The Devastating Clinical Consequences of Child Abuse and Neglect: Increased Disease Vulnerability and Poor Treatment Response in Mood Disorders

Inflammation and minority stress: A moderated mediation model of childhood adversity and mental health in young men who have sex with men

RATIONALE

Adverse childhood experiences (ACEs) are linked to later anxiety and depression, and inflammation has been implicated as a mediating mechanism. Black and Latinx men who have sex with men (MSM) face higher prevalences of ACEs, anxiety, and depression compared to White, heterosexual peers. Understanding the links between ACEs and mental health is crucial to addressing these disparities.

METHODS

This study used structural equation modeling to test moderated mediation models examining inflammation as a mediator of the relationship between ACEs and symptoms of anxiety/depression and minority stress as a moderator on the path between ACEs and inflammation. Data was from a community sample of Black and Latinx MSM (n = 246; mean age = 22.6).

RESULTS

ACEs were significantly associated with symptoms of anxiety (B = 0.414; p < 0.001) and depression (B = 0.346; p < 0.001), but inflammation did not show a significant mediating effect. Additionally, the interaction between ACEs and minority stress had no significant indirect effect on anxiety/depression.

CONCLUSIONS

These findings underscore the possibility that inflammation may not represent the global perturbations of stress processes after ACEs at younger ages, particularly among a relatively healthy sample of emerging adults.

Clinical conceptualisation of PTSD in psilocybin treatment: disrupting a pre-determined and over-determined maladaptive interpretive framework

Post-traumatic stress disorder (PTSD) and associated trauma and stressor-related disorders are common and debilitating, presenting significant treatment challenges due to their complex interplay of biological, cognitive, affective, somatic and social factors. Current treatments, while advancing and effective, yield limited efficacy for many individuals, underscoring the need for novel therapeutic approaches. This review explores the multifaceted nature of PTSD, emphasising its intricate predisposing and maintaining factors and explores the potential of psilocybin, a classical psychedelic, as a therapeutic agent. This review synthesises recent literature on the safety, efficacy and proposed mechanisms of action and change of psychedelic therapies for psychiatric conditions associated with traumatic stress, including treatment-resistant depression, end-of-life anxiety and anorexia nervosa. Correspondingly, it proposes a conceptual framework for psilocybin treatment in PTSD, framing the condition as a complex, maladaptive interpretive framework that is both predetermined and over-determined. A clinical narrative illustrates how psilocybin's unique psychopharmacological properties and catalysed subjective effects may facilitate therapeutic progress by disrupting this rigid and restricting framework. Finally, we offer recommendations for the safe administration of psilocybin for traumatised patients in medical research settings, emphasising the importance of rigorous and trauma-informed protocols and comprehensive patient care.

Prevalence of child abuse and common mental comorbidity among university of Khartoum medical students, Khartoum, Sudan

INTRODUCTION

Child abuse and neglect are significant public health issues worldwide, with severe and lasting effects on children's mental and physical well-being. Despite being prevalent in Sub-Saharan Africa, including Sudan, limited research has been conducted on this topic. This study investigates the prevalence of childhood abuse and neglect among Sudanese medical students and explores its impact on their mental health.

METHODS

This cross-sectional study involved 313 medical students from the University of Khartoum. Participants completed a self-administered questionnaire that included the Childhood Trauma Questionnaire (CTQ-28) and the General Health Questionnaire (GHQ-12). Statistical analyses were conducted using non-parametric tests and multiple linear regression to identify correlations and predictors of psychological distress. Propensity score matching was also performed to check the effect of gender matching on the results.

RESULTS

Approximately 40% of students reported experiencing childhood trauma, with sexual abuse (23.3%) and emotional neglect (19.2%) being the most common types. Female students reported higher levels of psychological distress (p = 0.049). Students who experienced abuse or sexual assault had significantly higher distress levels (p = 0.001 and p = 0.014, respectively). Still, this significance disappeared after matching Emotional abuse showed the strongest correlation with psychological distress (r = 0.405), followed by emotional neglect (r = 0.232). Regression analysis revealed that past abuse, sexual assault, and emotional abuse were significant predictors of distress, with emotional abuse having the most substantial impact both before (p < 0.001) and after matching (p-value = 0.005).

CONCLUSION

Childhood maltreatment is common among Sudanese medical students and significantly affects mental health, particularly emotional abuse and neglect. The only type of abuse which significantly contributed to psychological distress was emotional abuse. More focus is needed towards emotional abuse as it is still hidden, unlike physical and sexual abuse, which show visible marks. More researches need to be done toward addressing the domains of emotional abuse and how to prevent it.

The mediating role of anxiety between child abuse and pain among a sample of Lebanese adults

Pain is defined as an unpleasant sensory and emotional experience in response to a noxious stimulus. Nowadays, it is increasingly prevalent among adults and may be influenced by past experiences such as child abuse, trauma or psychiatric conditions like anxiety. Thus, this study aims to evaluate the mediating effect of anxiety between child abuse and pain among a sample of Lebanese adults. This cross-sectional study was conducted between March and April 2024. Participants were selected using a snowball sampling method from various Lebanese governorates, and completed a self-administered online questionnaire via Google Forms. All adults over the age of 18 were eligible to participate. The questionnaire included sociodemographic questions, the short form of McGill pain questionnaire, the generalized anxiety disorder-7 (GAD-7), and the child abuse self report scale (CASRS-12). A total of 507 Lebanese adults completed the questionnaire. The mean age was 26.80 ± 10.29 years and 73.2% were female. The results showed that anxiety partially mediated the association between child abuse and pain. Higher levels of child abuse were significantly associated with greater anxiety, which in turn was significantly associated with increased pain. Child abuse was directly associated with higher pain levels. The study highlights the relationship that child abuse has on pain in adults and its relationship with anxiety. Future research delving into the relationship between child abuse and chronic pain in adulthood is essential to better understand the underlying pathways and support effective prevention and intervention strategies.

Childhood maltreatment's influence on the dynamic course of depression: symptom trajectories during inpatient treatment and after discharge

BACKGROUND

Many studies have highlighted the detrimental effect of childhood maltreatment (CM) on depression severity and the course of illness in major depressive disorder (MDD). Yet our understanding of how CM influences the dynamic symptom change throughout a patient's trajectory remains limited. Hence, we investigated the impact of CM on depression severity in MDD with a focus on various treatment phases during inpatient treatment and after discharge (1 or 2 years later) and validated findings in a real-world setting.

METHODS

We used longitudinal data from a cohort study sample (n = 567) and a clinical routine sample (n = 438). CM was measured with the Childhood Trauma Questionnaire (CTQ), and depression severity was assessed using Beck's Depression Inventory (BDI). The long-term clinical trajectory was assessed using the Life Chart Interview.

RESULTS

Our analyses revealed that CM significantly increased depression severity before, during, and after inpatient therapy in both samples. Although CM was associated with higher depression severity at the beginning of inpatient treatment and lower remission rates upon discharge, no discernible impact of CM was evident on the relative change in symptoms over time during inpatient treatment. CM consistently predicted higher relapse rates and lower rates of full remission after discharge during long-term follow-up in both samples.

CONCLUSIONS

Our findings affirm the link between CM and the development of more severe and persistent clinical trajectories within real-world clinical settings. Furthermore, conventional psychiatric treatments may not lead to comparable outcomes for individuals with a history of CM, underscoring the necessity for tailored therapeutic interventions.

Amygdala hyperactivation in childhood maltreatment: An ALE-based meta-analysis on emotion-related processing

Childhood maltreatment (CM), encompassing various forms of abuse and neglect, is associated with adverse developmental outcomes and heightened risk for psychiatric conditions. Functional magnetic resonance imaging (fMRI) studies point to altered neural responses during tasks involving emotion-related processing in maltreated individuals, yet inconsistent findings have limited the field's ability to draw clear conclusions about the loci of altered brain function. This meta-analysis aimed to synthesize existing task-based fMRI data on emotional processing in individuals with a history of childhood maltreatment, with particular emphasis on identifying consistent patterns of hyperactivation compared to non-maltreated controls. A systematic search following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines across Web of Science, Scopus, PubMed, and PsycInfo identified 674 studies, of which 30 met the inclusion criteria. Using the Activation Likelihood Estimation (ALE) method, the meta-analysis incorporated 368 brain coordinates (foci) and 93 contrasts from experiments involving 2474 participants (1169 in the maltreatment group and 1305 in the control group). The ALE analysis identified a robust cluster of hyperactivation in the right amygdala in maltreated individuals during emotional processing tasks. Peak activation was observed at [20, -4, -16], suggesting heightened threat detection and emotional reactivity in those with a history of childhood maltreatment. No significant clusters emerged for increased activation in the control group. These findings underscore the amygdala's central role as a neural substrate affected by childhood maltreatment, contributing to heightened emotional reactivity and dysregulated emotion-related processing in affected individuals.

Early maladaptive schemas from child maltreatment in depression and psychotherapeutic remediation: a predictive coding framework

Schemas are affective-cognitive conceptual models of self, others and the world, derived from life experience. Predictive Coding theory proposes schema are created from perceptual input as follows: Based on previous similar experiences, the brain generates schema, with "predictions," expectations of future sensory experiences. Discrepancy between predicted versus actual experience produces a "prediction error." Exposure to prediction errors considered more certain than the predictions of a schema prompts the hippocampus to update and revise the schema. Hypothesized underlying mechanisms include memory reconsolidation, extinction and pattern separation. Depression is characterized by negative schemas predicting helplessness, hopelessness and worthlessness. Early maladaptive schemas, from childhood, are implicated in mediating the greater risk of depression from childhood maltreatment. Prominent examples include the Defectiveness/Shame self-schema, predicting a flawed, unlovable self and the Social Isolation/Alienation schema, predicting isolation. Predictive Coding offers the following biopsychosocial hypothesis explaining how childhood maltreatment promotes depressogenic early maladaptive schema, and how psychotherapy can help: Schema can be difficult to change because of an attention/memory bias away from schema-incongruent information that generate prediction errors prompting schema revision. Childhood maltreatment exacerbates this learning bias. Maladaptive coping styles associated with childhood maltreatment, decrease exposure to experiences contradicting depressogenic schema. Biological changes from childhood maltreatment, including inflammation, interfere with hippocampal updating of schema. Finally, impaired socio-occupational function, associated with childhood maltreatment, reinforces depressogenic schema. By targeting factors associated with childhood maltreatment, which reinforce depressogenic early maladaptive schema or diminish prediction errors, psychotherapy can facilitate revision of depressogenic schema.

The influence of emotion dysregulation and perceived social support on the link between childhood emotional abuse and depressive symptoms in college students: a moderated mediation model

Background

Childhood emotional abuse is strongly linked to an increased risk of depression. However, the pathways linking the two remain elusive. Our study sought to examine how emotion dysregulation and perceived social support influence the link between childhood emotional abuse and depressive symptoms among Chinese college students.

Methods

This study involved 1728 Chinese college students aged 18-24. We utilized the Emotional Abuse (EA) subscale of the Childhood Trauma Questionnaire, Beck Depression Inventory (BDI), Difficulties in Emotion Regulation Scale (DERS) and Perceived Social Support Scale (PSSS) to assess the interrelationships among the study variables. A moderated mediation model was constructed to elucidate these relationships.

Results

Our results indicated a positive correlation between EA, DERS, and BDI. Conversely, PSSS was negatively correlated with EA, BDI, and DERS. Notably, EA is linked to a heightened vulnerability to BDI, with DERS mediating this association. PSSS moderated both the direct path of EA on BDI and the association between DERS and BDI. Furthermore, gender difference was observed in the role of PSSS. PSSS moderated the link between EA and BDI was significant only in the male group and no longer significant under the condition of high PSSS.

Conclusion

This study sheds light on the mediating effect of emotion dysregulation and the moderating effect of perceived social support in the connection between childhood emotional abuse and depressive symptoms. The adverse influence of childhood emotional abuse on subsequent depression may be mitigate through interventions focused on enhancing perceived social support and skills in regulating emotions in college students.

The mediating role of distress tolerance in the relationship between childhood maltreatment and anxiety in a sample of Lebanese adults

Childhood maltreatment is a widespread issue worldwide and has a significant impact on the society at multiple levels, as it affects children. Numerous studies have shown the relationship between various forms of child abuse and the development of adverse outcomes in affected individuals. This study aims to assess the mediating role of distress tolerance in the relationship between childhood maltreatment and anxiety among a sample of Lebanese adults. This cross-sectional study was conducted between March and April 2024; 507 participants were recruited using a snowball sampling method. The results of the mediation analysis were adjusted over sex and physical activity. Distress tolerance partially mediated the association between child abuse and anxiety (indirect effect: Beta = 0.01; Boot SE = 0.01; Boot CI 0.001; 0.02). Higher child abuse was significantly associated with less distress tolerance and directly associated with more anxiety. Higher distress tolerance was significantly associated with less anxiety. The mediating role of distress tolerance in the relationship between childhood maltreatment and anxiety as a mental health outcome was established in this study. Thus, this study highlights the importance of enhancing distress tolerance through therapeutic means including Cognitive and Behavioral Therapies and Dialectical Behavioral Therapy. By doing so, individuals can learn to cope with anxiety caused by childhood maltreatment.

Childhood abuse and neglect in routine care psychotherapy patients

Background

Childhood maltreatment has been well established to contribute to the development and the poorer course of mental disorders across the lifespan. However, studies focusing on patients who are undergoing psychotherapy in natural settings are rare. On this background, the current study aimed to investigate (1) the prevalence of childhood maltreatment in routine care psychotherapy patients, (2) associations between childhood maltreatment and symptom severity, and (3) the influence of childhood maltreatment on treatment outcome.

Method

Data from N = 549 outpatients [60.3% female; age: M(SD) = 36.29 (13.47), range: 17-74 years] who received cognitive behavioral therapy at an outpatient clinic were collected. Self-report measures of childhood maltreatment, depression, anxiety, positive mental health, and treatment satisfaction were assessed before and after treatment.

Results

Any form of childhood maltreatment was reported by 57.6% of the study sample; women were more affected than men, and childhood maltreatment was associated with heightened symptom severity and lowered positive mental health. Emotional abuse was predictive of increased posttreatment depression, anxiety, and reduced positive mental health, whereas emotional neglect was predictive of lower patient-reported global treatment success-after controlling for age, gender, pretreatment depression, anxiety, and positive mental health.

Discussion

Childhood maltreatment is prevalent in routine care psychotherapy patients and associated with symptom severity as well as reduced treatment response. Emotional abuse and emotional neglect exert an especially pernicious influence; particular attention must therefore be paid to these respective childhood experiences, as they can easily go unnoticed in the early phases of psychotherapy.

A Novel Diathesis-Stress Model of Comorbid Early Onset Psychiatric Disorders

Importance

Psychiatric comorbidity is the norm. Identifying transdiagnostic risk factors will inform our understanding of developmental pathways and early intervention targets.

Objective

We recently reported that many psychiatric outcomes are predicted by a three-factor model composed of adolescent externalizing (EXT) behaviors, early life adversity, and dopamine autoreceptor availability. Here, we investigated whether this model could be reproduced in a large population-based sample using functional magnetic resonance imaging (fMRI) instead of positron emission tomography.

Design

Data were collected by the IMAGEN consortium beginning in 2010 when cohort members were 14 years old, with follow-up testing at ages 16 and 19. These longitudinal data were used to predict psychiatric disorders by 19 years of age.

Setting

Participants were recruited from secondary schools across Europe.

Participants

Adolescents (n = 1338) with fMRI, behavioural, diagnostic, and early life trauma data.

Main Outcomes and Measures

Binary regression models tested whether a combination of EXT behaviors, childhood trauma, and mesocorticolimbic reward anticipation responses at age 14 or 19 predicted the presence of a disorder by age 19.

Results

A total of 1338 participants had the required data (52.4% female). In all models, EXT and adversity scores were significant predictors (p < 0.001). Reward anticipation responses in the ventral striatum, caudate, putamen, and anterior cingulate cortex (ACC) at age 14 (p ≤ 0.05) and in the ventral striatum at age 19 (p ≤ 0.029) were predictors in their respective models. The three-factor models overall were highly significant (p < 1.0 × 10-21), yielding greater predictive strength than each factor alone. They had an accuracy of nearly 75%, accounting for ≥ 11% (Nagelkerke R2) of the variance in psychiatric disorders. The relationship between trauma and diagnoses was partially mediated by higher EXT (indirect path B = 0.0535, 95% CI = 0.0301-0.0835), and moderated by fMRI responses in the ACC (p = 0.0038) and putamen (p = 0.0135) at age 14.

Conclusions and Relevance

The results extend our previous findings, increasing confidence in a novel diathesis-stress model of commonly comorbid early onset psychiatric disorders. The results have implications for diagnostic classification schemes and pleiotropic views of psychiatric disorder etiology.

Childhood maltreatment influences coping in youths with major depression and bipolar depression through resilience and impulsivity

Empirical research on the link between childhood maltreatment and coping styles in youths with depression remains scarce. This study explores the relationship between childhood maltreatment and coping styles in youths with major depressive disorder (MDD) and bipolar depression (BD). We recruited 277 youths with depression and 98 healthy controls (HC) using convenience sampling. Participants completed the Childhood Trauma Questionnaire-Short Form (CTQ-SF), the Connor-Davidson Resilience Scale (CD-RISC), the adapted Chinese version of the Barratt Impulsiveness Scale-11 (BIS-11), and the Simplified Coping Style Questionnaire (SCSQ). Differences between groups were assessed using ANOVA and Chi-square tests. The mediating roles of resilience and impulsivity between childhood maltreatment and coping style were analyzed with the PROCESS macro for SPSS. Among youths with depression, resilience and impulsivity were found to mediate the relationship between childhood maltreatment and coping style, with resilience accounting for 37.75% and impulsivity 17.72% of the total effect. Additionally, childhood maltreatment indirectly influenced coping style through resilience, which subsequently affected impulsivity, explaining 7.95% of the total effect. No direct effect of childhood maltreatment on coping style was observed in the BD group, and impulsivity did not mediate this relationship in the HC group. The study highlights that childhood maltreatment is directly related to coping styles in youths with depression and indirectly affects them through resilience and impulsivity. These findings suggest that improving resilience and managing impulsivity could enhance positive coping styles in this population.

Early Life Stress and Substance Use Disorders: Underlying Neurobiology and Pathways to Adverse Outcomes

Early life stress (ELS) has been established as a major risk factor for a multitude of psychiatric and medical disorders. ELS is highly prevalent in the general population and constitutes a major public health concern. The current review will focus on the clinical literature that suggests a link between adverse early life experiences and vulnerability for adolescent and adult substance use disorders. It will investigate the characteristics of ELS that appear to increase risk for disorder onset and a more severe disease course, characterized by earlier onset, greater risk of relapse, and treatment resistance. The authors explore how ELS may increase risk for adverse substance use outcomes through long-lasting changes in the HPA axis and development of stress, reward, and executive control brain systems. The review will also discuss potential pathways to substance use disorder following ELS, with a focus on the role of comorbid mood and anxiety disorders and other modifiable traits. Finally, the authors will discuss how the current body of work presents the potential for prevention and intervention strategies to reduce the psychosocial consequences following early life stress and minimize adverse substance use outcomes. Reprinted from Advers Resil Sci 2020; 1:29-47, with permission from Springer. Copyright © 2020.

Co-Occurring Bipolar and Substance Use Disorders: A Review of Impacts, Biopsychosocial Mechanisms, Assessment, and Treatment

Individuals with bipolar disorder are at significant risk for having a co-occurring substance use disorder-particularly, alcohol and cannabis use disorders. Having a co-occurring substance use disorder is associated with a more pernicious clinical course, lower quality of life, and poorer treatment outcomes. Despite its increased morbidity, there is little research and clinical evidence-based guidelines on the treatment of individuals with co-occurring bipolar and substance use disorders. This review details current knowledge on the prevalence, clinical correlates, and biopsychosocial mechanisms underlying co-occurring bipolar and substance use disorders. The authors present recent research that highlights underlying mechanisms of comorbidity, including aberrant reward processing, stress sensitization, early childhood maltreatment, and gene-environment interactions. Next, the authors review current evidence-based recommendations for the assessment and treatment of co-occurring bipolar and substance use disorder, highlighting areas of needed future clinical research.

Efficacy of probiotic adjuvant therapy in women with major depressive disorder: insights from a case series study

BACKGROUND

The therapeutic targeting of the intestinal microbiota has gained increasing attention as a promising avenue for addressing mood disorders. This study aimed to assess the potential effect of supplementing standard pharmacological treatment with the probiotic kefir in patients with Major Depressive Disorder (MDD).

METHODS

Thirty-eight female participants diagnosed with moderate MDD by the Hamilton Rating Scale for Depression (HAM-D) were selected to receive the probiotic kefir in conjunction with antidepressant therapy for 12 weeks. The participants were evaluated at baseline (T0) and 90 days after probiotic kefir supplementation (T90). HAM-D scores and blood samples were collected at both time points.

RESULTS

Probiotic supplementation significantly reduced MDD severity, as evidenced by lower HAM-D scores compared to baseline. Probiotic consumption for 90 days also significantly decreased interleukin-6 (IL-6), C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) levels compared to baseline. However, probiotic kefir supplementation did not significantly affect serum serotonin levels. Additionally, after 90 days of probiotic consumption, insulin and morning cortisol levels were significantly reduced. In contrast, no significant changes were observed in serum levels of prolactin, vitamin D, and afternoon cortisol.

CONCLUSION

This study provides valuable insights into the potential benefits of probiotics, specifically kefir, as adjunctive therapy for female patients with MDD. The findings highlight promising results in ameliorating depressive symptoms and modulating inflammatory and hormonal markers.

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

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

Altered Brain Functional Connectivity and Peripheral Transcriptomic Profiles in Major Depressive Disorder With Childhood Maltreatment

Background: Childhood maltreatment (CM) is a significant risk factor for major depressive disorder (MDD), yet the underlying biological mechanisms remain unclear. This study aimed to investigate brain functional networks and peripheral transcriptomics in patients with MDD who have a history of CM. Methods: Functional imaging data were collected and network-based statistics were used to identify differences in functional networks among MDD patients with CM (MDD_CM, n = 78), MDD patients without CM (MDD_nCM, n = 61), and healthy controls (HC, n = 126). Additionally, blood transcriptional data were clustered into co-expression modules, and module differential connectivity analysis was utilized to assess variations in gene co-expression network modules among the groups. Results: The results revealed a significant difference in an inferior occipital gyrus-centered functional network among the three groups. Furthermore, eight gene co-expression modules differed among the groups and were enriched in multiple branches related to immune responses or metabolic processes. Notably, a module enriched in type I interferon-related signaling pathways demonstrated a significant correlation with the disrupted network in the MDD_nCM group. Moreover, multiple immune-related gene modules were found to be significantly correlated with sleep disturbances in MDD_CM patients. Conclusions: Dysregulation of an inferior occipital gyrus-centered functional network and immune-related transcriptomic alterations significantly associate with the pathophysiology of MDD_CM.

Stressful and potentially traumatic events and healthcare utilization: the 7th Tromsø survey

BACKGROUND

Stressful and potentially traumatic life events (SLEs/PTEs) can have a profound negative impact on the individual's mental and physical wellbeing and health. Consequently, an association of SLEs/PTEs with increased healthcare utilization has been found. However, most studies have been conducted in selected samples (e.g., veterans), and there is a paucity of studies in the general population. The present study examined the associations between SLEs/PTEs and the utilization of healthcare services in the general population using data from the seventh survey of the Tromsø study (Tromsø7).

METHODS

The sample comprised 20,069 participants aged 40 years and above (52.5% female, mean age 57.3 years, SD = 11.4 years) who completed measures of SLE/PTE exposure in childhood/adolescence and adulthood (including a question about mental preoccupation with SLEs/PTEs), utilization of a variety of healthcare services (general practitioner, medical specialist, hospital, emergency room, mental health services, physiotherapist, and complementary and alternative medicine provider) in the previous year, and self-reported feeling of being anxious or depressed.

RESULTS

The results showed that SLE/PTE exposure is associated with an increased use of all healthcare services, especially mental health professionals. Exposure to physical and emotional neglect in childhood/adolescence, violence, and sexual abuse showed the strongest associations with the utilization of mental health services. The strength of the associations with health service utilization increased with the number of SLEs/PTEs. Finally, mental preoccupation with the event(s) moderated the associations between SLE/PTE exposure and the utilization of healthcare services but not self-reported feeling of being anxious or depressed.

CONCLUSION

It is concluded that the prevention of SLEs/PTEs and screening for SLE/PTE exposure in healthcare services to provide trauma-informed care should be a prioritized public health focus.

Alterations in cerebral resting state functional connectivity associated with social anxiety disorder and early life adversities

Social Anxiety Disorder (SAD) involves fear of negative evaluation and social avoidance, impacting quality of life. Early life adversities (ELA) are recognized as risk factors for SAD. Previous research indicated inconsistent alterations in resting state functional connectivity (RSFC) in SAD, particularly in the prefrontal cortex and precuneus. This study investigated the interaction between SAD and ELA at the RSFC level. Functional magnetic resonance imaging (fMRI) was conducted on 120 participants (aged 19-48). Four groups were formed: low/ high ELA controls (n = 49, n = 22) and low/ high ELA SAD participants (n = 30, n = 19). Seed-based correlation analyses (SCA) and multi-voxel pattern analysis (MVPA) were applied. A network in which ELA moderates the neural correlates of SAD during the resting state was identified, involving key nodes like the subgenual anterior cingulate cortex, left middle frontal gyrus, and an area in the calcarine fissure/precuneus. Five distinct interaction patterns of SAD and ELA were observed, showcasing opposite RSFC patterns in individuals with SAD based on ELA experience. Results remained significant when controlled for general anxiety and depression measures. Emotional aspects of ELA played a significant role in these interactions. These findings stress the necessity of considering primarily emotional ELA as covariate in neuroimaging studies investigating SAD and potentially also other psychiatric disorders, addressing inconsistencies in prior research. The left middle frontal gyrus emerges as a link in the SAD-ELA interaction during resting state and anxiety-relevant stimulation. Longitudinal studies, starting from childhood, are needed to understand ELA's impact on brain function and to identify potential neuromarkers for SAD predisposition post-ELA exposure.

A Systematic Review and Meta-Analysis of the Association Between Childhood Maltreatment and Adult Depression

INTRODUCTION

Childhood maltreatment (CM) and depression are serious global issues with high prevalence and lifelong impacts on physical and mental health. CM has been proposed as a modifiable risk factor for depression that, if prevented, may contribute to a reduction in the global incidence of depressive disorders. Despite this, there is a paucity of reviews examining the strength of the association between these variables. The aim of this systematic review and meta-analysis was to evaluate the empirical evidence and determine if CM is supported as a preventable risk factor for depression.

METHODS

A search was performed in July 2024 for all peer-reviewed journal articles written in English examining the relationship between CM and adult depression in the electronic databases EBSCOhost, Proquest, and Embase. Studies were included in this review if they measured maltreatment before 18 years of age as the independent variable and adult depression as the dependent variable. Studies were excluded if the outcome variable was grouped with comorbidity and if they did not report primary quantitative data. A total of 77 studies with 516,302 participants met the inclusion criteria for review.

RESULTS

A random-effects meta-analysis was used to generate a pooled odds ratio from 87 effect estimates and demonstrated that individuals with a history of any CM are 2.5 times more likely to experience adult depression (OR = 2.49 [95% CI: 2.25-2.76]). This increase in odds remained regardless of how the primary studies screened for depression.

CONCLUSIONS

These findings confirmed the strong association between the experience of CM and adult depression. High heterogeneity in the meta-analytic results also suggested that further research is required that applies consistent adjustments for comorbidities and confounding factors and examines the temporal relationship between the variables to establish causality.

Sexual abuse history and psychotropic use characteristics of inpatient children and adolescents with major depressive disorders

OBJECTIVE

This study aimed to investigate the clinical and psychopharmacologic characteristics of child and adolescent inpatients diagnosed with major depressive disorder (MDD), with and without a history of sexual abuse.

METHODS

The 337 consecutive patients who were followed up in a University Child and Adolescent Psychiatry inpatient clinic between 2017 and 2019 were evaluated, and 149 were diagnosed with MDD. MDD diagnosed children and adolescents were divided into two groups based on whether they had a history of sexual abuse (n = 44; Group 1) or did not (n = 105; Group 2).

RESULTS

The mean age of group 1 was 14.6 ± 1.6 years (range: 6-18) and group 2 was 14.6 ± 2.2 years (range: 6-18). Group 1 had a significantly higher prevalence of psychiatric comorbidities (p = 0.002), non-suicidal self-injury (p = 0.018), domestic violence (p = 0.008), physical (p = 0.008) and emotional abuse history (p = 0.007), and a longer duration of hospitalization (p < 0.0001). Antipsychotic combination therapy (χ2 = 10.772; p = 0.005) and total chlorpromazine equivalent doses were also higher in the sexually abused group (Z = -2.749; p = 0.006).

CONCLUSION

These findings suggest that depressive symptoms in sexually abused children and adolescents may be more resistant to psychopharmacological treatment. Further studies are needed to determine whether these differences are attributable to the neurochemical and neuroanatomical effects of trauma or psychiatric comorbidities.

A Qualitative Phenomenological Study of the Lived Experiences of Female Sex Workers in a Bangladesh Brothel

AIM

The purpose of this study was to explore the lived experiences of female sex workers in the Kandapara Brothel in Tangail to build a better understanding of their lived perspective.

DESIGN

This qualitative study was based on the philosophical underpinnings of Giorgi's descriptive phenomenological philosophy.

METHODS

A purposive, convenience sample of 24 participants (N = 24) was recruited in the brothel, sufficient for data saturation. The inclusion criteria included (a) must work in the brothel and (b) must be ≥ 18 years old. In-depth interviews were conducted, and transcript data were reduced, managed and coded.

ETHICS

The university institutional review board and ethics committee approved the study, and participants provided written informed consent.

FINDINGS

A qualitative analysis of transcribed in-depth interviews revealed four major themes: (1) Early Trauma and Dysregulation, which reflects the trauma experienced by the women working in the brothel and being trafficked at a very early age; (2) Internal life describes the emotional experience and gratitude; the feelings of the sex workers in the brothel, (3) External life reflects the view of the greater Bangladeshi society of the sex workers and (4) The Brothel Life examines the relationships, competition, isolation, health concerns and workers' desire/uncertainty to leave the brothel. The four themes, while appearing separate, overlap with the other themes.

CONCLUSIONS

This phenomenological study illustrates the complexity of brothel workers' lived experiences. Understanding sex workers' lived experiences through a caring lens promotes care that allows for self-determination, reflection, growth, acceptance and, most of all, healing.

Association between adverse childhood experiences and menstruation-related symptoms among Japanese female workers: A cross-sectional study

BACKGROUNDS

Menstruation-related symptoms are a common and serious health problem even without a specific diagnosis such as premenstrual dysphoric mood disorder (PMDD) or dysmenorrhea. Various adverse childhood experiences (ACEs) might be associated with menstruation-related symptoms, not only traditional traumatic events such as abuse, but also expanded ACEs such as childhood poverty, school bullying, or natural disasters.

OBJECTIVE

This study examined the association between expanded ACEs (ACEs for Japanese) and menstruation-related symptoms among Japanese working women.

METHODS

Data came from an online survey conducted in October 2023 that included women aged 20-44 working full-time, who have never been pregnant and are not currently using contraception. Menstruation-related symptoms severity was evaluated using the Menstrual Distress Questionnaire (MDQ) and the Premenstrual Dysphoric Disorder (PMDD) scale. The MDQ score of the premenstrual and menstrual phases were classified into four categories as menstrual symptoms severity of each phase. Logistic regression assessed the association between ACEs and each outcome, adjusting for covariates.

RESULTS

The analysis included 2000 women. Premenstrual and menstrual symptoms severity increased with two or more ACEs. In the fully adjusted model, women with four or more ACEs significantly showed severe premenstrual symptoms (adjusted odds ratio [aOR] = 2.81, 95%CI:2.12-3.72), and severe menstrual symptoms (aOR = 3.03, 95%CI: 2.29-4.02). Four or more ACEs were associated with PMDD (aOR = 5.61, 95%CI: 2.65-11.89). Childhood poverty and school bullying were also associated with menstruation-related symptoms severity, and natural disasters with PMDD.

CONCLUSIONS

Expanded ACEs were associated with menstruation-related symptoms. The results suggested the importance of trauma-informed care in gynecology, obstetrics, and occupational health practice.

The effects of unconditional cash transfers on child abuse and neglect in early childhood: Evidence from New Zealand

BACKGROUND

Child abuse and neglect is recorded at higher rates in families with low incomes, and in contexts with lower public spending on families. However, it is not clear whether modest cash transfers could reduce rates.

OBJECTIVE

To estimate the effects of unconditional cash transfers to mothers with children under 3 years of age on child abuse and neglect.

SETTING AND PARTICIPANTS

In 2018, New Zealand - an ethnically diverse rich democracy with above average child poverty - introduced a "Families Package" of largely unconditional cash transfers for mothers of children aged 0-3. The majority of the package comprised a universal payment for children aged 0-1 of NZ$60 (US$37) a week, and a payment of up to that amount for families in all but the top third of incomes for children aged 1-3. Mothers chose whether to receive payments weekly, monthly or annually. We use administrative data for all children born in New Zealand between 2013 and 2019 (N = 172,170).

METHOD

Difference-in-difference estimation compared the difference in child abuse and neglect for 3-year-olds born before and after the introduction of the Families Package in July 2018, with the differences between the same birth month periods for children born in the previous 3 years.

RESULTS

The Families Package reduced the odds of child protective services' referrals to family services in non-urgent cases of suspected maltreatment by 19 % overall (OR: 0.81, CI: 0.80-0.81, p = 0.003). The reduction was 26 % (OR: 0.74, CI: 0.61-0.91, p = 0.003) both for Māori, the indigenous people of New Zealand, and for those for whom child protective services had a record of concern for older siblings. The Families Package also reduced substantiated cases of neglect in single mother families (OR 0.6, CI 0.38-0.93, p = 0.022). There were no significant effects on urgent cases, substantiations of physical or emotional abuse, or hospitalizations for traumatic brain injuries.

CONCLUSIONS

Small unconditional cash transfers in early childhood can lead to meaningful reductions in non-acute cases of suspected child abuse and neglect among at-risk groups.

Experiential Learning in Mental Health Diversion: Interdisciplinary Approaches Using Kolb's Learning Theory

PURPOSE

This study evaluated student responses to an interprofessional experiential learning opportunity (ELO) grounded in Kolb's Learning Theory.

MATERIALS AND METHODS

Students from several disciplines, including Social Work, Criminal Justice, Communication, and Teacher Education, were placed in various internship roles within the court system to provide interventions, services, and resources to low-level offenders and families as an alternative to criminal consequences. Qualitative data from student discussions and reflections was reviewed using a thematic approach. The research sought to find meaningful patterns that emerged and better understand student experiences and perspectives as they developed throughout the project.

RESULTS

Students who participated in this study demonstrated increased empathy, critical thinking, self-efficacy, and enhanced professional skills.

DISCUSSION

This project offered students a real-world experience to develop practical knowledge and skills for increasing mental health literacy and effectively serving those with mental health issues within the criminal justice system.

Dampening of positive affect partially accounts for the association between women's history of child maltreatment and current depressive symptoms

BACKGROUND

Child maltreatment exerts lasting effects on emotion regulation, which in turn accounts for adult's risk for psychopathology such as depression. In this vulnerable population, deficits in emotion regulation of negative affect are well established and include reliance on emotional suppression and rumination strategies. In contrast, alterations in the regulation of positive affect associated with child maltreatment history are less understood. We examined the role of positive rumination and dampening of positive affect, two emotion regulation strategies that may be impaired by the experience of child maltreatment and are associated with depression risk. We hypothesized that alterations in positive rumination and dampening would explain the association between women's childmaltreatment history and heightened risk for current depressive symptoms. To determine if positive affect regulation accounts for unique variance between child maltreatment history and depression risk we controlled for brooding rumination.

METHODS

Undergraduate women (n = 122) completed surveys on child maltreatment, depressive symptoms, and their tendency to dampen or engage in positive rumination in response to positive affect, reflecting cross-sectional data. The PROCESS macro, model 4 was run in SPSS to examine the extent to which emotion regulation strategies accounted for the association between child maltreatment history and current depressive symptoms.

RESULTS

Child maltreatment history was associated with a higher tendency to dampen positive affect but was not linked with positive rumination. Dampening partially explained the link between child maltreatment and women's current depressive symptoms. Dampening and brooding rumination each accounted for unique variance in the association between child maltreatment and depressive symptoms.

CONCLUSIONS

Results suggest that emotion suppression strategies among child maltreatment survivors may also extend to positive affect, with impairments in specific regulation strategies. Currently dysphoric women with a history of child maltreatment tend to dampen their positive moods and reactions to events as well as ruminate on their dysphoric moods, both tendencies accounted for unique variance in current depression risk. Longitudinal research is warranted to clarify the role of alterations in positive emotion regulations strategies in understanding how child maltreatment fosters risk for psychopathology such as depression.

Association between Adverse Childhood Experiences and long-term outcomes in people at Clinical High-Risk for Psychosis

Adverse childhood experiences (ACEs) are common in people at clinical high-risk for psychosis (CHR), however, the relationship between ACEs and long-term clinical outcomes is still unclear. This study examined associations between ACEs and clinical outcomes in CHR individuals. 344 CHR individuals and 67 healthy controls (HC) were assessed using the Childhood Trauma Questionnaire (CTQ), the Bullying Questionnaire and the Childhood Experience of Care and Abuse (CECA). CHR were followed up for up to 5 years. Remission from the CHR state, transition to psychosis (both defined with the Comprehensive Assessment of an At Risk Mental State), and level of functioning (assessed with the Global Assessment of Functioning) were assessed. Stepwise and multilevel logistic regression models were used to investigate the relationship between ACEs and outcomes. ACEs were significantly more prevalent in CHR individuals than in HC. Within the CHR cohort, physical abuse was associated with a reduced likelihood of remission (OR = 3.64, p = 0.025). Separation from a parent was linked to an increased likelihood of both remission (OR = 0.32, p = 0.011) and higher level of functioning (OR = 1.77, p = 0.040). Death of a parent (OR = 1.87, p = 0.037) was associated with an increased risk of transitioning to psychosis. Physical abuse and death of a parent are related to adverse long-term outcomes in CHR. The counter-intuitive association between separation from a parent and outcomes may reflect the removal of a child from an adverse environment. Future studies should investigate whether interventions targeting the effect of specific ACEs might help to improve outcomes in this population.

The impact of emotional abuse on Internet addiction in Chinese children: the sequential mediation roles of emotional dysregulation and regulatory emotional self-efficacy

Background

In China, emotional abuse and Internet addiction are increasingly prevalent among children, with significant negative effects on their development. Previous research has identified childhood emotional abuse as a major risk factor for Internet addiction in both adolescents and adults. However, the immediate impact of emotional abuse on children's Internet addiction within Chinese culture remains unclear.

Objective

This study aimed to investigate the impact of emotional abuse on Internet addiction through emotional dysregulation and regulatory emotional self-efficacy in Chinese children.

Methods

A sample of 556 fourth to sixth grade primary school students (girls, 46.6%) with an average age of 10.30 ± 0.93 years were recruited from a central province in China. Participants completed the paper-and-pencil survey on emotional abuse, emotional dysregulation, regulatory emotional self-efficacy, and Internet addiction. The hypothesized model was tested using Mplus 8.3 with 5,000 bootstrap samples.

Results

Emotional abuse positively predicts Internet addiction in children; emotional dysregulation and regulatory emotional self-efficacy mediate this relationship independently, and have chain-mediating effects in this relationship.

Conclusion

Emotional abuse impacts children's Internet addiction through the development of emotional regulation and self-perception of their abilities in emotional regulation. The findings offer potential strategies for preventing children's Internet addiction.

Play Nicely Program in the prevention of violence against children: strengthening sustainable development

OBJECTIVE

to understand the perception of teachers and health professionals regarding the use of the Play Nicely Program for parents/caregivers in the prevention of violence against children.

METHOD

a descriptive and exploratory qualitative study was conducted through three focus groups with twenty primary school teachers and primary health care professionals who implemented the Program for parents/caregivers in 2022. The data analysis was guided by French discourse analysis, interpreted through the lens of Urie Bronfenbrenner's theory.

RESULTS

three categories emerged from the participants' perceptions: innovation and utility; theory applicability in practice; reinterpreting attitudes of austerity and impatience towards children; disciplining rather than punishing children: dilemmas and challenges. The testimonies highlighted that the Program is innovative, easily accessible, clear in language, and easy to apply in practice for parents/caregivers.

CONCLUSION

the use of the Program added knowledge and fostered positive attitudes toward the development of the bioecological system in addressing and preventing violence against children.

The impact of adverse childhood experiences on adult physical, mental health, and abuse behaviors: A sex-stratified nationwide latent class analysis in Japan

Adverse childhood experiences (ACEs) have been reported to detrimentally impact physical and mental health. While experiencing multiple ACEs is common, previous research primarily assessed ACEs by their total count, neglecting the impacts of different experience types. Furthermore, sex-based differences in ACEs and their influences remain unclear. This study employed Latent Class Analysis (LCA) to uncover patterns of ACEs with consideration for sex differences, aiming to elucidate their effects on adult physical and mental health. A geographically nationally representative dataset from the "Japan COVID-19 and Society Internet Study (JACSIS)" conducted in 2022 was used. 13,715 men and 14,327 women retrospectively reported their experiences across fifteen ACEs. The analysis revealed four distinct ACE patterns for both sexes: a Multiple Adversities class with a wide range of severe ACEs, a Psychological Abuse class experiencing emotional abuse at home and bullying at school, a Poverty class facing economic hardships, and a Low Adversities class with the fewest ACEs. Multinomial logistic regression analysis indicated that more severe patterns of exposure correlated with heightened adverse adult outcomes. However, the extent of these impacts varied by sex and ACE pattern. For instance, men in Multiple Adversities and Psychological Abuse classes exhibited higher tendencies towards conducting physical and psychological abuse behaviors. While ACEs in men were linked to both underweight (in cases of psychological abuse) and obesity (across all classes), women with ACEs generally leaned towards higher body weight. These findings highlight the importance of developing support strategies sensitive to sex differences and the specific content of ACEs.

Early life stress and functional connectivity in antipsychotic-naïve first episode psychosis patients

The neural mechanisms underlying the association between childhood trauma (CT) and psychosis spectrum disorders remains unclear. The objective of this study is to examine the relationship between childhood trauma and functional connectivity of fronto-limbic regions in a large sample of antipsychotic-naïve patients with first episode psychosis (FEP). Resting state fMRI data from 105 FEP patients and 123 healthy controls (HC) were used. Our regions of interest included bilateral hippocampus/amygdala and ventromedial prefrontal cortex (vmPFC). Childhood Trauma Questionnaire (CTQ) total and subscale scores were correlated with the resting state functional connectivity (rsFC) data. Partial correlation analyses indicated that higher CTQ sexual abuse subscale scores in FEP patients were associated with increased left amygdala-vmPFC rsFC (r(59) = 0.27, p < 0.05) and higher CTQ emotional neglect subscale scores in FEP patients were associated with increased left hippocampus-vmPFC rsFC (r(59) = 0.26, p < 0.05). Follow-up analysis showed a significant interaction effect of group (FEP and HC) and CTQ score (sexual abuse subscale) on left amygdala-vmPFC rsFC (β = 0.014, p < 0.05). Higher CTQ sexual abuse subscale scores were associated with increased rsFC in FEP patients (β = 0.56, p < 0.001). but reduced rsFC in healthy controls (β = -0.56, p < 0.001). The results also provide support for the long-term differential impact of trauma subtypes on the human brain. Overall, the results contribute to the understanding of the neural mechanisms underlying the association between childhood trauma and psychosis spectrum disorders.

Breaking the cycle between caregiver mental health and child behavioral issues: Does food insecurity matter?

Food insecurity is a key determinant of not only caregiver's mental health but also children's emotional problems and hyperactivity symptoms. Although substantial studies have explored such a relationship, it is unclear to us whether this relation would vary when considering that caregiver's mental health and aforementioned children's behavioral issues can be the cause and effect of each other. Addressing this research gap is a key to advancing our understanding of how to promote a healthier family dynamic, especially for those facing material needs. This research applies the family stress model to explore how food insecurity affects caregiver psychological distress and child emotional problems and hyperactivity symptoms, while considering the reciprocal relationships between caregiver mental health and these child behavioral issues. Utilizing data from the 2019 Panel Study of Income Dynamic and 2019-2020 Child Development Supplements, this study conducts path analyses applied with propensity score weighting to support causal inference. Results support the family stress model framework, where food insecurity significantly predicts an increase in psychological distress in caregivers, which in turn leads to more severe child emotional problems and hyperactivity symptoms. This study also shows that food insecurity is a risk factor resulting in a reciprocal association between caregiver psychological distress and child emotional problems, where the strength of both directions is similarly harmful to each other. These findings underscore the need to address food insecurity, not only to meet material needs but also to break the harmful cycle of mental health and behavioral issues within families.

Prevalence and correlates of post-traumatic stress disorder and depression among welfare- and justice-involved adolescents in Nigeria

Background: Childhood maltreatment (CM) is higher among welfare- and justice-involved youth than in those not involved in these systems, which increases the risk of depression and post-traumatic stress disorder (PTSD). However, the mechanisms underlying the link between CM and these two psychiatric conditions are less well understood among at-risk populations in low- and middle-income countries.Objective: This study attempts to fill this gap by examining the prevalence of and risk factors for depression and PTSD among at-risk groups in Nigeria.Method: A cross-sectional research design using multistage sampling was adopted. The sample comprised 205 adolescents: justice-involved [102 (49.8%)] and welfare-involved [103 (50.2%)]. In total, 151 (73.7%) were males, while 54 (26.3%) were females. Multivariate logistic regression analysis and multivariate analysis of variance were applied.Results: The results showed that 66.1% of welfare-involved adolescents and 69.6% of justice-involved adolescents reported PTSD, while 68.9% of welfare-involved adolescents and 75.5% of justice-detained adolescents reported depression. Neglect (OR = 0.253; 95% CI 0.146-0.571; p < .001) and witnessing violence (OR = 0.230; 95% CI 0.114-0.597; p < .004) predicted depression. Emotional abuse (OR = 0.186; 95% CI 0.090-0.80; p < .015), witnessing violence (OR = 0.147; 95% CI 0.014-0.876; p < .043), neglect (OR = 0.187; 95% CI 0.14-0.90; p < .008), and physical abuse (OR = 0.27; 95% CI 0.254-0.937; p < .001) predicted PTSD. Also, PTSD significantly differed based on type of placement (F = 6.08, p < .014, η2 = .029), but depression did not differ based on type of placement (F = 2.46, p > .118, η2 = .012).Conclusions: CM profiles are risk factors in PTSD and depression among at-risk groups. CM screening should be included in mental health services of out-of-home placements to prevent the cycle of mental health problems and reoffending. Trauma-focused and cognitive-behavioural therapies have the potential to alleviate the suffering of traumatized adolescents.

Molecular mechanisms and behavioral relevance underlying neural correlates of childhood neglect

BACKGROUND

Childhood neglect is associated with brain changes, yet the molecular mechanisms and behavioral relevance underlying such associations remain elusive.

METHODS

We calculated fractional amplitude of low-frequency fluctuations (fALFF) using resting-state functional MRI and tested their correlation with childhood neglect across a large sample of 510 healthy young adults. Then, we investigated the spatial relationships of the identified neural correlates of childhood neglect with gene expression, neurotransmitter, and behavioral domain atlases.

RESULTS

We found that more severe childhood neglect was correlated with higher fALFF in the bilateral anterior cingulate cortex. Remarkably, the identified neural correlates of childhood neglect were spatially correlated with expression of gene categories primarily involving neuron, synapse, ion channel, cognitive and perceptual processes, and physiological response and regulation. Concurrently, there were significant associations between the neural correlates and specific neurotransmitter systems including serotonin and GABA. Finally, neural correlates of childhood neglect were associated with diverse behavioral domains implicating mental disorders, emotion, cognition, and sensory perception.

LIMITATIONS

The cross-sectional study design cannot unequivocally establish causality.

CONCLUSIONS

Our findings may not only add to the current knowledge regarding the relationship between childhood neglect and mental health, but also have clinical implications for developing preventive strategies for individuals exposed to childhood neglect who are at risk for mental disorders.

Prevalence and pattern of child maltreatment at home among secondary school students in Ibadan North Local Government, Oyo State, Nigeria

BACKGROUND

Child maltreatment is an action that endangers a child's health or survival and is often committed by individuals in positions of responsibility, trust, or power. The extent of maltreatment among secondary school students in developing countries, including Nigeria, requires further exploration, and evaluating this burden can inform preventive interventions.

OBJECTIVE

The study aimed to evaluate the prevalence, pattern and factors associated with maltreatment at home among secondary school students in Ibadan North LGA, Oyo State, Nigeria.

PARTICIPANTS AND SETTING

A cross-sectional study including 422 students in secondary school was conducted in randomly selected secondary schools in Ibadan North LGA, Nigeria using a multistage-sampling procedure to select students.

METHODS

The study used a pre-tested, semi-structured, questionnaire administered by the interviewer, incorporating questions on sociodemographic and the child home version of the ISPCAN Child Abuse Screening Tool (ICAST-CH). Data analysis involved descriptive statistics and the Chi-square test, done by setting the significance level at 5 %.

RESULTS

Respondents had a mean age of 13.9 ± 1.8 years, with 52.1 % being female and 69.5 % living with their parents. More than a quarter (26.8 %) of the respondents experienced all forms of maltreatment, with emotional and physical maltreatment rates at 85.3 % and 81.8 %, respectively, and neglect and sexual maltreatment at 47.4 % and 55.9 %. Age, school type, Parental education, and living arrangements were significantly associated with experience of all forms of maltreatment.

CONCLUSIONS

All child maltreatment forms were significantly present among the students. Measures like engaging parents/guardians through parenting programs and sensitization efforts are crucial in reducing the occurrence of maltreatment.

Investigating the contribution of childhood maltreatment to suicide attempt: A multivariable Mendelian randomization study

Childhood maltreatment has been associated with suicidal behavior. However, whether this risk is causal and uniquely due to consequences of childhood maltreatment such as mental disorders, socioeconomic difficulties, and cognitive skills impairments needs clarification. We investigated direct and indirect contributions of childhood maltreatment to suicide attempt using a two-sample multivariable Mendelian randomization design. We used 7 single nucleotide polymorphisms from the childhood maltreatment genome-wide association study as instruments for childhood maltreatment. Multivariable Mendelian randomization was used to investigate the association of childhood maltreatment with suicide attempt accounting for risk of major psychiatric disorders (major depression, schizophrenia, attention-deficit/hyperactivity disorder), cognitive factors, and socioeconomic factors. Evidence supported a possible causal role of childhood maltreatment on suicide attempt (OR 4.36, CI 2.36-7.97). Significant associations with suicide attempt were identified for subtypes of maltreatment (physical abuse, physical neglect, emotional abuse, emotional neglect, sexual abuse), although unclear for sexual abuse. In multivariable analyses, childhood maltreatment was associated with suicidal attempt independently from selected mental disorders, socioeconomic factors, and cognitive factors although these factors accounted for most of the association (OR 1.51, CI 1.10-2.09). To prevent suicide among children exposed to maltreatment, it may be important to combine interventions to reduce mental disorders, psychosocial intervention, and suicide-specific preventive intervention.

Differential association between childhood trauma subtypes and neurocognitive performance in adults with major depression

BACKGROUND

Neurocognitive impairment is one of the prominent manifestations of major depressive disorder (MDD). Childhood trauma enhances vulnerability to developing MDD and contributes to neurocognitive dysfunctions. However, the distinct impacts of different types of childhood trauma on neurocognitive processes in MDD remain unclear.

METHODS

This study comprised 186 individuals diagnosed with MDD and 268 healthy controls. Childhood trauma was evaluated using the 28-item Childhood Trauma Questionnaire-Short Form. Neurocognitive abilities, encompassing sustained attention, vigilance, visual memory, and executive functioning, were measured by the Cambridge Neuropsychological Testing Automated Battery.

RESULTS

Multivariable linear regressions revealed that childhood trauma and MDD diagnosis were independently associated with neurocognitive impairment. Physical neglect was associated with impaired visual memory and working memory. MDD diagnosis is associated with working memory and planning. Interactive analysis revealed that physical/sexual abuse was associated with a high level of vigilance and that emotional neglect was linked with better performance on cognitive flexibility in MDD patients. Furthermore, childhood emotional abuse, physical abuse, and emotional neglect were revealed to be risk factors for developing early-onset, chronic depressive episodes.

CONCLUSION

Thus, specific associations between various childhood traumas and cognitive development in depression are complex phenomena that need further study.

Effectiveness of Collaborative, Trauma-Informed Care on Depression Outcomes in Primary Care: A Cluster Randomized Control Trial in Chile

PURPOSE

The purpose of this study was to evaluate the effectiveness of collaborative trauma-informed care (CTIC) for treating depression in primary care in Chile.

METHODS

From August 2021 through June 2023, 16 primary care teams in the Maule Region of Chile, were randomly assigned to either the CTIC or usual treatment (UT) group. At baseline, 3 months, and 6 months, 115 patients in the CTIC group, and 99 in the UT group, were blindly evaluated. The primary outcome was reduction in depressive symptoms. Secondary outcomes included improvement in anxiety symptoms, interpersonal and social functioning, emotional regulation, and adherence. Intention-to-treat data analysis, using analysis of covariance was conducted.

RESULTS

There were 214 patients recruited; 85% were women, and 61% had 4 or more adverse childhood experiences. At 6 months, depressive symptoms declined significantly in the CTIC arm relative to UT (adjusted mean difference [AMD]= -3.09, 95% CI, -4.94 to -1.23; d = -0.46, 95% CI,-0.73 to -0.18; P = .001). Anxiety symptoms exhibited a trend toward improvement in the CTIC vs UT group (AMD = -1.50, 95% CI, -3.03 to 0.31; P = .055). No significant differences were observed in other secondary outcomes, except for adherence, which was significantly higher in the CTIC vs UT groups (AMD = 2.59, 95% CI, 1.80-4.99; P = .035).

CONCLUSIONS

The CTIC approach demonstrated superior outcomes in treating depression and improving adherence compared with UT. Moreover, the observed trends in anxiety improvement warrant further exploration in future research with a larger sample size. It is necessary to assess the effectiveness of this approach in treating more complex, difficult-to-treat forms of depression.

Specificity of Episodic Future Thinking in Adolescents: Comparing Childhood Maltreatment, Autism Spectrum, and Typical Development

Maltreatment and autism can be associated with overlapping difficulties across functional domains (e.g., social, emotional, and sensory) and high rates of mental health problems. A cognitive approach focussing on affect-laden cognition, here on episodic future thinking (FT), could help inform cognitive assessments and adapt psychological interventions. Three groups of adolescents (N = 85), (i) maltreatment (n = 28), (ii) autism (n = 29), and (iii) typical development without maltreatment/autism (TD; n = 28), matched in age (10-16 years old), sex (assigned at birth), and socioeconomic status, completed a newly adapted online Autobiographical Future Thinking Test. As predicted, the maltreatment group generated significantly fewer specific future events relative to the TD group, however, the number of specific future events did not significantly differ between the autism and the other groups. Exploratory analyses showed that lower FT specificity was significantly associated with more depressive (but not anxiety) symptoms across the three groups. These findings shed light on the cognitive profiles of both maltreatment and autism during adolescence and signal FT as a potential therapeutic target for adolescents with these developmental differences. Our study lays the foundation for additional comparisons of maltreatment-related presentations versus autism with improved designs and a broader set of cognitive and clinical domains.

'Flashforward' mental imagery in adolescents: exploring developmental differences and associations with mental health

BACKGROUND

Future events can spring to mind unbidden in the form of involuntary mental images also known as 'flashforwards', which are deemed important for understanding and treating emotional distress. However, there has been little exploration of this form of imagery in youth, and even less so in those with high psychopathology vulnerabilities (e.g. due to developmental differences associated with neurodiversity or maltreatment).

AIMS

We aimed to test whether flashforwards are heightened (e.g. more frequent and emotional) in autistic and maltreatment-exposed adolescents relative to typically developing adolescents. We also explored their associations with anxiety/depression symptoms.

METHOD

A survey including measures of flashforward imagery and mental health was completed by a group of adolescents (n=87) aged 10-16 (and one of their caregivers) who met one of the following criteria: (i) had a diagnosis of autism spectrum disorder; (ii) a history of maltreatment; or (ii) no autism/maltreatment.

RESULTS

Flashforwards (i) were often of positive events and related to career, education and/or learning; with phenomenological properties (e.g. frequency and emotionality) that were (ii) not significantly different between groups; but nevertheless (iii) associated with symptoms of anxiety across groups (particularly for imagery emotionality), even after accounting for general trait (non-future) imagery vividness.

CONCLUSIONS

As a modifiable cognitive risk factor, flashforward imagery warrants further consideration for understanding and improving mental health in young people. This implication may extend to range of developmental backgrounds, including autism and maltreatment.

Childhood maltreatment patterns and suicidal ideation: mediating roles of depression, hope, and expressive suppression

Childhood maltreatment has long-term negative effects on individuals' physical and mental well-being, and may increase the risk for suicidal ideation. However, how different patterns of childhood maltreatment affect subsequent suicidal ideation and the underlying mediating mechanisms remain unclear, particularly among Chinese adolescents. This study used latent profile analysis to identify patterns of childhood maltreatment among adolescents and explored how these patterns predicted subsequent suicidal ideation via depression, hope, and expressive suppression. This study used a two-wave, 1-year longitudinal design and included 2156 adolescents (Mage = 13.97 years, SDage = 1.61 years; 49.6% females). We identified three patterns of childhood maltreatment: low maltreatment, high psychological neglect, and high maltreatment. Compared with the low maltreatment group, the high maltreatment group indirectly predicted subsequent suicidal ideation 1 year later via depression through hope and expressive suppression, whereas the direct effect on suicidal ideation was not significant. Compared with the low maltreatment group, the high psychological neglect group had a significant direct effect on subsequent suicidal ideation and indirectly predicted suicidal ideation through depression or hope. Identifying patterns of childhood maltreatment among adolescents will assist mental health workers in developing targeted interventions to effectively alleviate suicidal ideation.

Shedding Light on the Aftermath: Childhood Maltreatment's Role in Modifying the Association Between Recent Life Stress and Resting-State Network Connectivity

Childhood maltreatment has been demonstrated to impact brain development. However, whether childhood maltreatment can influence the effects of recent stress on brain networks remains unclear. This study aimed to investigate whether childhood maltreatment moderates the longitudinal relationship between recent life stress and within- and between-network connectivity in key brain networks, including the anterior salience (ASN), central executive (CEN), default mode (DMN), and emotional regulation network (ERN). A cohort of 172 individuals from the Neuroscience in Psychiatry Network (NSPN) underwent MRI scans at two specific time points and undertook evaluations of childhood maltreatment and recent life stress. The results showed that childhood abuse moderated the association of recent life stress with the within-network connectivity of ASN and ERN but not DMN and CEN. Furthermore, recent life stress significantly interacted with childhood abuse to be associated with the between-network connectivity of ASN-DMN, ASN-CEN, ASN-ERN, DMN-ERN and CEN-ERN. Overall, among youth exposed to higher degrees of childhood abuse, greater recent life stress was longitudinally associated with increased network connectivity. Understanding these interactions can provide valuable insights for developing prevention strategies and interventions aimed at mitigating the lasting impact of childhood maltreatment on brain development and overall well-being.

Effectiveness of a multidimensional collaborative approach versus usual care in the treatment of adult depression in primary care in Chile: study protocol for a single blinded cluster randomized controlled trial

Background

Major depression (MD) is a prevalent and disabling condition in Chile, with most cases being treated at the primary care level. In Chilean primary care, the authors have identified key factors associated with more complex presentations of MD and a poorer prognosis, such as a history of childhood trauma, suicidality, and comorbidities. These findings underscore the need for a multidimensional, trauma-informed, and interprofessional approach to the treatment of depression.

Methods

This protocol is a two-arm, single-blinded, cluster RCT to compare the effectiveness of a collaborative multidimensional approach for depression (CMAD) versus usual care to treat MD in primary care clinics in Chile. In total, 394 depressed adults from 18 to 65 years of age in twelve clinics located in Chile's Maule Region will be consented to participate in the study. Patients and care teams from each clinic will be randomized to the intervention or to the control arm.Interprofessional teams in the intervention arm will attend 27 hours of didactic and active learning sessions focused on clinical competences to effectively engage, treat and follow up patients with the factors associated to the complex presentation of MD. Team in the control arm will receive 27 didactic sessions on current clinical guidelines for MD.Patients of both arms will be blindly assessed at baseline, three months, and six months. The primary outcome will be the reduction in depressive symptoms, with secondary outcomes including improvements in anxiety symptoms, interpersonal and social functioning, and treatment adherence.

Discussion

This protocol proposes the evaluation of an intervention designed to improve depression symptoms by enhancing the clinical competencies of primary care teams. These competencies are structured around collaborative care and trauma-informed practices.

Trial registration

NCT05016388, registered on 16 August 2021 at ClinicalTrials.gov.

The relationship between childhood psychological abuse and depression in college students: internet addiction as mediator, different dimensions of alexithymia as moderator

BACKGROUND AND OBJECTIVE

Childhood psychological abuse (CPA) is highly associated with depression among college students. However, the underlying mechanisms between these variables need further exploration. This study aims to investigate internet addiction as a mediating factor and alexithymia and its different dimensions as moderating factors, to further complement the psychological mechanisms between CPA and depression among college students.

METHODS

A self-report survey was conducted on 625 college students from two universities in Hunan Province, China. The survey included CPA, internet addiction, alexithymia, and depression. Descriptive and correlational analyses were performed on these variables, and a moderated mediation model was constructed.

RESULTS

CPA is positively correlated with depression, internet addiction, and alexithymia among college students. Internet addiction partially mediates the relationship between CPA and depression among college students, while alexithymia enhances the relationship between CPA and internet addiction as well as depression among college students. The moderating effect of the different dimensions of alexithymia is inconsistent, with the modulation effect of difficulty in identifying feelings being the strongest.

CONCLUSION

This study further elucidates the psychological mechanisms between CPA and depression among college students. Internet addiction serves as a mediating factor, while alexithymia may strengthen the relationship between CPA and internet addiction, as well as between CPA and depression.

Differential effects of lifetime stressors on major depressive disorder severity: a longitudinal community-based cohort study

BACKGROUND

Stressors across the lifespan are associated with the onset of major depressive disorder (MDD) and increased severity of depressive symptoms. However, it is unclear how lifetime stressors are related to specific MDD subtypes. The present study aims to examine the relationships between MDD subtypes and stressors experienced across the lifespan while considering potential confounders.

METHODS

Data analyzed were from the Zone d'Épidémiologie Psychiatrique du Sud-Ouest de Montréal (N = 1351). Lifetime stressors included childhood maltreatment, child-parent bonding, and stressful life events. Person-centered analyses were used to identify the clusters/profiles of the studied variables and multinomial logistic regression analyses were performed to examine the relationships between stressors and identified MDD subtypes. Intersectional analysis was applied to further examine how distal stressors interact with proximal stressors to impact the development of MDD subtypes.

RESULTS

There was a significant association between proximal stressors and melancholic depression, whereas severe atypical depression and moderate depression were only associated with some domains of stressful life events. Additionally, those with severe atypical depression and melancholic depression were more likely to be exposed to distal stressors such as childhood maltreatment. The combinations of distal and proximal stressors predicted a greater risk of all MDD subtypes except for moderate atypical depression.

CONCLUSIONS

MDD was characterized into four subtypes based on depressive symptoms and severity. Different stressor profiles were linked with various MDD subtypes. More specific interventions and clinical management are called to provide precision treatment for MDD patients with unique stressor profiles and MDD subtypes.

Characterization of sleep difficulties in maltreated children and adolescents

Numerous studies have identified connections between child maltreatment and sleep-related issues. However, poor is known on potential links between sleep patterns and day-to-day functioning, along with psychopathology in maltreated youths. Additionally, existing research on the relationship between sleep difficulties and maltreatment often lacks investigation into specific sleep difficulty profiles across different age ranges. The current study aimed to determine the prevalence of diverse sleep disturbance profiles in a sample of maltreated children and adolescents, exploring distinct sleep disorder profiles based on sex, age, and the type of maltreatment experienced. Potential variations in adaptive and psychopathological profiles between maltreated children with and without sleep disturbances were also explored. This retrospective study included 91 children and adolescents (56% males, 44% females), aged 6 to 17, with a history of maltreatment (physical maltreatment, sexual abuse, psychological abuse, or neglect), referring for a neuropsychiatric and psychological evaluation at a pediatric hospital. Data were obtained through a retrospective file review. Sleep difficulties were measured through the Sleep Disturbance Scale for Children; cognitive abilities, adaptive skills, and emotional and behavioral features were also investigated. Among maltreated youth, difficulties in initiating and maintaining sleep were the most frequently observed by caregivers. Poor sex differences emerged, whereas adolescents exhibited more daytime somnolence than school-age children. Children with sleep difficulties exhibited more anxiety symptoms and worse global functioning in comparison with children without sleep difficulties.Conclusion: Considering the vital impact of sleep quality on healthy development, practitioners should offer tailored services to child maltreatment victims. Enhancing the sleep quality of these children could help foster their resilience.

Alexithymia: A Defense of the Original Conceptualization of the Construct and a Critique of the Attention-Appraisal Model

Objective

Our goal was to compare the original conceptualization of the alexithymia construct with the attention-appraisal model, focusing primarily on the removal of the reduced imaginal activity component, a seminal aspect of the construct in the original model. We also examined associations between alexithymia and emotional distress and emotion regulation, attachment, and trauma, and whether alexithymia is a transdiagnostic risk factor. We discuss differences between the models in the treatment of alexithymia and also differences in measurement.

Method

We conducted a narrative review of the scientific literature validating the original model of alexithymia and examined the comparatively few empirical studies evaluating the attention-appraisal model. Articles describing contemporary theoretical ideas about the relationship between imagination and emotion were reviewed, as well as studies exploring associations between alexithymia and imaginal activity.

Results

The attention-appraisal model of alexithymia is theoretically derived and examined empirically in studies using correlation/measurement-based methods that employed self-report measures with mostly non-clinical samples and conducted primarily by researchers led by developers of the model. The original model of alexithymia is derived from observations of patients in clinical settings; its validity is supported by findings from hundreds of empirical investigations spanning nearly four decades with nonclinical and a variety of clinical samples using both correlation-based and experimental studies and methods of measurement other than self-report, and by independent teams of researchers. The reduced imaginal activity component of the alexithymia construct is mostly supported by these studies.

Conclusions

Because of the dearth of studies with clinical samples, the absence of investigations by independent researchers, and the limited range of methods and measurements to evaluate and assess the model, there is insufficient evidence to warrant removal of the imaginal activity component of the alexithymia construct and for replacing the original conceptualization of the construct with the attention-appraisal model.

Interaction of perceived social support and childhood maltreatment on limbic responsivity towards negative emotional stimuli in healthy individuals

Childhood maltreatment (CM) is associated with increased limbic activity, while social support is linked to decreased limbic activity towards negative stimuli. Our study aimed to explore the interaction of perceived social support with CM, and their combined impact on limbic activity in negative emotion processing. A total of 130 healthy individuals (HC) underwent a negative emotional face processing paradigm. They were divided into two groups based on the Childhood Trauma Questionnaire: n = 65 HC without CM matched with n = 65 HC with CM. In a region-of-interest approach of the bilateral amygdala-hippocampus-complex (AHC), regression analyses investigating the association of CM and perceived social support with limbic activity and a social support x CM ANCOVA were conducted. CM was associated with increased AHC activity, while perceived social support tended to be associated with decreased AHC activity during negative emotion processing. The ANCOVA showed a significant interaction in bilateral AHC activity (pFWE ≤ 0.024) driven by a negative association between perceived social support and bilateral AHC activity in HC without CM. No significant association was observed in HC with CM. Exploratory analyses using continuous CM scores support this finding. Our results suggest that CM moderates the link between perceived social support and limbic activity, with a protective effect of perceived social support only in HC without CM. The lack of this effect in HC with CM suggests that CM may alter the buffering effect of perceived social support on limbic functioning, highlighting the potential need for preventive interventions targeting social perception of HC with CM.

Early life stress is associated with greater negative emotionality and peripheral inflammation in alcohol use disorder

Early life stress (ELS) increases risk for psychiatric illness, including alcohol use disorder (AUD). Researchers have hypothesized that individuals with and without a history of ELS who have the same primary DSM-5 diagnosis are clinically and biologically distinct. While there is strong support for this hypothesis in the context of mood disorders, the hypothesis remains largely untested in the context of AUD. This study investigated the impact of ELS on the neuroclinical phenomenology and inflammatory profile of individuals with AUD. Treatment-seeking adults with AUD (N = 163) completed the Adverse Childhood Experiences (ACE) Questionnaire and phenotypic battery as part of a pharmacotherapy trial for AUD (NCT03594435). Participants were classified as having "no-ELS," (ACE = 0) "moderate-ELS," (ACE = 1, 2 or 3) or "high-ELS" (ACE = 4 + ). The Addictions Neuroclinical Assessment domains incentive salience and negative emotionality were derived and used to assess the neuroclinical phenomenology of AUD. We tested (1) cumulative ELS as a predictor of ANA domains and (2) ELS group differences in ANA domains. A subset of participants (N = 98) provided blood samples for a biomarker of peripheral inflammation (C-reactive protein; CRP); analyses were repeated with CRP as the outcome variable. Greater ELS predicted higher negative emotionality and elevated CRP, but not incentive salience. The high-ELS group exhibited greater negative emotionality compared with the no-ELS and moderate-ELS groups, with no difference between the latter two groups. The high-ELS group exhibited elevated CRP compared with the no/moderate-ELS group. Findings suggest that high-ELS exposure is associated with a unique AUD neuroclinical presentation marked by greater negative emotionality, and inflammatory profile characterized by elevated peripheral CRP.