, respectively. However, for those reporting high levels of perceived control, we found no association between ACEs and self-reported symptoms.

CONCLUSION

We offer evidence that perceived control may serve as a protective factor for mental health and wellbeing against the influence of adverse childhood experiences.

Childhood maltreatment and outcomes following electroconvulsive therapy in adults with depression

OBJECTIVE

Childhood maltreatment is associated with less favourable treatment outcomes with pharmacotherapy and psychotherapy for depression. It is unknown whether this increased risk of treatment resistance in maltreated individuals extends to electroconvulsive therapy (ECT).

METHODS

This retrospective cohort study included 501 consecutive adult referrals for an acute course of twice-weekly ECT for unipolar or bipolar depression at an academic inpatient centre in Ireland between 2016 and 2024. Retrospectively reported physical and sexual childhood maltreatment were assessed on hospital admission. Response was defined as a score of 1 or 2 and remission was defined as a score of 1 on the Clinical Global Impression - Improvement scale 1-3 days after final ECT session. Logistic regression analyses were used to examine the associations between childhood maltreatment and ECT nonresponse and nonremission, adjusting for covariates. Mediation analyses were conducted to explore the role of psychiatric comorbidities, persistent depressive symptoms lasting 2 years or more in the current episode, and baseline depression severity.

RESULTS

Compared to the group with no childhood maltreatment, the childhood maltreatment group had similar odds of ECT nonresponse (adjusted odds ratio = 1.47, 95% CI = 0.85-2.53) but significantly elevated odds of ECT nonremission (adjusted odds ratio = 3.75, 95% CI = 1.80-7.81). In a mediation analysis, presence of persistent depressive symptoms mediated 7.4% of the total effect of childhood maltreatment on ECT nonremission.

CONCLUSION

Individuals with exposure to childhood maltreatment may be less likely to achieve full remission following a course of ECT.

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.

The Association Between Adverse Childhood Experiences (ACEs), Bullying Victimization, and Internalizing and Externalizing Problems Among Early Adolescents: Examining Cumulative and Interactive Associations

Both adverse childhood experiences (ACEs) and bullying victimization are linked with mental health problems in adolescents. However, little is known about the overlap between the two factors and how this impacts adolescent mental health problems (i.e., internalizing and externalizing problems). The current study analyzed data from 8,085 participants (47.7% female; 44.1% racial/ethnic minority) in the Adolescent Brain Cognitive Development (ABCD) study, baseline (2016-2018, ages 9-10 years) to Year 2. Regression analyses were used to estimate associations between ACEs, bullying victimization and mental health problems, respectively, adjusting for sex, race/ethnicity, country of birth, household income, parental education, and study site. The findings showed that both ACEs and bullying victimization were independently associated with higher internalizing and higher externalizing problems. However, no significant interaction was found between ACEs and bullying victimization. Overall, the results align with the cumulative risk model of adversity, linking cumulative ACEs and bullying victimization to internalizing and externalizing problems in early adolescents.