Adolescent health outcomes: associations with child maltreatment and peer victimization

Exposure to neighborhood violence, self-efficacy, and child maltreatment

BACKGROUND

Child maltreatment is a significant public health concern in the United States, with long-lasting consequences for children's development. Exposure to community violence is a known risk factor for child maltreatment, yet the mechanisms underlying this relationship are unclear. Self-efficacy, a construct reflecting an individual's perceived ability to influence their environment, may play a critical mediating role in this pathway.

OBJECTIVE

This study aimed to investigate whether self-efficacy mediates the relationship between exposure to community violence and child maltreatment, including physical assault, psychological aggression, and neglect.

PARTICIPANTS AND SETTING

Data were drawn from the Future of Families and Child Wellbeing Study, a longitudinal study of 4898 children born in 20 major cities in the United States. The analysis focused on the third wave of data when children were age 3.

METHODS

Structural equation modeling was employed to assess the direct and indirect effects of exposure to community violence on three forms of child maltreatment through the mediating variable of self-efficacy.

RESULTS

Exposure to community violence had a direct negative impact on maternal self-efficacy. In turn, higher self-efficacy was protective against all three forms of child maltreatment. Self-efficacy partially mediated the relationship between exposure to community violence and child maltreatment, highlighting a pathway through which exposure to violence affects parenting behaviors.

CONCLUSIONS

Findings underscore the importance of self-efficacy as a protective pathway in mitigating the effects of community violence on child maltreatment. Interventions aimed at enhancing parental self-efficacy and reducing community violence may have significant implications for preventing child maltreatment.

Changes in Bullying Experiences and Mental Health Problems Among Adolescents Before and After the COVID-19 Pandemic in Greece

Bullying poses significant challenges to adolescent health and well-being. This time-trend study examined the impact of the COVID-19 pandemic on bullying behaviors and associated emotional and behavioral difficulties among Greek adolescents. Data were collected from two cross-sectional surveys in 2016 (n = 1574) and 2023 (n = 5753) conducted in Greece. Both samples comprised students aged 12-16 years, with near-equal gender distribution (2016, 53.4% girls; 2023, 54.5% girls) and a predominance of urban residents (approximately 73% in both samples). Traditional and cyberbullying experiences were assessed via structured questionnaires, while mental health outcomes were measured using the Strengths and Difficulties Questionnaire (SDQ). Post-pandemic findings revealed substantial increases in bullying involvement; traditional bullying victimization rose from 12.4% to 21.7%, and cyberbullying victimization increased from 4.0% to 11.6%. Correspondingly, mean SDQ total scores increased significantly from 8.59 to 14.16, reflecting heightened emotional and behavioral problems. Logistic regression analyses identified male gender, urban residence, and non-traditional family structures as significant predictors of bullying involvement. These results underscore the amplified burden of bullying and mental health difficulties in the post-pandemic era, highlighting the urgent need for targeted prevention and intervention strategies to address both traditional and cyberbullying within diverse sociodemographic contexts.

Sexual identity, child maltreatment, mental health, and substance use among emerging adults aged 18 to 23 years

OBJECTIVES

Although past studies have identified sex differences in child maltreatment experiences and poor mental and physical health‒related outcomes, more research is needed to understand child maltreatment among sexual minorities (i.e., those who identify as other than heterosexual) and how child maltreatment and sexual identity are related to depression, anxiety, and at-risk alcohol and cannabis use among emerging adults.

METHODS

Data were drawn from the longitudinal Well-Being and Experiences (WE) Study collected from 2017 (14 to 17 years) to 2022 (18 to 23 years) from Manitoba, Canada (n = 584). Descriptive statistics and logistic regression models were computed.

RESULTS

Compared to heterosexual or straight sexual identity: homosexual, gay or lesbian; bisexual; and different or other identity were associated with an increased likelihood of experiencing child maltreatment, with the most robust relationships for bisexual identity and all child maltreatment outcomes. Indicating "I don't know" for sexual identity compared to heterosexual identity was associated with 7.45 increased odds of exposure to intimate partner violence in adjusted models. Bisexual identity compared to heterosexual identity had the most robust association, with increased odds of depression, anxiety, at-risk alcohol use, and at-risk cannabis use. Findings provide some evidence to suggest that trends may be worse for some mental health and substance use outcomes among sexual minorities who also experience child maltreatment.

CONCLUSION

Preventing child maltreatment among all children, including youth identifying as other than heterosexual, is a public health priority. Such efforts will work towards optimizing mental health and reducing substance use in early adulthood.

Latent profiles and transition of child maltreatment and peer victimization among Chinese internal migrant children: Associations with their psychological maladjustment

Internal migrant children often face dual challenges from both child maltreatment and peer victimization, yet the impact of various profiles of these experiences, along with their developmental transitions, on psychological maladjustment over time remains unclear. To fill these gaps, this study employed latent profile analysis and latent transition analysis to explore the associations between patterns of child maltreatment and peer victimization and psychological maladjustment (including loneliness, depressive symptoms, behavioral problems, and non-suicidal self-injury) and to determine whether changes in these patterns over time predict future psychological maladjustment. The participants comprised 544 Chinese internal migrant children (51.1% male, Mage = 11.75, SD = 1.12) who completed two surveys. At both Time 1 and Time 2, four distinct profiles were identified. The doubly disadvantaged profile was linked to increased loneliness, while no significant differences were observed among the four profiles regarding the other three indicators. Five transitioning profiles were identified: Stable both low profile, fluctuation profile, stable risk profile, exacerbation profile, and mitigation profile. Internal migrant children in distinct transitioning profiles showed different levels of psychological maladjustment. The findings underscore the co-occurring and transitional nature of child maltreatment and peer victimization, emphasizing the necessity for robust family and school support systems to foster optimal mental health for internal migrant children.

Bullying victimization and suicidal ideation among Chinese adolescents: a moderated mediation model of depressive symptoms and perceived family economic strain

BACKGROUND

There is substantial evidence linking bullying victimization to suicidal ideation, but the mechanism behind this link is not well understood. This study investigates whether depressive symptoms mediate the relationship between bullying victimization and suicidal ideation, and whether perceived family economic strain moderates this mediation.

METHODS

Data were collected from 7,702 adolescents (mean age = 14.74 ± 1.69 years, 52% girls) using a self-report questionnaire that assessed bullying victimization, depressive symptoms, suicidal ideation and perceived family economic strain. Mediation and moderated mediation analyses were conducted using the PROCESS macro in SPSS.

RESULTS

Suicidal ideation was significantly associated with both bullying victimization and depressive symptoms, as determined by linear regression analysis (both p < 0.001). The relationship between bullying victimization and suicidal ideation was partially mediated by depressive symptoms, accounting for 66.74% of the effect. Additionally, perceived family economic strain could moderate the link between bullying victimization and depressive symptoms (β=-0.017, p < 0.001), indicating that increased perceived family economic strain attenuates the impact of bullying victimization on depressive symptoms.

CONCLUSION

Our research affirms bullying victimization substantial influence on adolescent suicidal ideation, with depressive symptoms mediating this link. The study also reveals that perceived family economic strain moderates this relationship, indicating the necessity for interventions that address both psychological and economic factors to holistically support the mental health of bullied adolescents.

Research Review: Sex differences in the clinical correlates of nonsuicidal self-injury in adolescents - a systematic review

BACKGROUND

Nonsuicidal self-injury (NSSI), or 'the deliberate, self-inflicted destruction of body tissue…without suicidal intent and for purposes not culturally sanctioned', is a robust predictor of future suicide-related behavior and therefore a modifiable target for suicide prevention. The prevalence of NSSI is rising in adolescents, particularly among females; however, it is unknown whether sex differences also exist in the clinical and psychosocial factors associated with NSSI. Understanding how the correlates of NSSI differ by sex is important for developing tailored treatments. This study systematically reviews sex differences in the clinical and psychosocial correlates of NSSI among adolescents.

METHODS

MEDLINE and PsycINFO were searched using the keywords 'adolescents', 'self-injury', and 'sex factors' and synonyms for English-language articles published between January 1, 2000 and May 10, 2022. We included studies that presented original data on NSSI, included adolescents ages 10-19, reported sex differences, and explicitly defined self-injury as that done without suicidal intent. Fifty-seven studies containing 54 unique samples were included. Data were summarized by sex and recorded by: (a) characteristics of NSSI, (b) clinical and psychosocial correlates of NSSI, and (c) associations with suicide.

RESULTS

We used data on NSSI from 54 unique samples of adolescents worldwide. Males more commonly used violent methods of NSSI, such as burning, and were more likely to be physically aggressive and experience substance abuse. Females more commonly self-injured by cutting, and their NSSI was more likely to be repetitive and associated with emotional distress. In both sexes, NSSI was associated with adverse childhood experiences (ACEs) such as sexual abuse/violence and bullying. NSSI was predictive of suicide in females but not males.

CONCLUSIONS

Data from 22 countries and 352,516 participants suggest important sex differences in the clinical and psychosocial factors associated with NSSI among adolescents that future assessment and treatment strategies ought to consider.

The Combined Effects of Adverse and Positive Childhood Experiences on Adolescent Bullying Victimization and Perpetration

Bullying is a persistent social and behavioral problem in the United States. Bullying victimization and perpetration are linked to a host of negative physical, social, and emotional outcomes. Research suggests that a key risk factor for bullying behaviors is adverse childhood experiences (ACEs). On the other hand, positive childhood experiences (PCEs) may counter some of the negative effects of ACEs. This study (a) assesses the independent effects of ACEs and PCEs on adolescent bullying victimization and perpetration, and (b) examines whether ACEs and PCEs interact to affect bullying victimization and perpetration.We use data from the 2020 to 2021 National Survey of Children's Health, a nationally representative survey of children ages 0 to 17 in the United States. The analytic sample was limited to children who were 6 years old or older at the time of the survey (N = 60,809). Using caregiver reports of bullying victimization and perpetration, we created a cumulative ACEs scale comprised of 10 items and a cumulative PCEs scale comprised of eight measures. We then estimated a set of logistic regression models to predict bullying behaviors. The results showed that ACEs are associated with a higher likelihood of both bullying victimization and perpetration. Although PCEs have a slight mitigating effect, ACEs and PCEs interact such that even in the presence of PCEs, children with many ACEs still have a higher likelihood of both bullying victimization and perpetration. This highlights the considerable impact of ACEs on bullying behaviors. These findings suggest that enhancing ACE-aware care and ACE prevention is important because even promoting PCEs is unlikely to decrease bullying levels on their own.

Differences in ambulance attendances between children with and without an identified history of out-of-home-care

BACKGROUND

Children in out-of-home-care (OOHC) are a vulnerable population, typically with complex needs, however there is minimal research examining the behavioural presentations that lead to the increased use of acute emergency care by OOHC children.

OBJECTIVE

This study aimed to describe differences in lifetime complexity factors identified during ambulance attendances between children with and without an identified history of OOHC. Further, this study aimed to describe whether having an identified history of being in OOHC was associated with increased utilisation of emergency care resources and increased likelihood of multiple ambulance attendances.

METHOD

Electronic patient care records from ambulance attendances during the period January 2017 and June 2023 for 27,565 children 0-17 years in Victoria, Australia were examined.

RESULTS

Children with an identified history of OOHC had a substantially higher co-occurrence of substance-related harms, violence, self-harm, suicide ideation and attempts, a developmental or intellectual disability and mental health conditions compared with children where there was no identified OOHC history. As hypothesised, logistic regression found, after controlling for all complexity factors, an identified history of OOHC increased likelihood of multiple ambulance attendances (OR = 2.65; 95 % CI: 2.17-3.24, p < .001).

CONCLUSIONS

The findings suggest children within OOHC have increasingly complex comorbidities, and this may be associated with increased emergency care utilisation. Development of tailored support to these multiple and complex needs is necessary to help reduce repeated emergency care responses for this at-risk population.

Relationship between early traumatic experiences and emotional regulation skills in major depressive and bipolar disorders

Childhood trauma can cause deficits in emotional regulation. However, few studies have investigated childhood trauma and emotional regulation skills in patients with mood disorders. We aimed to investigate how childhood trauma and Emotion Regulation Skills Questionnaire (ERSQ) scores are associated with mood disorders.This study included 779 patients with mood disorders (major depressive disorder [MDD, n = 240], bipolar I disorder [BDI, n = 121], and bipolar II disorder [BDII, n = 418]). We used their Childhood Trauma Questionnaire-Short Form (CTQ) and ERSQ scores for the evaluation.The between-group differences in CTQ and ERSQ scores were examined. The CTQ and ERSQ total scores were negatively correlated. Among the CTQ subscales, emotional neglect showed a significant correlation with the ERSQ total score, whereas acceptance and tolerance showed higher negative correlations with the CTQ than with the other ERSQ subscales. The negative relationship between emotional regulation and childhood trauma varied significantly depending on the group, with the BDI group showing a more prominent association than the other groups.Based on various mood disorders, we observed associations between childhood trauma and emotional regulation skills. Consequently, our study offers notable insights for future research on the impact of childhood trauma on ERSQ.

Relational peer victimization and depression symptoms in young adults: longitudinal evidence from before and during the COVID-19 pandemic

Introduction

Some targets of relational peer victimization become depressed because of their poor treatment. These associations are well documented in youth but are rarely studied in adults.

Methods

The longitudinal pathways between relational peer victimization (being excluded, stonewalled, etc.) and symptoms of depression were examined in a sample of 392 young adults from Ontario, Canada using annual assessments from age 19 to 24. The role of the COVID-19 pandemic was also examined.

Results

Latent curve models with structured residuals indicated that individuals who reported greater relational peer victimization than others also reported more symptoms of depression (between-person association) and those who were more relationally victimized than their expected level were more depressed than expected (within-person association). During the COVID-19 pandemic, the within-time association between relational peer victimization and depression symptoms was reduced. Specifically, accounting for between-person effects and prior individual differences, we found a predicted decoupling of relational peer victimization and depression symptoms in the first year of the pandemic when social non-pharmaceutical interventions (NPIs) were heavily implemented in Ontario, but not the second year, when NPIs were relaxed (but not abandoned).

Discussion

Our findings indicate that the social NPIs implemented in the initial year of the pandemic may have inadvertently led to a positive impact on the association between relational peer victimization and depression symptoms. This finding underscores the importance of minimizing interactions with abusive peers whenever feasible as a strategy to enhance mental well-being.

Sex Differences in the Global Prevalence of Nonsuicidal Self-Injury in Adolescents: A Meta-Analysis

Importance

Nonsuicidal self-injury (NSSI) is a strong predictor of suicide attempts. The prevalence of NSSI has been increasing among female adolescents in North America and Europe, but less is known about trends in other geographical regions.

Objective

To examine sex differences in the prevalence of NSSI among adolescents within and between geographical regions.

Data Sources

MEDLINE and PsycINFO were searched using the keywords adolescents, self-injury, sex factors, and synonyms for articles published in English between January 1, 2000, and May 10, 2022.

Study Selection

Studies were included if they presented original data (any study design), included adolescents aged 10 to 19 years, reported results stratified by sex, and explicitly defined self-injury as behaviors occurring without suicidal intent.

Data Extraction and Synthesis

This meta-analysis was registered with PROSPERO and conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Articles were assessed for quality by 2 independent coders (F.M. and J.A.). A random-effects model was used to calculate prevalence. Data were analyzed from July 2022 to April 2023.

Main Outcomes and Measures

The prevalence of NSSI in male and female adolescents within and between regions was the main outcome. Odds ratios (OR) with 95% CIs were calculated for community samples.

Results

Eight hundred and two studies were screened, and 38 were included (266 491 participants). Across 17 countries, the pooled prevalence of NSSI was 17.7% (female:male OR, 1.60; 95% CI, 1.29-1.98). NSSI was twice as prevalent among female adolescents compared with male adolescents in North America (OR, 2.49; 95% CI, 2.16-2.86) and Europe (OR, 2.08; 95% CI, 1.69-2.58), but not in Asia (OR, 1.00; 95% CI, 0.71-1.41).

Conclusions and Relevance

In this meta-analysis of sex differences in global prevalence of NSSI, the female predominance of NSSI observed among adolescents in North America and Europe aligned with rising rates of suicide in these populations. The comparable prevalence of NSSI among male and female adolescents in Asia also aligned with the lower male-to-female suicide ratio compared with other countries. More research is needed to characterize regional (and potentially cultural) sex differences among adolescents with NSSI to prevent and treat the behavior and to understand the possible interplay with corresponding regional trends in suicide.

Adverse childhood experiences, mental distress, self-harm and suicidality, and cumulative HIV risk by sex in Lesotho

BACKGROUND

Adverse childhood experiences (ACEs) have been understudied in low- and middle-income countries, especially in sub-Saharan Africa.

OBJECTIVES, PARTICIPANTS, SETTING

We explored associations between mental distress, self-harm or suicidality, and HIV risk and individual and cumulative ACEs (sexual, emotional, and physical violence; witnessing community and interparental violence; orphanhood) among youth aged 13-24 in Lesotho.

METHODS

Multivariable logistic regressions stratified by sex using nationally representative 2018 Lesotho Violence Against Children and Youth Survey (nfemale = 7101; nmale = 1467) data.

RESULTS

Over 75 % of males and females experienced at least 1 ACE. Among males, physical and community violence were significantly associated with mental distress; orphan status and emotional violence was associated with self-harm/suicidality. Males who witnessed interparental violence had higher odds of disclosing 2 types and 3 or more types of HIV risk versus none. Among females, being a double orphan and having experienced sexual, emotional, physical, community, and interparental violence were significantly associated with mental distress and any self-harm/suicidality in both models. Females who experienced physical violence had higher odds of disclosing 3 or more risk types versus no risk. Statistically significant associations emerged between cumulative ACEs and mental distress, self-harm/suicidality, and higher levels of HIV risk for both males and females.

CONCLUSIONS

Differential patterns of associations between ACEs and mental health problems and HIV risk emerged by sex. Scalable, integrated individual and community efforts to prevent ACEs, provide mental health supports, and encourage safer sexual behaviors among those exposed are needed and could benefit youth in Lesotho.

Struggling Can Also Show on the Inside: Current Knowledge of the Impact of Childhood Maltreatment on Biomarkers in Mood Disorders

The link between childhood maltreatment and mood disorders is complex and involves multiple bio-psycho-social factors that affect multiple molecular pathways. The present narrative review aims to clarify the current understanding of the impact of childhood maltreatment on biomarkers in patients with mood disorders and their first-degree relatives. Neurotransmitters, such as serotonin, dopamine, norepinephrine, and hormones (eg the stress hormone cortisol), play a crucial role in regulating mood and emotion. Childhood maltreatment can alter and affect the levels and functioning of these neurotransmitters in the brain; further, childhood maltreatment can lead to structural and connectivity changes in the brain, hence contributing to the development of mood disorders and moderating illness presentation and modifying response to treatments. Childhood maltreatment information, therefore, appears mandatory in treatment planning and is a critical factor in therapeutic algorithms. Further research is needed to fully understand these pathways and develop new treatment modalities for individuals with mood disorders who have experienced childhood maltreatment and effective preventive interventions for individuals at risk of developing mood disorders.

The role of positive childhood experiences in the link between childhood maltreatment and affective lability in a sample of incarcerated men and women

BACKGROUND

Individuals with a history of child maltreatment (CM) tend to show high affective lability (AL) and criminal behavior. However, positive childhood experiences (PCEs) may act as a protective factor even in the presence of child maltreatment.

OBJECTIVE

The present study aimed to analyze the relationship between CM, PCEs, and AL in adulthood, identify the predictors of AL and analyze the moderating role of PCEs in the relationship between CM and AL in a sample of 424 incarcerated men (n = 343) and women (n = 81), aged between 18 and 73 years (M = 37.88).

METHODS

Participants responded to an online protocol consisting of a sociodemographic questionnaire, the Childhood Trauma Questionnaire (CTQ), the Benevolent Childhood Experiences Scale (BCEs), and the Affective Lability Scale - Short Version (ALS-18).

RESULTS

CM was positively associated with AL and negatively associated with PCEs, and PCEs are negatively associated with AL. Regression analyses, after controlling for age, sex, and education, confirmed the role of PCEs on AL, above and beyond CM. However, moderation analysis showed that PCEs did not moderate the relationship between CM and AL for either men or women.

CONCLUSIONS

These results highlight the complexity of human development and behavior from early childhood into adulthood. Further studies are needed to better understand the role of PCEs in the relationship between ACEs and AL among inmates in order to develop more appropriate prevention and intervention programs.

Perception of School Violence: Indicators of Normalization in Mapuche and Non-Mapuche Students

The current social and political scenario in Chile has opened up the debate on two centuries of usurpation and discrimination towards the Mapuche people. Educational centers are not oblivious to the social exclusion faced by indigenous children and young people, and this forms part of the phenomenon of school violence. This study explores the differences in perception between Mapuche and non-Mapuche students regarding school violence. The issue is the lack of knowledge regarding cultural variations in the perception of school violence in spaces of social and cultural diversity in the Mapuche context. This study describes the characteristics of school violence perceived by students in relation to differences based on ancestry and characterizes the variations in perception. A total of 1404 students participated from urban schools in the city of Temuco, Chile, aged 10 to 13 (M = 11.4; SD = 1.1) who completed the CENVI questionnaire. The confirmatory factor analysis (CFA) of the total sample and categories provides indexes that fit the proposed model. The omega coefficients provide internal reliability guarantees. This study tests configural, metric and scalar invariance for all the categories explored, and statistically significant differences are found between Mapuche and non-Mapuche students in the perception of physical and verbal violence, where the Mapuche student perceives more violence. Results are discussed based on existing research on education in spaces of social and cultural diversity in the Mapuche context, with research into elements that can help explain the findings.

Risk Factors for Substance Use across the Lifespan

Substance use is a perennial public health concern with associated health risks and economic impacts on society. In this article, we present a selective review of the epidemiological and clinical literatures on alcohol and substance use from a lifespan developmental perspective. We compare and contrast risk factors for the initiation of use and the development of a substance use disorder in adolescence, young adulthood, middle-age and later life. During adolescence, alcohol use experimentation is at its peak. Specific risk factors have been identified including trauma and parenting style that can increase the risk of substance use for teenagers. Emerging adults and college students are likely to experiment with other substances in addition to alcohol such as nicotine, marijuana, cocaine, and prescription medication such as Adderall. Middle-age and older adults with alcohol and substance use in their developmental histories may have an undiagnosed alcohol use disorder. Others will develop a late-onset substance use disorder in older age, possibly due to a dearth of social support, coping with bereavement, and medical complication. Based on Social Cognitive Theory, the roles of expectancies and self-efficacy are hypothesized to impact substance use and the risk of substance use disorder across the lifespan. Implications of the present review for future research on age-specific risk factors in alcohol use in relation to underlying developmental processes are considered.

An Examination of Parents' Adverse Childhood Experiences (ACEs) History and Reported Spanking of Their Child: Informing Child Maltreatment Prevention Efforts

The current evidence indicates that spanking is harmful to children's health and development and should never be used by parents or other caregivers. However, the critical factors that inform effective spanking prevention strategies are still not well understood. The objective of the current study was to determine if a parent's own adverse childhood experiences (ACEs) history was associated with increased likelihood of reporting their child being spanked at age 10 or younger. Data were drawn from the Well-Being and Experiences Study (the WE Study), a community survey of parents and adolescents from 2017-2018 (N = 1000) from Canada. The results indicated that a parent's own history of physical abuse, emotional abuse, spanking, and household mental illness in childhood were associated with an increased likelihood that their child would have been spanked. These findings indicate that a parent's ACEs history may be related to how their own child is parented and identify families who may be more likely to rely on spanking. Preventing physical punishment is necessary for healthy child development, reducing the risk of further violence, and upholding children's rights to protection. Parent's ACEs history may be an important factor to consider when developing and implementing child maltreatment prevention efforts.