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Yu J, Haynie DL, Gilman SE. Patterns of Adverse Childhood Experiences and Neurocognitive Development. JAMA Pediatr 2024:2819225. [PMID: 38805237 DOI: 10.1001/jamapediatrics.2024.1318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Abstract
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.
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Affiliation(s)
- Jing Yu
- Social and Behavioral Sciences Branch, Division of Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
| | - Denise L Haynie
- Social and Behavioral Sciences Branch, Division of Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
| | - Stephen E Gilman
- Social and Behavioral Sciences Branch, Division of Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Salokangas RKR, Salokangas HRW, From T, Lehtoranta L, Juolevi A, Hietala J, Koskinen S. Gender differences in the association between adverse childhood experiences and premature mortality: A prospective population study. CHILD ABUSE & NEGLECT 2024; 153:106838. [PMID: 38744042 DOI: 10.1016/j.chiabu.2024.106838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 04/22/2024] [Accepted: 04/30/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND Birth cohort studies have shown that adverse childhood experiences (ACEs) are associated with all-cause mortality. The effect of ACEs on premature mortality among working-age people is less clear and may differ between the genders. OBJECTIVE In this prospective population study, we investigated the association of ACEs with all-cause mortality in a working-age population. PARTICIPANTS AND METHODS In a representative Finnish population study, Health 2000, individuals aged 30 to 64 years were interviewed in 2000, and their deaths were registered until 2020. At baseline, the participants (n = 4981, 2624 females) completed a questionnaire that included 11 questions on ACEs and questions on tobacco smoking, alcohol abuse, self-reported health and sufficiency of income. All-cause mortality was analysed by Cox regression analysis. RESULTS Of the ACEs, financial difficulties, parental unemployment and individual's own chronic illness were associated with mortality. High number (4+) of ACEs was significantly associated with all-cause mortality in females (HR 2.11, p < 0.001), not in males. Poor health behaviour, self-reported health and low income were the major predictors of mortality in both genders. When the effects of these factors were controlled, childhood family conflicts associated with mortality in both genders. CONCLUSIONS Among working-age people, females seem to be sensitive to the effects of numerous adverse childhood experiences, exhibiting higher premature all-cause mortality. Of the individual ACEs, family conflicts may increase risk of premature mortality in both genders. The effect of ACEs on premature mortality may partly be mediated via poor adult health behaviour and low socioeconomic status. WHAT IS ALREADY KNOWN In birth cohort studies, adverse childhood experiences (ACEs) have been associated with all-cause mortality. In working-age people, the association of ACEs with premature mortality is less clear and may differ between the genders. WHAT THIS STUDY ADDS In working-age people, high number of ACEs associate with all-cause premature mortality in females, not in males. The effect of ACEs on premature mortality may partly be mediated via poor adult health behaviour, self-reported health and low socioeconomic status.
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Affiliation(s)
| | - Henri R W Salokangas
- Department of Economics, University of Turku, Turku, Finland; Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Tiina From
- Department of Psychiatry, University of Turku, Turku, Finland
| | | | - Anne Juolevi
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Jarmo Hietala
- Department of Psychiatry, University of Turku, Turku, Finland; Department of Psychiatry, Turku University Hospital, The Wellbeing services county of Southwest Finland, Turku, Finland
| | - Seppo Koskinen
- Finnish Institute for Health and Welfare, Helsinki, Finland
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Wang X, Jiang L, Barry L, Zhang X, Vasilenko SA, Heath RD. A Scoping Review on Adverse Childhood Experiences Studies Using Latent Class Analysis: Strengths and Challenges. TRAUMA, VIOLENCE & ABUSE 2024; 25:1695-1708. [PMID: 37594222 DOI: 10.1177/15248380231192922] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/19/2023]
Abstract
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.
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Barger SD, Oláis JA. Partitioning the Composition of Adverse Childhood Experiences From Accumulated Adversity: Cross-Sectional Evidence From 2 U.S. Samples. AJPM FOCUS 2024; 3:100192. [PMID: 38419615 PMCID: PMC10899063 DOI: 10.1016/j.focus.2024.100192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
Introduction Adverse childhood experiences are linked to adult morbidity and mortality. However, it is unknown whether the patterning of adverse childhood experiences, individually and in combination, confer health risk distinct from that of a cumulative adversity score. This study evaluates whether individual and comorbid adverse childhood experience exposures within a cumulative risk score are equally associated with current smoking and lifetime history of depression. Methods Cross-sectional analysis of adverse childhood experience assessments in the Behavioral Risk Factor Surveillance System from 21 states in 2019 (n=115,183) and 23 states in 2020 (n=120,416) was performed. We modeled cumulative adverse childhood experience scores and the 5 most common distinct adverse childhood experience components that compose a given adverse childhood experience score, up to a cumulative score of 4. We compared adverse childhood experience components, adjusting for covariates. Results Across both samples, 23% and 57%-58% of persons reported 1 adverse childhood experience and 2 or more adverse childhood experiences, respectively. In 2019 smoking prevalence was 10.4% for persons reporting zero adverse childhood experiences and 14.2% for persons reporting 1 adverse childhood experience. When the single adverse childhood experience was experiencing parental divorce, smoking was higher (16.6%) than when the single adverse childhood experience was verbal abuse (11.8%) or living with a mentally ill household member (9.5%). Lifetime depression prevalence was 9.6% and 14.1% across zero and 1 adverse childhood experience, respectively, whereas it was 26.6% if the single adverse childhood experience was living with a mentally ill household member and 11.0% when the adverse childhood experience was experiencing parental divorce. This heterogeneity was replicated in 2020 data. Additional heterogeneity was observed for higher cumulative adverse childhood experience scores. Conclusions Cumulative adverse childhood experience scores mask substantial health risk heterogeneity, which can be delineated by examining distinct components of cumulative adverse childhood experience scores.
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Affiliation(s)
- Steven D Barger
- Department of Psychological Sciences, Northern Arizona University, Flagstaff, Arizona
- the Center for Health Equity Research, Northern Arizona University, Flagstaff, Arizona
| | - Jose A Oláis
- Department of Psychological Sciences, Northern Arizona University, Flagstaff, Arizona
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Ray JG, Fu L, Austin PC, Park AL, Brown HK, Grandi SM, Vandermorris A, Boblitz A, Cohen E. Teen Pregnancy and Risk of Premature Mortality. JAMA Netw Open 2024; 7:e241833. [PMID: 38483391 PMCID: PMC10940968 DOI: 10.1001/jamanetworkopen.2024.1833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 01/15/2024] [Indexed: 03/17/2024] Open
Abstract
Importance Unintentional injury, suicide, and homicide are leading causes of death among young females. Teen pregnancy may be a marker of adverse life experiences. Objective To evaluate the risk of premature mortality from 12 years of age onward in association with number of teen pregnancies and age at pregnancy. Design, Setting, and Participants This population-based cohort study was conducted among all females alive at 12 years of age from April 1, 1991, to March 31, 2021, in Ontario, Canada (the most populous province, which has universal health care and data collection). The study period ended March 31, 2022. Exposures The main exposure was number of teen pregnancies between 12 and 19 years of age (0, 1, or ≥2). Secondary exposures included how the teen pregnancy ended (birth or miscarriage vs induced abortion) and age at first teen pregnancy. Main Outcomes and Measures The main outcome was all-cause mortality starting at 12 years of age. Hazard ratios (HRs) were adjusted for year of birth, comorbidities at 9 to 11 years of age, and area-level education, income level, and rurality. Results Of 2 242 929 teenagers, 163 124 (7.3%) experienced a pregnancy at a median age of 18 years (IQR, 17-19 years). Of those with a teen pregnancy, 60 037 (36.8%) ended in a birth (of which 59 485 [99.1%] were live births), and 106 135 (65.1%) ended in induced abortion. The median age at the end of follow-up was 25 years (IQR, 18-32 years) for those without a teen pregnancy and 31 years (IQR, 25-36 years) for those with a teen pregnancy. There were 6030 deaths (1.9 per 10 000 person-years [95% CI, 1.9-2.0 per 10 000 person-years]) among those without a teen pregnancy, 701 deaths (4.1 per 10 000 person-years [95% CI, 3.8-4.5 per 10 000 person-years]) among those with 1 teen pregnancy, and 345 deaths (6.1 per 10 000 person-years [95% CI, 5.5-6.8 per 10 000 person-years]) among those with 2 or more teen pregnancies; adjusted HRs (AHRs) were 1.51 (95% CI, 1.39-1.63) for those with 1 pregnancy and 2.14 (95% CI, 1.92-2.39) for those with 2 or more pregnancies. Comparing those with vs without a teen pregnancy, the AHR for premature death was 1.25 (95% CI, 1.12-1.40) from noninjury, 2.06 (95% CI, 1.75-2.43) from unintentional injury, and 2.02 (95% CI, 1.54-2.65) from intentional injury. Conclusions and Relevance In this population-based cohort study of 2.2 million female teenagers, teen pregnancy was associated with future premature mortality. It should be assessed whether supports for female teenagers who experience a pregnancy can enhance the prevention of subsequent premature mortality in young and middle adulthood.
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Affiliation(s)
- Joel G. Ray
- Department of Medicine, St Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada
- Department of Obstetrics and Gynaecology, St Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
| | | | | | | | - Hilary K. Brown
- ICES, Toronto, Ontario, Canada
- Department of Health and Society, University of Toronto Scarborough, Scarborough, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Sonia M. Grandi
- ICES, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Ashley Vandermorris
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
- Division of Adolescent Medicine, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | | | - Eyal Cohen
- ICES, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- Edwin S. H. Leong Centre for Healthy Children, University of Toronto, Toronto, Ontario, Canada
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Kraal AZ, Zaheed AB, Krasnova A, Vadari H, Byrd DR, Zahodne LB. Time-lagged associations between two adverse childhood experiences and later-life cognitive function through educational attainment and stroke. J Int Neuropsychol Soc 2024; 30:107-116. [PMID: 37401463 DOI: 10.1017/s135561772300036x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/05/2023]
Abstract
OBJECTIVE Adverse childhood experiences (ACEs) have been associated with worse cognitive health in older adulthood. This study aimed to extend findings on the specificity, persistence, and pathways of associations between two ACEs and cognition by using a comprehensive neuropsychological battery and a time-lagged mediation design. METHOD Participants were 3304 older adults in the Health and Retirement Study Harmonized Cognitive Assessment Protocol. Participants retrospectively reported whether they were exposed to parental substance abuse or experienced parental physical abuse before age 18. Factor scores derived from a battery of 13 neuropsychological tests indexed cognitive domains of episodic memory, executive functioning, processing speed, language, and visuospatial function. Structural equation models examined self-reported years of education and stroke as mediators, controlling for sociodemographics and childhood socioeconomic status. RESULTS Parental substance abuse in childhood was associated with worse later-life cognitive function across all domains, in part via pathways involving educational attainment and stroke. Parental physical abuse was associated with worse cognitive outcomes via stroke independent of education. CONCLUSIONS This national longitudinal study in the United States provides evidence for broad and persistent indirect associations between two ACEs and cognitive aging via differential pathways involving educational attainment and stroke. Future research should examine additional ACEs and mechanisms as well as moderators of these associations to better understand points of intervention.
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Affiliation(s)
- A Zarina Kraal
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
- G. H. Sergievsky Center, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Afsara B Zaheed
- Department of Psychology, College of Literature, Science, and the Arts, University of Michigan, Ann Arbor, MI, USA
- Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, CA, USA
| | - Anna Krasnova
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Harita Vadari
- Department of General Medicine, Michigan Medicine, Ann Arbor, MI, USA
| | - DeAnnah R Byrd
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA
| | - Laura B Zahodne
- Department of Psychology, College of Literature, Science, and the Arts, University of Michigan, Ann Arbor, MI, USA
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Currie J, Stafford A, Hutton J, Wood L. Optimising Access to Healthcare for Patients Experiencing Homelessness in Hospital Emergency Departments. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2424. [PMID: 36767794 PMCID: PMC9916150 DOI: 10.3390/ijerph20032424] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 01/20/2023] [Accepted: 01/23/2023] [Indexed: 06/18/2023]
Abstract
The ED is often the first and sometimes the only place where people experiencing homelessness seek medical assistance. While access to primary healthcare is a preferable and more cost-effective alternative to ED, for many reasons, people experiencing homelessness are much less likely to have a regular General Practitioner compared to those living in stable accommodation. Drawing on a growing body of emergency care and homelessness literature and practice, we have synthesised four potential interventions to optimise access to care when people experiencing homelessness present to an ED. Although EDs are in no way responsible for resolving the complex health and social issues of their local homeless population, they are a common contact point and therefore present an opportunity to improve access to healthcare.
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Affiliation(s)
- Jane Currie
- School of Nursing, Queensland University of Technology, Kelvin Grove, Brisbane, QLD 4059, Australia
| | | | - Jennie Hutton
- Emergency Department, St Vincent’s Hospital Melbourne, Melbourne, VIC 3065, Australia
- Department of Medicine, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, VIC 3010, Australia
| | - Lisa Wood
- Institute for Health Research, University of Notre Dame, Fremantle, WA 6061, Australia
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Altman N. Unpacking and Reworking Trauma. PSYCHOANALYTIC DIALOGUES 2022. [DOI: 10.1080/10481885.2022.2138086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- Neil Altman
- Massachusetts Institute for Psychoanalysis, Boston, Massachusetts, USA
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