Adverse Childhood Experiences among Reproductive Age Women: Findings from the 2019 Behavioral Risk Factor Surveillance System

Gender differences in the associations of adverse childhood experiences with depression and anxiety: A systematic review and meta-analysis

BACKGROUND

Gender differences in the associations of adverse childhood experiences (ACEs) with depression and anxiety, remain underexplored. We aimed to quantify and directly compare gender-specific associations between ACEs and depression and anxiety.

METHODS

We systematically searched PubMed, Medline, and Embase for observational studies. Eligible articles should have reported effect sizes for depression or anxiety associated with varying number or specific types of ACEs. Using a random-effects model, we calculated the gender-specific pooled odds ratios (ORs) and derived the pooled women-to-men ratio of ORs (RORs) for the associations of ACEs with depression or anxiety, with corresponding 95 % confidence intervals (CIs).

RESULTS

In total, 42 articles met inclusion criteria. Regarding anxiety, gender differences were most pronounced for individuals exposed to 2 ACEs (compared to none), with women showing significantly higher odds of anxiety than men (ROR = 2.04, 95 % CI = 1.15-3.62), In addition, women exposed to emotional abuse (ROR = 0.66, 95 % CI = 0.52-0.83), sexual abuse (ROR = 0.58, 95 % CI = 0.37-0.91), and having a family member incarcerated (ROR = 0.83, 95 % CI = 0.71-0.98) showed lower odds of anxiety than men. For depression, women exposed to bullying showed lower odds of depression compared to men (ROR = 0.86, 95 % CI = 0.83-0.88).

CONCLUSIONS

Gender differences in the associations between ACEs and mental health outcomes vary by type and cumulative exposure to ACEs. This finding highlights the importance of incorporating gender-specific perspectives in research and interventions addressing the long-term mental health effects of ACEs.

My Story and Me: a narrative study of young women and girls' stories of their mental health and associated support

BACKGROUND

Recent data in England show rising levels of mental health difficulties among young women, as compared to young men. Thus, the aim of this study was to explore the lived experiences of young women and girls (across different ethnic groups, who are neurodivergent, and/or who identify with the LGBTQIA + community) in the UK about their mental health and associated support.

METHOD

Narrative interviews were conducted with 29 young women and girls aged 14 to 24 years. Using ideal-type analysis, a method for identifying broad patterns or 'types' within qualitative datasets, two typologies were developed to explore similarities and differences between participants' stories and delineate overarching narratives across stories.

RESULTS

The first typology was titled: 'What is my mental health story?' Three overarching types or narratives within the dataset were identified in terms of participants' mental health stories: 'Traumatic and impactful experiences'; 'Body-mind-society interaction'; and 'Prolonged distress and disruption'. The second typology was titled: 'How would I like to be supported in relation to my mental health?' Three overarching types or narratives were also identified in relation to participants' stories about how they would like to be supported with their mental health: 'Empathy, understanding, and connection'; 'Support from/for intersecting (overlapping) identities'; and 'Heard, seen, and accepted'.

CONCLUSIONS

Hearing from young women and girls, in their own words, about their mental health stories is crucial to optimise prevention and treatment efforts. Our findings show that a positive therapeutic relationship, supportive social relationships, feeling heard and accepted, and consideration of the multiple overlapping facets of one's identity are key mechanisms influencing the utility of support. Ultimately, mental health support should be individualised, consistent, and available.

Adverse Childhood Experiences and Suboptimal Self-Rated Health in Adulthood: Exploring Effect Modification by Age, Sex and Race/Ethnicity

PURPOSE

This study examined whether the relationship between adverse childhood experiences (ACEs) and self-rated health among adults in a nationally representative population is modified by age, sex, or race/ethnicity.

DESIGN

Cross-sectional study.

SETTING

United States.

SAMPLE

Data from the 2020 and 2021 Behavioral Risk Factor Surveillance System were obtained from 185 731 (weighted N = 47 862 016) persons 18 years or older.

MEASURES

The ACE cumulative score (range: 0-11) was calculated using 11 questions about childhood emotional abuse, physical abuse, sexual abuse, and household dysfunction before age 18 and classified as 0 (reference), 1, 2, 3, or ≥4. Self-rated health was divided into (excellent/very good/good [reference]) and suboptimal (fair/poor) categories.

ANALYSIS

Multivariable-adjusted logistic regression was conducted to test for the interaction with age, sex, and race/ethnicity with ACEs. After adjustment for potential confounders, an increasing number of ACEs had statistically significantly higher odds of suboptimal self-rated health in a graded manner except for 1 ACE (1 ACE: aOR:1.09; 95% CI: 1.00-1.20, 2 ACEs: 1.16; 1.03-1.30, 3 ACEs: 1.17; 1.03-1.32 and ≥4 ACEs: 1.39; 1.26-1.53). There was a significant interaction between ACEs and age. Younger age (18-24 years) had the strongest association for ≥4 ACEs compared to the older age groups. There was no effect modification by sex or race.

CONCLUSION

ACEs should be considered when creating health-promoting interventions to improve health.

Trends in youth acute care hospital visits for anxiety and depression in Illinois

PURPOSE

This study analyzes the trajectory of youth emergency department or inpatient hospital visits for depression or anxiety in Illinois before and during the COVID-19 pandemic.

METHODS

We analyze emergency department (ED) outpatient visits, direct admissions, and ED admissions by patients ages 5-19 years coded for depression or anxiety disorders from 2016 through June 2023 with data from the Illinois Hospital Association COMPdata database. We analyze changes in visit rates by patient sociodemographic and clinical characteristics, hospital volume and type, and census zip code measures of poverty and social vulnerability. Interrupted times series analysis was used to test the significance of differences in level and trends between 51 pre-pandemic months and 39 during-pandemic months.

RESULTS

There were 250,648 visits to 232 Illinois hospitals. After large immediate pandemic decreases there was an estimated -12.0 per-month (p = 0.003, 95% CI -19.8-4.1) decrease in male visits and a - 13.1 (p = 0.07, 95% CI -27 -1) per-month decrease in female visits in the during-pandemic relative to the pre-pandemic period. The reduction was greatest for outpatient ED visits, for males, for age 5-9 and 15-19 years patients, for smaller community hospitals, and for patients from the poorest and most vulnerable zip code areas.

CONCLUSIONS

llinois youth depression and anxiety hospital visit rates declined significantly after the pandemic shutdown and remained stable into 2023 at levels below 2016-2019 rates. Further progress will require both clinical innovations and effective prevention grounded in a better understanding of the cultural roots of youth mental health.

Factors Associated with Depressive and Anxiety Symptom Trajectories Across Pregnancy and Postpartum in Selective Serotonin Reuptake Inhibitor-Treated Individuals

Objective

The primary purpose of this article is to identify factors that are associated with worsening mood and anxiety trajectories across the perinatal period among pregnant individuals receiving treatment with a selective-serotonin reupdate inhibitor.

Methods

This secondary analysis of primary data from the original article, Trajectories of Depressive and Anxiety Symptoms Across Pregnancy and Postpartum in Selective Serotonin Reuptake Inhibitor-Treated Women, explores if number of lifetime episodes of depression as characterized in the Mini-International Neuropsychiatric Interview, elevated maternal adverse childhood experiences (ACE) score, or specific obstetric or neonatal factors from the Peripartum Events Scale (PES) were associated with membership in trajectory groups with the highest symptom burden.

Results

No difference in ACE scores or obstetric or neonatal factors were associated with membership in the trajectory groups using Wilcoxon rank sum tests and bi-variable logistic regression. The trajectory group with the highest anxiety symptom burden experienced more lifetime episodes of depression compared to other groups (odds ratio = 1.17, 95% confidence intervals, 1.02-1.34, p = 0.03).

Conclusions

Congruent with other studies, we found a high prevalence of co-occurring mood and anxiety symptoms and that past episodes of depression remain an important historical risk factor for perinatal symptom burden. This reinforces that past experiences of depression increase not only the risk of future symptoms but also higher symptom burden during antidepressant treatment.

Childhood adversity and risk of type 2 diabetes in early adulthood: results from a population-wide cohort study of 1.2 million individuals

AIMS/HYPOTHESIS

To examine whether childhood adversity is related to development of type 2 diabetes in early adulthood (16 to 38 years) among men and women.

METHODS

We used nationwide register data of 1,277,429 individuals born in Denmark between 1 January 1980 and 31 December 2001, who were still resident in Denmark and without diabetes at age 16 years. Individuals were divided into five childhood adversity groups based on their yearly exposure to childhood adversities (from age 0-15 years) across three dimensions: material deprivation, loss or threat of loss, and family dynamics. We estimated HR and hazard differences (HD) for type 2 diabetes according to the childhood adversity groups using Cox proportional hazards and Aalen additive hazards models.

RESULTS

During follow-up from age 16 to 31 December 2018, 4860 individuals developed type 2 diabetes. Compared with the low adversity group, the risk of type 2 diabetes was higher in all other childhood adversity groups among both men and women. For example, the risk was higher in the high adversity group characterised by high rates of adversity across all three dimensions among men (HR 2.41; 95% CI 2.04, 2.85) and women (1.58; 1.31, 1.91), translating into 36.2 (25.9, 46.5) additional cases of type 2 diabetes per 100,000 person-years among men and 18.6 (8.2, 29.0) among women.

CONCLUSIONS/INTERPRETATION

Individuals who experienced childhood adversity are at higher risk of developing type 2 diabetes in early adulthood. Intervening upon proximal determinants of adversity may help reduce the number of type 2 diabetes cases among young adults.