Associations between adverse childhood experiences and health outcomes in adults aged 18-59 years

Adverse childhood experiences, positive childhood experiences, suicidal thoughts or behaviors and psychological distress among Kenyan youth-an exploratory analysis of the 2019 Kenya Violence Against Children and Youth Survey (VACS)

BACKGROUND

Early childhood experiences, whether positive or adverse, significantly impact health across the lifespan. Children and youth in low-resource settings face unique challenges that increase their vulnerability to poor mental health.

OBJECTIVE

To examine the relationship between adverse childhood experiences (ACEs) and suicidal thoughts or behaviors as well as psychological distress, and to explore the moderating role of parent-related positive childhood experiences (PPCEs) on this association.

PARTICIPANT AND SETTING

We used data from the 2019 Kenya Violence Against Children and Youth Survey.

METHODS

Analyses were restricted to youth ages 18-24. ACEs were dichotomized (into those who have experienced at least one ACEs and those who have not), and logistic regression was used to examine the relationship between ACEs, PPCEs, and suicidal thoughts or behaviors and psychological distress stratified by sex.

RESULTS

Significantly more males (75.8 %) than females (57.6 %) experienced at least 1 ACE in their lifetime (p = 0.0003). PPCEs are common; however, significantly more males (59.9 %) than females (41.2 %) had a strong father-child relationship (p = 0.0003). ACEs were positively associated with suicidal thoughts or behaviors and psychological distress, with notable sex-specific differences in the associations. Conversely, PPCEs were negatively associated with those outcomes, but there were also sex-specific differences in the associations. No significant interaction effect was observed between ACEs, PPCEs, and the mental health outcomes.

CONCLUSION

Suicidal thoughts or behaviors and psychological distress are pervasive problems that are common among youth in Kenya, and the associations with ACEs vary by sex. A multilevel approach and evidenced-based intervention strategies that consider the context of sociocultural norms are crucial to prevention and response efforts.

Increased Prevalence of Childhood Complex Trauma in Comorbid Posttraumatic Stress Disorder and Substance Use Disorders Compared to Either Disorder Alone: A Systematic Review

OBJECTIVE

Childhood complex trauma (CCT) prevalence among individuals with comorbid posttraumatic stress disorder (PTSD) and substance use disorder (SUD) is unknown. We conducted a meta-analysis to compare CCT prevalence in samples of PTSD alone, SUD alone and comorbid PTSD+SUD.

METHOD

A systematic review of PTSD, CCT and SUD literature was conducted using online databases. Binary outcome meta-analytic models were fitted comparing CCT prevalence in comorbid PTSD + SUD to PTSD and SUD only.

RESULTS

Seven studies were included, and estimates for CCT prevalence were higher, on average, among individuals with comorbid PTSD+SUD (35%-78%) compared to PTSD alone (4%-70%) and SUD alone (2%-65%). A meta-analysis of four studies indicated individuals with comorbid PTSD+SUD were 18% more likely to have experienced CCT compared to individuals with PTSD only (RR = 1.18, 95% CI [1.13, 1.25]) and 24% more likely compared to individuals with SUD only (RR = 1.24, 95% CI [1.20, 1.29]).

CONCLUSIONS

Further research is needed to establish a more accurate prevalence rate for individuals with comorbid PTSD and SUD. Evidence of greater CCT prevalence will inform research study design and clinical targets during treatment for individuals with comorbid PTSD and SUD.

The mediating role of family functioning between childhood adversity and adult Health- related risk behaviors: a moderated mediation analysis of generational gap in Chinese migrant workers

BACKGROUND

Adverse Childhood Experiences have been implicated in a range of health-related risk behaviors in adulthood, but there is limited research on how these patterns manifest among internal migrant workers in China. This study aims to elucidate the mediating role of family functioning and explore generational differences in this relationship.

METHODS

A cross-sectional study was conducted among two groups of migrant workers in China: first-generation migrant workers (FGWs) and new-generation migrant workers (NGMWs). A total of 2,187 participants completed surveys that assessed adverse childhood experiences, family functioning, and health-related risk behaviors. Mediation analysis was performed to examine the indirect effects of adverse childhood experiences on health risks through family functioning. Additionally, moderated mediation analysis was conducted to explore potential differences between FGWs and NGMWs.

RESULTS

Adverse childhood experiences significantly predicted higher health-related risk behaviors and lower family functioning (p < 0.001). Family Functioning mediated the relationship between adverse childhood experiences and health-related risks behaviors, which accounted for approximately 16.67% of the total effect (95% CI 0.03 to 0.07, p < 0.001). There was a significant difference in the indirect effects between NGMWs and FGWs (95% CI 0.01 to 0.06, p < 0.05). The indirect effect of adverse childhood experiences through family functioning was significant for NGMWs (p < 0.001), but non-significant for FGWs.

CONCLUSION

Our study fills a critical gap in understanding the intricate links between adverse childhood experiences, family functioning, and health-related risk behaviors among China migrant workers in China. It highlights the role of family functioning as a significant mediator of the impact of early adverse childhood experiences on adult health-related risks behaviors, particularly in a vulnerable population like migrant workers. More importantly, our findings indicate that this mediation varies significantly between FGWs and NGMWs. Family functioning exhibited a stronger mediating effect between early adverse childhood experience and adult health-related risks behaviors for NGMWs compared to FGWs.

Prevalence of Adverse Childhood Experiences (ACEs) and its association with current mental wellbeing among young adults in Pakistan

BACKGROUND

Adverse Childhood Experiences (ACEs) are significant stressors that can have lasting effects on an individual's health, especially on mental wellbeing. While ACEs affect up to 91 % of individuals in low- and middle-income countries (LMICs) such as Uganda and India, research in Pakistan remains sparse and underdeveloped, limiting cross-country comparisons.

OBJECTIVE

To determine the prevalence of ACEs among young adults aged 18 to 25 in Pakistan and their impact on current mental wellbeing.

PARTICIPANTS AND SETTING

Students aged 18-25 years enrolled in grade 13th-16th of selected public and private colleges of Rawalpindi, Pakistan.

METHODS

Participants were recruited through convenience sampling. ACE exposure was assessed using a modified version of the ACE-International Questionnaire. Mental wellbeing was evaluated using the Short Warwick-Edinburgh Mental Wellbeing Scale. Descriptive statistics were used to characterize participants' socio-demographics including age, gender, type of institution (public vs. private), parents' marital status, parental education, monthly household income, and number of siblings. Multivariable logistic regression was conducted to determine association between ACEs and the mental wellbeing of the students.

RESULTS

Among 454 participants (203 males, 251 females; mean age 22.1 ± 2.2 years), 98 % experienced at least one ACE during their lifetime, with 82.4 % experiencing three or more ACEs. The most common ACEs were witnessing community (88 %), peer (83 %), and household (73 %) violence. Emotional abuse (60 %) was more prevalent than physical (47 %) and sexual (37 %) abuse. Students experiencing 6 or more ACEs had 3.39 times higher odds of inadequate mental wellbeing compared to those with 0-2 ACEs (AOR = 3.39; CI 1.44-8.0; p < 0.01).

CONCLUSIONS

The study reveals a concerning ACEs prevalence among Pakistani students, with higher ACE exposure correlating with poorer mental wellbeing. Addressing ACEs requires a broader public health approach, urging policy interventions to mitigate long-term health impacts.

Longitudinal influences of adverse childhood experience patterns on mental health among older Chinese people

BACKGROUND

Childhood experiences have been shown to affect mental health in later life. However, the relationships between childhood adversity patterns and mental health trajectories in later life have not been fully examined. Using a pattern-based approach, this research identified distinct patterns of exposure to adverse childhood experiences (ACEs) and longitudinal relationships between ACE patterns and mental health trajectories among older Chinese people.

METHODS

Using data on 4,343 respondents aged 60 or older from four waves of the China Health and Retirement Longitudinal Study (2011, 2013, 2015, and 2018) and a 2014 life history survey, latent class analysis was employed to identify patterns of ACEs. Parallel process latent growth curve models were applied to examine the longitudinal relationships between ACE patterns and depressive symptoms and cognitive function.

RESULTS

Three meaningful patterns of ACE emerged: Low ACEs, Polyvictimization, and Absence of parental care. ACE patterns were associated with the trajectory of cognitive function but not depression, and the effects were particularly evident in the Polyvictimization class.

CONCLUSIONS

This study emphasizes the significant influences of ACE patterns on cognition in later life. Additionally, early screening, prevention, assessment, and interventions for people with polyvictimization experiences are critical for alleviating or delaying cognitive decline in later life.

Association of childhood health with adulthood chronic kidney disease: results from the China Health and Retirement Longitudinal Study

Objective

Adverse Childhood Experiences have been well-documented as a risk factor for chronic kidney disease (CKD) in adulthood. However, the link between childhood health and adulthood CKD risk is still unclear. This study aimed to explore the connection between childhood health and the likelihood of developing CKD in adulthood.

Methods

Participants were drawn from the third wave of the China Health and Retirement Longitudinal Study (CHARLS). The CKD was identified based on the estimated Glomerular Filtration Rate (eGFR) and self-reported doctor-diagnosed kidney disease. Childhood health status was assessed through a standard questionnaire and categorized into excellent, fair, and poor groups.

Results

The prevalence of CKD was 11.7% (1,480 out of 12,609). The eGFR levels in the self-reported Fair and Poor groups were significantly lower than those in the Excellent group (p < 0.05). Compared to the Excellent group, individuals in the Poor group reported a higher risk of CKD (OR = 1.38; 95% CI: 1.12-1.70; p = 0.002), even after adjusting for factors such as age, sex, smoking, alcohol consumption, physical activity, highest education level, use of Chinese traditional medicine, diabetes, hypertension, BMI, marital status, and annual household income (OR = 1.24; 95% CI: 1.01-1.54; p = 0.047).

Conclusion

The CKD prevalence is notably high in the Chinese adults aged more than 45 years, and a history of poor health in childhood may significantly contribute to the risk of CKD in later life.

Markers of Negative Emotionality in Individuals With Comorbid Alcohol Use Disorder and Post-Traumatic Stress Disorder: Role of Childhood Trauma

Post-traumatic stress disorder (PTSD) and alcohol use disorder (AUD) are characterized with heightened negative emotionality (NE) and are frequently comorbid. However, little research has investigated NE in individuals with comorbid AUD/PTSD. We compared psychological and biological markers of NE phenotypes, and alcohol-related outcomes between individuals with AUD with and without PTSD, and healthy controls. Additionally, we evaluated whether childhood trauma severity moderated these relationships. Participants [N = 1292; healthy controls (HC): n = 502 (38.9%); AUD only: n = 610 (47.2%), and AUD/PTSD (CMB); n = 180 (13.9%)] enrolled in the National Institute on Alcohol Abuse and Alcoholism Natural History Protocol underwent clinical, biological and behavioural phenotyping that included psychiatric diagnoses, markers of negative emotionality and allostatic load, alcohol use behaviour, and history of childhood trauma. The CMB group had the most severe alcohol use and childhood trauma history. Psychological NE were the most dysregulated among the CMB group. Biological markers of NE were also dysregulated among the AUD and CMB group, where they displayed greater resting heart rate, diastolic blood pressure and HDL cholesterol relative to HC. Greater childhood trauma severity was associated with greater psychological NE. However, the childhood trauma did not moderate any relationship between diagnosis and NE phenotypes. These results highlight important differences in NE, childhood trauma and alcohol use in individuals with AUD with and without comorbid PTSD. Targeting NE and alcohol-related behaviours is critical in effective treatment of individuals with comorbid AUD/PTSD. Trial Registration: ClinicalTrials.gov: NCT02231840.

The Psychometric Properties of the ACE-IQ Questionnaire's Binary and Frequency Scoring Methods in a Chilean Community Sample

Background/Objectives: Adverse childhood experiences (ACEs) impact social, emotional, psychological, and physical development, often leading to health risk behaviors in adulthood. Instruments like the Adverse Childhood Experiences International Questionnaire (ACE-IQ) are essential for assessing ACEs globally and confirming their association with health outcomes in adulthood. Methods: This study evaluates the ACE-IQ's validity in a Chilean cohort by analyzing the prevalence of ACEs and the instrument's psychometric properties. Structural validity, internal consistency, and concurrent validity were assessed using the Marshall Scale as a comparative measure. Additionally, binary and frequency scoring methods were compared. Results: Structural validity analyses showed the best fit for three- and four-dimensional models using frequency scoring. The overall internal consistency of the scale was adequate (α > 0.7), although dimensions such as childhood neglect and violence outside the home demonstrated lower internal consistency. Concurrent validity showed significant positive correlations between ACE-IQ scores (both binary and frequency methods) and the Marshall Scale. Conclusions: The ACE-IQ demonstrates adequate reliability for the full scale, with strong evidence of construct validity using the frequency scoring method and concurrent validity for both scoring methods. These findings support the ACE-IQ's use for measuring childhood adversities in Chile and assessing their association with adult health outcomes.

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.

The impact of adverse childhood experiences on postpartum post-traumatic stress disorder in women: A prospective cohort study in China

BACKGROUND

Women are more prone to experience adverse childhood experiences (ACEs), placing them at higher risk of postpartum mental health disorders. However, research on ACEs, particularly their association with postpartum Post-Traumatic Stress Disorder (PTSD) in non-Western contexts, is limited.

OBJECTIVE

To utilize a cumulative risk approach and latent class analysis (LCA) to operationalize ACEs among postpartum women in China and examine their association with postpartum PTSD.

METHODS

In this prospective cohort study, 856 eligible participants from a tertiary hospital in Guangdong province of China between October 2022 and August 2023 completed assessments of demographic and obstetric characteristics, and ACEs within 2-3 days postpartum, followed by PTSD evaluation at 42 days postpartum. The cumulative risk approach and LCA were employed to operationalize ACEs, and their association with postpartum PTSD was assessed using log-binomial regression models, adjusting for potential confounders.

RESULTS

Among the participants, 80.4 % (688/856) reported ACEs, with 18.2 % experiencing four or more ACEs, a threshold above which there was a particularly higher risk of postpartum PTSD in the adjusted model (OR = 8.27, 95 % CI = 3.08-22.20). LCA identified three groups: low ACEs, household and community violence, and multiple ACEs, with women in the multiple ACEs group exhibiting the most severe postpartum PTSD symptoms in the adjusted model (OR = 4.39, 95 % CI = 1.58-12.24).

CONCLUSIONS

This study demonstrates that ACEs are a significant risk factor for postpartum PTSD, especially for women who have experienced four or more ACEs, or multiple ACEs, placing them at particularly high risk for developing postpartum PTSD.

Association of maternal and paternal adverse childhood experiences with emotional and behavioral problems among preschool children

Although maternal adverse childhood experiences (ACEs) are known to be related to the emotional and behavioral problems (EBPs) of offspring, few studies have surveyed the intergenerational effects of paternal ACEs. In addition, no study has yet explored the combination and interaction effects of maternal and paternal ACEs on preschool children's EBPs in China, and the gender differences in these relationships also remain to be explored. A total of 3,575 preschool children from 12 preschools from Hefei city of Anhui province were included in this study. We used a binomial logistic regression to examine the relationship between maternal ACEs, paternal ACEs and children's EBPs. Logistic regression analysis indicated that maternal and paternal ACEs were significantly related to EBPs in children, respectively. The high maternal ACEs + high paternal ACEs group had the greatest association with children's EBPs. Interaction analysis results showed that, compared with the reference group (low maternal ACEs×low paternal ACEs), the other group (high maternal ACEs×high paternal ACEs ) were significantly related to children's EBPs (OR = 1.84, 95%CI: 1.55-2.19). We found that there were no gender differences in the combination and interaction effects (P>0.05). When fathers and mothers were jointly exposed to high levels of ACEs, children had a higher risk of developing EBPs than when they were exposed independently. Future studies should fully explore the intergenerational health effects of parental ACEs so that references for promoting the physical and mental health of preschool children can be developed.

A person-centered examination of adverse childhood experiences and associated distal health, mental health, and behavioral outcomes in the United Arab Emirates

BACKGROUND

An increasing body of evidence highlights the utility of examining adverse childhood experiences (ACEs) utilizing person-centered analytical approaches, particularly for understanding the organization and co-occurrence of ACEs, and their contributions to risk, vulnerability, and the development of intervention efforts.

METHODS

In the first study of its kind, this paper uses Latent Class Analysis, to assess ACEs among a large community sample in Abu Dhabi, capital city of the United Arab Emirates, by examining patterns of ACEs and their associated impact on health, mental health, behavioral risk, and adult psychological function in a cross-sectional sample of 922 members of the Abu Dhabi community.

RESULTS

Findings support a 3-class solution, representing low-to-no ACEs, Household ACEs, and Violence ACEs among this sample, with variability in the age, sex, and nationality status reflected across classes. ACE categories notably differentiated later adult risk for a suite of diagnoses of health and mental health disorders, risk for elevated screening values for depression, anxiety and stress, and a range of adult risk-related behaviors.

CONCLUSION

These findings are considered in line with the extant literature and form the basis of considerable public health policy and intervention planning in Abu Dhabi, the United Arab Emirates, and the Arab region.

Association between adverse childhood experiences with chronic kidney diseases in middle-aged and older adults in mainland China

Adverse childhood experiences (ACEs) among middle-aged and elderly individuals may influence the subsequent occurrence of chronic kidney disease (CKD). We aim to investigate the association between ACEs and CKD among the middle-aged and elderly populations in China. The prospective cohort longitudinal study examined baseline data from the China Health and Retirement Longitudinal Study (CHARLS) from June 1 to December 31, 2014. Subsequent follow-up surveys were conducted in 2015, 2018, and 2020. The study population consisted of 4063 participants aged at least 45 years, who had CKD data and information on the 16 complete ACEs indicators included in this study. Utilizing correlation analysis to explore the relationship between CKD and the total score of ACEs, as well as the three dimensions (Conventional ACEs, Expanded ACEs, and New ACEs), along with specific items. The correlation between individual ACEs, disease-related factors, and CKD was examined using binary logistic regression models. Valuable diagnostic factors were then identified through the use of ROC curves. A Cox proportional hazards regression model, with age as the timescale and ACEs groups as covariates, was established to investigate the relationship between age-related CKD occurrence and ACE groups as individuals aged. Among the 4063 participants included in the analysis, in patients with CKD, the male proportion is 85 (64.9%), and the female proportion is 46 (35.1%). Of the participants, 2332 experienced at least two Conventional ACEs, 3786 experienced at least two Expanded ACEs, and 2774 experienced at least one New ACE. Factors influencing the occurrence of CKD in participants included Conventional ACEs 5 (OR 1.742; 95% CI 1.115-2.721; P = 0.015), Conventional ACEs 6 (OR 1.581; 95% CI 1.024-2.442; P = 0.039), Conventional ACEs 9 (OR 2.190; 95% CI 1.288-3.725; P = 0.004), Expanded ACEs 3 (OR 0.195; 95% CI 0.085-0.444; P < 0.001), memory-related disease (OR 3.297; 95% CI 1.140-9.538; P = 0.028), dyslipidemia (OR 2.536; 95% CI 1.521-4.230; P < 0.001), cancer (OR 6.369; 95% CI 2.464-16.461; P < 0.001), chronic lung disease (OR 2.261; 95% CI 1.091-4.684; P = 0.028), and liver disease (OR 3.050; 95% CI 1.432-6.497; P = 0.004). These three models showed significant statistical differences in CKD, the Conventional ACEs, and the New ACEs. In Model 1, 2, and 3, the risk was higher for individuals exposed to the Conventional ACEs group, indicating an increased likelihood of developing CKD, the risk was lower for individuals exposed to the New ACEs group, suggesting a reduced likelihood of developing CKD. ROC curve analysis of these variables showed that CA5, CA6, CA9, dyslipidemia had significant diagnostic value for the occurrence of CKD. The accuracy of diagnosis was CA5 (57.0%), CA6 (58.3%), CA9 (59.4%), and dyslipidemia (59.8%). This study, through longitudinal investigation, has identified potential links between ACEs and disease-related factors with CKD. These findings can still provide assistance to clinicians and public health administrators, helping them understand the association between ACEs and CKD, and offering theoretical support for their clinical decision-making or development of public health policies.

Trauma-informed healthcare systems: an evaluation of trauma-informed care training for hospital-based healthcare professionals in the aftermath of the 2023 earthquakes in Türkiye

Disasters are complex global problems with an increasing impact with rising prevalence of associated illness, mortality, and intensifying health inequities. In recent years, there has been an emphasis on integrating trauma-informed care approaches into health policies and protocols. The purpose of the current study was to investigate the benefits of a trauma-informed healthcare training program for hospital-based healthcare providers with a focus on knowledge acquisition, empowerment of professional practice, and personal well-being. The program was implemented in the aftermath of the 2023 earthquakes in southeastern Türkiye. The training consisted of four modules, developed based on psychological trauma theories and behavior change theories, and was evaluated using a mixed-methods approach. Assessments were conducted at the end of the training program, at baseline, and at a 6-month follow-up. A structured questionnaire including items covering the content of the training, trainer effectiveness, and program suitability was administered at the end of the training program. At 6 months, participants completed an 18-item follow-up questionnaire which assessed their understanding of the principles of the trauma-informed care approach. The Maslach Burnout Inventory (MTI) was also administered, and themes regarding the impact of the training program were extracted through in-depth individual qualitative interviews. Data were obtained from 501 program participants. The intervention program was found to improve healthcare workers' understanding of trauma, professional practices, and interpersonal relationships, and significantly reduced symptoms of burnout. These results demonstrate the critical role of trauma-informed training programs in hospitals in disaster-affected regions, especially when assistance to survivors will be enhanced by strengthening healthcare workers' resilience and improving their perceptions of service efficacy and value. The study highlights the need for more widespread adoption of these training initiatives and emphasizes that they may play significant future roles in transforming trauma-informed healthcare systems in disaster-prone countries and regions.

Influence of social determinants of health and adversity on computerized neurocognitive assessment

Introduction: Social determinants of health and adversity, including poverty, maltreatment, and neighborhood deprivation, are individual-level factors that may significantly affect baseline neurocognitive testing and management that have yet to be thoroughly explored within the computerized neurocognitive assessment.Objectives: Examine individual-level experiences of poverty, abuse, neighborhood deprivation, and social mobility on computerized cognitive testing.Methods: The sample included 3,845 student-athletes who completed a baseline Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) and were enrolled in the Child-Household Integrated Longitudinal Data database. Multivariable linear regressions were used to assess independent variables of Supplemental Nutrition Assistance Program enrollment, abuse or neglect cases, Area Deprivation Index scores, and other demographic factors on four baseline ImPACT composite scores: verbal and visual memory, visuomotor, and reaction time.Results: Individual-level factors of persistent poverty and neighborhood deprivation were associated with lower composite scores; however, upward social mobility was not significantly associated with cognitive performance. The effects of mother's race on computerized cognitive testing performance were attenuated when accounting for measures of adversity.Conclusion: Findings highlight the importance of social determinants of health in computerized neurocognitive testing to ensure more culturally sensitive and precise understanding of athletic baselines.

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.

Investigating the Impact of Caregiver Adverse Childhood Experiences Screening and Pediatrician-Led Discussions on Posttraumatic Stress Disorder Symptoms in a Majority-Hispanic Pediatric Primary Care Clinic Setting

BACKGROUND

Evidence suggests that screening and provider-led discussions of parental adverse childhood experiences (ACEs) may help identify at-risk families and be linked to positive health outcomes in caregivers and their children. However, the direct effect of ACEs screening and discussions on posttraumatic stress disorder (PTSD) has yet to be studied.

OBJECTIVES

To determine if screening or provider-led discussions of parental ACEs are associated with inadvertent worsening of PTSD symptoms 1 week after screening.

RESEARCH DESIGN

Data was obtained as part of a cluster randomized controlled trial to examine the effects of ACEs screening and provider-led discussions on child health care utilization outcomes. Baseline surveys were completed before scheduled infant well child checks (WCCs). Providers were randomized into the standard of care or intervention (discussion) conditions. Intervention providers were trained in delivering brief trauma-informed discussions about the impact of ACEs on parenting during WCCs.

SUBJECTS

Caregivers in a pediatric primary care clinic serving predominantly Hispanic and low socioeconomically resourced families (N=179, 93% female, 87% Hispanic).

MEASURES

The Primary Care PTSD Screen for DSM-5 (PC-PTSD-5), Brief Resilience Scale (BRS), and ACEs screening were completed at baseline. PC-PTSD-5 was repeated 1-week after screening.

RESULTS

Mixed-effects ordinal logistic regression analysis of PTSD scores from baseline to 1-week postscreening with the full sample showed no significant effect of time [odds ratio (OR)=1.21, P=0.68], group (OR=1.68, P=0.33), or their interaction (OR=0.48, P=0.21).

CONCLUSIONS

Screening or brief discussion of ACEs with providers trained in trauma-informed care were not associated with worsening PTSD symptoms.

Prioritizing Brain Health in Youth: Bringing Neuroscience to Society and Informing Policy, Lessons Learnt from the European Brain Council Expert Meeting Held at the Federation of European Neuroscience Societies Forum 2024

Good brain health plays a significant role in an individual's well-being and profoundly impacts the collective economy and society. Brain development does not stop at birth, and some aspects continue throughout childhood and adolescence, allowing the full development of cognitive functions. Different determinants related to physical health, healthy environments, safety and security, life-long learning and social connection as well as access to quality services influence the way our brains develop, adapt and respond to stress and adversity. Ongoing progress in neurobiology and cognitive neuroscience allows the design of better prevention and intervention strategies to help avoid brain deficits and/or limit their impact and maintain brain health. The European Brain Council (EBC) convened an expert meeting during the Federation of European Neuroscience Societies (FENS) Forum 2024 to address youth brain health challenges. In recent years, the importance of brain health has garnered significant attention across scientific, medical and policy-making communities. Although much focus has traditionally been on neurodegenerative conditions affecting the elderly, a paradigm shift towards prioritizing brain health in youth is both timely and necessary. This shift can profoundly impact individual lives and society, necessitating an interdisciplinary approach that brings neuroscience to the forefront of public health and informs evidence-based policy. The topic is of utmost importance as EBC launched this year a new campaign on No Health Without Brain Health rallying support with its member organizations and the wider brain community for the increased prioritization of brain health on EU health and research agendas.

Associations between adverse childhood experiences and psychological distress among Swedish upper secondary school students

BACKGROUND

The detrimental impacts of adverse childhood experiences (ACEs) on health have been extensively studied, mainly focusing on the effects of ACEs on adults. However, there is a dearth of studies exploring their influences on adolescents.

OBJECTIVE

This study aims to investigate the associations between ACEs and psychological distress among Swedish adolescents.

PARTICIPANTS AND SETTING

At the end of 2020, 1561 Swedish adolescents (15-19-years-old) participated in an electronic survey. The survey encompassed questions about alcohol and drug use problems within the students' families, questions about the students' experiences of physical and psychological abuse, and the administration of the Brief Symptom Inventory to assess their mental health.

METHODS

Descriptive and comparative non-parametric statistics were applied.

RESULTS

Nearly half of the study population reported experiencing one or more ACEs. Exposure to any ACE was significantly associated with a higher level of psychological distress. Of the ACEs examined, the experience of psychological abuse was the most substantial risk factor for psychological distress (with medium effect sizes of ε2 between 0.07 and 0.12 on each domain and a large effect size of ε2 = 0.14 on the General Severity Index scale). There was a positive correlation (r = 0.36) between the number of ACEs experienced and worsened mental health.

CONCLUSIONS

The significant impacts of any ACE, the cumulative number of ACEs, and, particularly, psychological abuse on adolescent mental health are discussed. To further enhance the understanding of these associations and identify effective interventions to prevent and mitigate the negative impact of ACEs on mental health, additional research is warranted.

Associations of adverse childhood experiences with blood pressure among early adolescents in the United States

The associations of adverse childhood experiences (ACEs) with blood pressure in adulthood are inconclusive. Similarly, the association between ACEs and blood pressure earlier in the life course is understudied. This study aims to assess the associations of ACEs with blood pressure among early adolescents. We utilized data collected at baseline (age: 9-10 years) and Year 2 follow-up from 4077 participants in the Adolescent Brain Cognitive Development (ABCD) Study. We used adjusted multiple linear regression models to estimate the associations of ACEs (cumulative score and subtypes) at baseline with systolic blood pressure (SBP) and diastolic blood pressure (DBP) at year 2 of follow-up. Experiencing ≥4 ACEs (compared to 0) was significantly associated with higher SBP (B = 3.31, 95 % CI 0.03, 6.57, p = 0.048). Of the ACEs subtypes, household substance use (B = 2.28, 95 % CI 0.28, 4.28, p = 0.028) and divorce or separation (B = 2.08, 95 % CI 0.01, 4.15, p = 0.048) were both significantly associated with a higher SBP while household mental illness (B = 2.57, 95 % CI 1.32, 3.81, p < 0.001) was significantly associated with a higher DBP. Our findings suggest that exposure to multiple ACEs is associated with higher blood pressure in adolescence.

Adverse childhood experiences and multimorbidity among middle-aged and older adults: Evidence from China

BACKGROUND

Associations between adverse childhood experiences (ACEs) and multimorbidity among middle-aged and older Chinese individuals have not been well documented.

OBJECTIVE

We aimed to examine the associations of ACEs and different multimorbidity measures among Chinese middle-aged and older adults.

PARTICIPANTS AND SETTING

The study population included 6428 participants aged 45 years or older who were obtained from the China Health and Retirement Longitudinal Study (CHARLS).

METHODS

Multimorbidity was assessed by the number of self-reported physician diagnoses of 14 chronic diseases, the Chinese multimorbidity-weighted index (CMWI), multimorbidity trajectories and multimorbidity patterns. ACEs were measured retrospectively by whether the individuals having physical abuse, emotional neglect, household substance abuse, household mental illness, domestic violence, incarcerated household member, parental separation or divorce, unsafe neighborhood, bullying, parental death, sibling death, and parental disability or not, which were characterized by the binarized presence or absence of any ACE. We estimated the associations between ACEs and multimorbidity using a mixed-effects model. Latent growth curve modelling was used to investigate the trajectory of multimorbidity by ACEs. Both models Adjusted for sociodemographic and other health risk factors. Patterns of multimorbidity by ACEs were explored using hierarchical cluster analysis.

RESULTS

Of the 6428 individuals included (mean [SD] age, 56.67 [8.00] years; 6181 [45.29 %] were females), 81.16 % had experienced ACEs at baseline. ACEs were associated with an increased number of chronic diseases (β = 0.30; 95 % CI, 0.21 to 0.40) and the lower CMWI (β = -0.49; 95 % CI, -0.64 to -0.33). ACEs were associated with an increased number of chronic diseases at the baseline (intercept: 0.28, 95%CI: 0.20 to 0.36) and a more rapid increase in the number of chronic diseases over 7 years (intercept: 0.03, 95%CI: 0.01 to 0.05). The results of continuous variables (the number of ACEs) were consistent with those of binary variables (ACEs). ACEs were associated with lower scores at the baseline (intercept: -0.46, 95%CI: -0.60 to -0.33) but weren't related to a faster decrease (intercept: -0.04, 95%CI: -0.07 to 0.00). The number of ACEs was associated with the lower scores of CMWI at baseline and the faster the decrease in CMWI scores (intercept: -0.17, 95%CI: -0.21 to -0.14; slope: -0.03, 95%CI: -0.04 to -0.02). The above results varied among different types of ACEs. The binary multimorbidity pattern (arthritis and stomach/digestive disease) had the highest prevalence (15.50 %) in the participants with ACEs. There were differences in multimorbidity patterns between individuals exposed to ACE or not. The liver-kidney cluster more likely clustered with the arthritis-stomach cluster in individuals without ACE, but with the cancer-psych cluster in counterparts with ACEs.

CONCLUSIONS

There was an association between ACEs and multimorbidity with its trajectories and patterns after age 45. This study encourages a comprehensive life-course perspective to better understand and potentially prevent multimorbidity.

Patterns of adverse childhood experiences and their associations with depression, life satisfaction and short-form video addiction in Chinese college students

BACKGROUND

Adverse childhood experiences (ACEs) are widespread in East Asia, heightening the susceptibility to psychological and behavioral complications in adulthood.

OBJECTIVE

To identify polyvictimization patterns among Chinese college students and investigate the associations between diverse patterns and symptoms of depression, short-form video addiction (SVA), and life satisfaction.

PARTICIPANTS AND SETTING

This study encompassed 13,307 college students from four urban centers in China (Mage = 20.2; 46.4 % female).

METHODS

Latent class analysis (LCA) was employed to discern patterns of ACEs among college students. The three-step method (R3step) was utilized to explore the influence of demographic characteristics on the distribution of latent classes. Additionally, the automatic Bolck-Croon-Hagenaars (BCH) Method was deployed to investigate the latent classes effect on distal outcomes.

RESULTS

Left-behind experience was the most common ACE among Chinese college students. Four ACEs patterns were identified: 1) No/Very Low ACEs class (N = 8936, 67.2 %); 2) Parental Absence class (N = 430, 3.2 %); 3) Low/Moderate ACEs class (N = 3565, 26.8 %); and 4) High Violence and Left-behind class (N = 376, 2.8 %). The findings revealed a progressive escalation in healthy outcomes associated with the four ACEs patterns. Specifically, from the first class to the fourth, the severity of associated consequences (depression, life satisfaction and SVA) intensified.

CONCLUSIONS

Distinct ACEs patterns correlate with varying degrees of mental health issues. Compared to participants solely separated from parents, those exposed to abuse and neglect demonstrate more pronounced mental health challenges and addiction susceptibilities.

Tobacco use, trauma exposure and PTSD: a systematic review

Tobacco use remains one of the most significant preventable public health problems globally and is increasingly concentrated among vulnerable groups, including those with trauma exposure or diagnosed with PTSD. The goal of this systematic review was to update and extend previous reviews. Of the 7224 publications that met the initial criteria, 267 were included in the review. Summary topic areas include conceptual frameworks for the relation between trauma or PTSD and tobacco use; associations between trauma exposure or PTSD and tobacco use; number and type of trauma exposures and tobacco use; PTSD symptoms and tobacco use; Treatment-related studies; and the examination of causal relations. Evidence continues to indicate that individuals exposed to trauma or diagnosed with PTSD are more likely to use tobacco products, more nicotine dependent and less likely to abstain from tobacco even when provided evidence-based treatments than individuals without trauma. The most commonly cited causal association proposed was use of tobacco for self-regulation of negative affect associated with trauma. A small proportion of the studies addressed causality and mechanisms of action. Future work should incorporate methodological approaches and measures from which we can draw causal conclusions and mechanisms to support the development of viable therapeutic targets.

What factors attenuate the relationship between childhood neglect and adverse health outcomes? Examining the role of socioeconomic status, health behaviors, and the presence of a protective adult

BACKGROUND

The detrimental effects of childhood neglect on adult health outcomes are well-recognized; however, less is known about factors that may attenuate this relationship.

OBJECTIVE

(1) To examine the associations between childhood neglect and various physical and mental health outcomes in adulthood among those who had not experienced childhood physical or sexual abuse; and (2) To determine whether adjusting for risk and protective factors, including socioeconomic status, health behaviors, and the presence of a trusted adult, attenuates these relationships.

PARTICIPANTS AND SETTING

Data came from the 2021 Behavioral Risk Factor Surveillance System (BRFSS), a representative sample of community-dwelling US adults (n = 41,322).

METHODS

The relationships between childhood neglect and health outcomes were investigated using logistic regression analyses. Adjustments were made for demographics, socioeconomic status, health behaviors, and the presence of a protective adult.

RESULTS

Childhood neglect was significantly associated with adverse health outcomes, including health behaviors (e.g., smoking, low physical activity), physical health indicators (e.g., self-reported fair/poor health, stroke, asthma, COPD), disabilities (e.g., hearing impairment, vision impairment, cognitive impairment, difficulty walking or climbing stairs, difficulty bathing), and mental health indicators (e.g., poor mental health/past month, depression) after controlling for demographics. All significant associations indicated small or very small effect sizes. Associations were substantially attenuated when controlling for adult socioeconomic status, and further attenuated when controlling for the presence of a protective adult, with several outcomes becoming non-significant.

CONCLUSIONS

Socioeconomic status and the presence of a protective adult in childhood considerably diminishes the association between childhood neglect and health outcomes in adulthood.

The associations between adverse childhood experiences and body pain among middle-aged and older adults: findings from China

BACKGROUND

Adverse Childhood Experiences (ACEs) have been implicated in the development of body pain, yet research on their impact on body pain and its progression remains scarce. This study aimed to examine the associations between ACEs and the presence and areas of body pain, as well as their developmental trajectories among middle-aged and older Chinese adults.

METHODS

We included participants aged 45 years and above from the China Health and Retirement Longitudinal Study (CHARLS) conducted between 2011 and 2018. Retrospective data on ACEs and pain sites were collected with questionnaires. The presence of pain at different body sites was categorized into three areas: head & neck, trunk, and limbs. ACEs consisted of ten types of adverse experiences and were cumulatively scored. For the cross-sectional analysis (2011), logistic regressions were performed to estimate the associations between ACEs and pain presence in specific areas. In the longitudinal analysis (2011-2018), we further applied group-based trajectory modelling (GBTM) to determine the developmental trajectories of body pain. Multinomial logistic regressions were then conducted to estimate the associations between ACEs and pain trajectories.

RESULTS

In the cross-sectional analysis (n = 8157), ACEs were positively associated with the presence of pain in the head & neck (odds ratio [OR] = 3.55, 95% confidence intervals [CI] = 2.37-4.74), trunk (OR = 3.28, 95% CI = 2.47-4.34), and limbs areas (OR = 2.30, 95% CI = 1.77-3.00) compared to no ACEs. These associations varied by sex and residence. In the longitudinal analysis (n = 5188), GBTM identified three developmental trajectories of body pain (n = 9521): high-increasing (7.44%), low-moderate (33.67%) and maintained-low trajectories (58.89%) trajectories. Compared to participants without ACEs, individuals had three ACEs and 4 or more ACEs were consistently associated with low-moderate (three ACEs: OR = 2.26, 95% CI = 1.81-2.83, four or more ACEs: OR = 3.11, 95% CI = 2.51-3.87) and high-increasing (three ACEs: OR = 3.28, 95% CI = 2.03-5.30, four or more ACEs: OR = 6.78, 95% CI = 4.30-10.68) body pain trajectories across sexes and residence.

CONCLUSION

This study highlighted the significant association between ACEs and body pain among middle-aged and older Chinese, emphasizing the importance of preventing or mitigating ACEs as a strategy for the prevention and management of body pain.

Adverse Childhood Experiences and Mental Distress Among Adolescents and Youth in Zimbabwe

Adverse childhood experiences (ACEs) are a global public health crisis associated with physical and poor mental health outcomes. The current study examined the prevalence and association between individual and cumulative ACEs with mental distress among adolescents and youth in Zimbabwe. Data from the 2017 Violence Against Children and Youth Survey were utilized (13-25 years old, n = 8,715). Bivariate analysis was conducted using chi-square tests to obtain the prevalence estimates. Two sets of logistic regression models were conducted to determine significant associations between independent variables (i.e., experiencing childhood physical, emotional, and sexual violence; witnessing intimate partner violence (IPV) and community violence; orphan status; and cumulative ACE exposure) and the dependent variable (i.e., mental distress in the past 30 days as measured by Kelser 6). 28.4% of the adolescents and youth reported experiencing mental distress in the past 30 days. Regarding ACEs, cumulative ACE exposure (34.7%; adjusted odds ratio [AOR] = 2.13) and individual ACEs (i.e., experiencing childhood physical violence [39.3%; AOR = 1.41], emotional violence [55.8%; AOR = 2.67], sexual violence [50.8%; AOR = 2.00], witnessing community violence [47.3%; AOR = 1.52], witnessing IPV [43.1%; AOR = 1.47], and being orphaned during childhood [33.6%; AOR = 1.24]) were significantly associated with higher prevalence rates and odds of experiencing mental distress in the past 30 days among adolescents and youth in Zimbabwe. These findings show that ACEs are highly prevalent and increases the risk of mental distress for vulnerable adolescents and youth in Zimbabwe. Effective interventions to reduce violence exposure in families, schools, and communities are essential to mitigate the negative consequences of ACEs and mental distress of adolescents and youth in Zimbabwe. Strengthening child protection policies and involving social workers, psychologists, and mental health workers are also crucial for safeguarding vulnerable children who might be impacted by ACEs in Zimbabwe. Implications for future research are further discussed.

The effects of a defendant's childhood physical abuse on lay support for sentencing: The moderating role of essentialism

Research suggests that a defendant's history of experiencing childhood abuse, and its effects on their life and later decision-making, may impact public support for a defendant's sentencing, particularly mitigation. However, no existing research has examined how and why sentencing support may vary based on the time period when the abuse occurs during a defendant's childhood. This experiment, using a sample of the U.S. public (N = 400), examines how the age at which a defendant's childhood physical abuse occurs affects lay support for the goals of their sentencing. We hypothesized that participants with higher levels of social and biological trait essentialism would moderate their increased support for more punitive sentencing goals-particularly when a defendant was abused earlier, rather than later, in childhood. Results suggest that social essentialism is associated with increased support for restoration and rehabilitation toward defendants with histories of childhood physical abuse, potentially indicating that the public views the effects of child abuse as more of a social, versus biological, process which may affect support for utilitarian punishment goals.

Investigating child-facing practitioners' understanding of adversity and its impact on children's development and service provision

Adversity during childhood is a common risk factor for poorer outcomes across physical, mental, and social health. Despite growing evidence and policy around preventing adversity and its sequalae, the incidence of adversity in childhood remains high. Child-facing practitioners (CfPs) may be well-placed to identify adversity and address its impact on children. This study investigated the understanding of adversity and current practice of CfPs working in the Education system, Healthcare and Social Care in England. An anonymous online survey was completed by 113 CfPs between April and June 2022. Data were analysed using descriptive statistics. Participating CfPs' reported using a range of assessment tools and direct observation, but there was a lack of consistency in the extent to which different types of adversity were explored in assessments. CfPs working in the Education system and Healthcare reported only liaising with Social Care services when a current worker was known to be involved with the family, or to make a referral. Indeed, a quarter of respondents from the Education system and Healthcare only considered early life experiences when capacity allowed. Over half of the CfPs in this survey 'did not know' or 'did not agree' that public services offer interventions to support families experiencing domestic abuse, parental mental health difficulties and addiction, or the impact of these adversities on children's wellbeing. The study highlights that CfPs could benefit from further training about the prevalence and impact of adversity to inform service delivery. A review of CfPs' routine assessments is needed to ensure that children's exposure to adversity is routinely identified; this will facilitate families to access appropriate support to mitigate the impact of such experiences.

Effects of adverse childhood experiences on university students' ability to lead healthy lives: an exploratory qualitative study in Lahore, Pakistan

BACKGROUND

Adverse Childhood Experiences are a significant global public health concern as these experiences have adverse effects on all the health determinants.

METHODS

The interpretive phenomenological research design was used to explore the implications of adverse childhood experiences on the adult life of university students. An interpretive thematic analysis method was employed to analyze this study.

RESULTS

Five major themes emerged after a comprehensive review of the information obtained from the interviews with the ten selected participants. These were (1) Chronic health struggles (2) Mental health disorders (3) Emotional and social difficulties (4) Paranoia and distrust and (5) Academic and professional under-performance.

CONCLUSION

This study concludes that adverse childhood experiences have long-lasting negative effects on university students' health and behaviour, preventing them from leading healthy lives and excelling academically and professionally.

The Relationship Between Adverse Childhood Experiences, Symptom Severity, Negative Thinking, Comorbidity, and Treatment Response in Youth with Obsessive-Compulsive Disorder

Although youth and adults with obsessive-compulsive disorder (OCD) endorse elevated incidence of exposure to traumatic life events during childhood, the existing literature on adverse childhood experiences (ACEs) and OCD is mixed and studies focusing on pediatric OCD are limited. The present study examines the relationship between ACEs and OCD onset, symptom severity, negative cognitive patterns, comorbidity, and cognitive-behavioral therapy (CBT) response in 142 children and adolescents with OCD. ACEs were ascertained from parent reports. Most parents reported child exposure to ACEs. Out of the parents who reported ACEs, 50% reported ACE exposure prior to OCD diagnosis and 50% reported ACE exposure after OCD diagnosis. No significant associations between ACEs and comorbidity or CBT response were found, suggesting that CBT for pediatric OCD is effective regardless of ACE exposure. Family financial problems were associated with increased obsessive-compulsive symptom severity and negative thinking. Implications for research and practice are discussed.

Exploring the impact of adverse childhood experiences on health and cognitive functions in older adults

This study examines whether adverse childhood experiences (ACEs) predict long-term health issues and how ACEs, alongside stress, impact well-being and cognitive abilities in older adults. 279 adults were categorized into three age groups (30-46, 47-60, and 61-80). Participants completed an online survey assessing health problems, stress, resilience, and ACEs. Additionally, 32 older adults underwent cognitive tests. ACE scores predicted physical and psychological diseases in adults but not in older adults. However, a significant correlation between ACEs and cognitive abilities was evident in older participants. ACEs are significant indicators of long-term health issues and stress in adults but may not predict these factors in older individuals. Understanding ACEs' impact on cognitive abilities in older adults is crucial for tailored interventions and support.

Adverse childhood experiences: A health risk in emerging adulthood

Adverse Childhood Experiences (ACEs) represent a child's exposure to negative events that are detrimental to their mental and physical health. Despite this, very few studies have focused on the relationship between ACEs and physical health problems, in non-English-speaking populations and in emerging adulthood. Therefore, the objective of this study was to investigate the cumulative and differential impact of ACEs on diverse physical health problems in a Spanish population. Participants were 648 young adults (22% men), between the ages of 18 and 30 (mean age = 21.37, SD = 3.11), who completed the ACE Questionnaire and answered some questions about their health (e.g. asthma, obesity, global health). From the cumulative perspective, ACEs had a significant relationship with global health and asthma. Additionally, the differential approach revealed some specific ACEs related to three out of five health outcomes. Therefore, early detection of ACEs is of paramount importance to reduce their impact.

Prevalence and repercussions of stress and mental health issues on primary and middle school students: a bibliometric analysis

Objective

This study analyzes the presence and reverberations of stress, anxiety, and other mental health issues on primary and middle school students using bibliometric analysis. The aim of this study is to map the research landscape by statistically analyzing existing literature and identifying key themes, trends, and research hotspots in the domain of stress in students. This study also presents analysis related to top contributing countries, journals, authors, citations, and collaboration networks.

Method

A total of 1,335 publications from 1962 to 10 September 2023 were included in this study using the Web of Science, PubMed, and Scopus databases. The steps involved in the bibliometric study included data collection, cleaning, and various analyses such as performance analysis, citation analysis, and network analysis. Biblioshiny by RStudio and Microsoft Excel were used for bibliometric analysis to determine the collaboration between countries and authors and to explore keyword analysis and thematic evolution.

Results

The findings show that China and USA have contributed the highest number of publications. Frontiers in Psychology with 50 publications turns out to be the most prominent journal. The study presents the thematic evolution and the trend topics in this research domain. Some of the trend topics are stress, test anxiety, bullying, depression, cyberbullying, virtual reality, mathematics anxiety, childhood maltreatment and self-compassion, primary school, and middle school. The paper also highlights the prominent authors and their collaboration network.

Discussion

The study has highlighted the various reasons for stress and its potential repercussions on students. This information can be used to help parents, teachers, and the school administration to spot the most susceptible group of students who need immediate intervention to address various mental health issues. We see a gradual progress in the research areas being covered under this domain. More relevant areas of concern related to stress are being explored with time. With the technological advancement and the vast unmonitored internet usage (especially for primary and middle school students), the stress caused by cyberbullying and peer victimization has also become an important topic of research in later years.

Analyzing the relationship between individual and cumulative score of adverse childhood experiences (ACEs) with self-reported mental health disorders in Chile

BACKGROUND

Adverse Childhood Experiences (ACEs) are widely recognized as significant predictors of poor mental health in adulthood. Latin America presents several unique challenges regarding ACEs, such as higher prevalence of violence and income and political inequality. However, little is known about this issue from nationally representative samples in the region, particularly in Chile.

OBJECTIVE

This investigation examines the association between individual and cumulative ACE scores and seven self-reported mental health conditions (substance abuse, depression, PTSD, generalized anxiety, suicide ideation, non-suicidal self-harm, and learning disorders) in a representative Chilean urban sample.

METHODS

A representative urban sample of 2101 adult Chileans completed the International Adverse Childhood Experiences Questionnaire (ACE-IQ) and disclosed any prior mental health diagnoses.

RESULTS

Around 40 % of the sample had experienced four or more ACEs in their lifetime. For these individuals, the risk of reporting a mental health disorder was significantly higher. Several logistic regression analyses were conducted to address the associations between ACEs and the seven mental health conditions. Notably, sexual abuse, bullying, and exposure to collective violence were the ACEs most strongly associated with self-reported mental health issues. Additionally, a cumulative ACE score was found to be a significant predictor of having a previous mental health diagnosis.

CONCLUSIONS

We found a significant predictive association between exposure to collective violence and six out of the seven self-reported mental health disorders. Similarly, sexual abuse demonstrated an association with all mental health conditions. Finally, individuals who experienced four or more ACEs had a notably higher chance of reporting a previous mental health diagnosis. We recommend conducting further ACE research in Latin America due to its cultural and contextual singularities.

Examining adverse childhood experiences and Black youth's engagement in a hospital-based violence intervention program using administrative data

BACKGROUND

Stemming from poverty and systemic racism, Black youth are disproportionately represented in hospital-based violence intervention programs (HVIPs) due to greater violence exposure. HVIPs are a critical intervention that have been shown to reduce rates of reinjury in urban hospitals and trauma centers across the United States; however, they are plagued by low enrollment and engagement rates. Few studies have examined factors related to engagement, particularly among Black youth.

METHODS

Guided by Trauma Theory and Critical Race Theory, this study uses a retrospective cohort design. Between-group differences of adverse childhood experiences (ACEs) among engaged youth compared to nonengaged youth who were violently injured and recruited for a HVIP were examined using chi-square and logistic regression. ACEs were approximated using a novel approach with administrative data.

RESULTS

Results indicated that the total ACE score was not significantly associated with engagement status. Individual ACEs were tested across age groups.

CONCLUSIONS

This study highlights a novel approach to understanding ACEs among a hard-to-reach population and illuminates the significant level of ACEs faced by violence-exposed Black youth at young ages. Considering theory, Black families may be more reluctant to engage due to fear and past harms in social service systems stemming from systemic racism. Though ACEs did not predict engagement in this study, considering the high rates of ACEs experienced by Black youth and their families in the context of systemic racism suggests that HVIPs should acknowledge historical harms and foster trauma-informed and healing-centered interactions during recruitment and later stages of engagement.

Are Function-Based Interventions for Students with Emotional/Behavioral Disorders Trauma Informed? A Systematic Review

Students with emotional/behavioral disorders (EBD) commonly engage in both externalizing and internalizing behaviors-a behavioral profile that has been connected to childhood trauma. Although the efficacy of function-based interventions for students with EBD has been documented, the extent to which these interventions align with principles of trauma-informed care (TIC) is unknown. We conducted a systematic review of function-based intervention studies for students with EBD to evaluate whether and how these interventions incorporated critical elements of TIC. We identified 56 articles that met the eligibility criteria and used an iterative process to identify intervention practices consistent with each of six pillars of TIC, then evaluated the extent to which interventions in the study sample incorporated these practices. Despite identifying 45 function-based intervention practices aligned with pillars of TIC, we found most of these practices were absent in most interventions. We identified teaching skills, building healthy relationships, and including family, culture, and community as three pillars of TIC that warrant more attention when developing function-based interventions for students with EBD. For pillars of TIC that lack a strong empirical foundation in behavior analysis, we point to related literatures and disciplines with potential to inform next steps in behavior analytic research and practice.

Longitudinal evidence of the influence of early life circumstances, family characteristics, social ties and psychological distress on healthy behaviours of Brazilian adults: The Pro-Saude cohort study

BACKGROUND

This study examined the influence of early life circumstances, family characteristics, social ties and psychological distress in adulthood on adult's health-related behaviours.

METHODS

A cohort study (Pro-Saúde Study) involving technical and administrative civil servants at university campuses in Rio de Janeiro State, Brazil was conducted in Rio de Janeiro, Brazil. Data from 2155 adults were collected at baseline (1999) and after a 13-year period (2012-13). Family characteristics at 12 years of age were assessed retrospectively in 1999. Gender, marital status, living situation, social support, social networks of relatives and psychological distress were also measured in 1999. Data collection in 2012-13 included information about marital status, social networks of relatives, cigarette smoking, fruit and vegetable consumption and physical exercise. A conceptual model testing the relationships between variables was assessed through structural equation modelling.

RESULTS

Female gender (β = 0.043), better social networks of relatives in 1999 (β = 0.053) and 2012-13 (β = 0.069) and low psychological distress (β = -0.048) directly predicted less smoking. Better social networks of relatives in 2012-13 was directly linked to higher consumption of fruits (β = 0.045) and vegetables (β = 0.051) and being physically active (β = 0.070). Low psychological distress directly predicted higher fruit consumption (β = -0.040). Family characteristics at 12 years-old, marital status and living with other people were linked indirectly with health behaviours through social networks, social support and psychological distress.

CONCLUSIONS

Adults with better early life family and social circumstances, and those who were married reported positive health behaviours through indirect pathways. Stronger social ties and lower psychological distress represented the pathways by which early life circumstances and relationship status influenced positive health behaviours.

Patterns of maternal adverse childhood experiences and the intergenerational association of preschool children's emotional and behavioral problems

Introduction

Children of whose mothers exposed to adverse childhood experiences (ACEs) are at increased risk for developmental problems. This study aims to investigate the relationship between types and patterns of maternal ACEs and preschool children's emotional and behavioral problems (EBPs) in China, and to explore gender differences associated with these problems.

Methods

In this cross-sectional study, we selected 9,647 children from 36 preschools in three cities of Anhui province, China. Questionnaires were used to report the details of maternal ACEs and children's EBPs. We used the latent class analysis (LCA) to identify "patterns" in the types of maternal ACEs. Binomial logistic regressions was performed to examine the relationship between types and patterns of maternal ACEs and preschoolers' EBPs.

Results

Latent class analysis (LCA) revealed four different classes of maternal ACEs. Logistic regression analysis showed that compared with the low ACEs class, children of mothers in the high abuse and neglect class had the highest risk of developing EBPs (OR = 5.93, 95%CI: 4.70-7.49), followed by moderate ACEs class (OR = 2.44, 95%CI: 1.98-3.00), and high household dysfunction class (OR = 2.16, 95%CI: 1.19-3.90). We found gender differences in the effects of high abuse and neglect/moderate ACEs class and maternal childhood physical abuse/neglect on children's EBPs, which had a stronger impact on EBPs in boys than girls (P<0.05).

Discussion

This study supports and refines existing research that confirms an intergenerational association between types and patterns of maternal ACEs and children's EBPs in a large Chinese sample, so as to provide references for the early prevention and control of children's EBPs.

Coping motives as a mediator of the relationship between child maltreatment and substance use problems in south African adolescents

BACKGROUND

Evidence suggests that adults with a history of child maltreatment (CM) engage in substance misuse driven by 'coping motives': maladaptive beliefs that substances help them cope with negative emotions. However, the specificity of this risk pathway is under-researched in younger and non-Western cohorts.

OBJECTIVE

The present study aimed to determine whether coping motives play a distinct role compared to other motives for substance use in mediating the relationship between CM and problematic alcohol and marijuana use in a sample of South African adolescents.

PARTICIPANTS AND SETTING

A sample of 688 high school students (M age = 15.03 years; 62.5 % female) in Cape Town, South Africa, completed a cross sectional survey.

METHODS

Participants completed self-report measures of CM exposure, motives for using alcohol and marijuana (coping, enhancement, social and conformity), and alcohol and marijuana related problems. Participants who endorsed using alcohol (N = 180) or marijuana (N = 136) were included in analysis. A parallel mediation model was conducted for each substance (alcohol and marijuana, respectively) to assess which motives mediated the relationship between CM exposure and substance-related problems.

RESULTS

CM exposure predicted both alcohol-and marijuana related problems. The relationship between CM exposure and alcohol-related problems was partially mediated by coping motives (p < .001, 95%CI 0.028, 0.115) and, to a lesser extent, conformity motives (p < .01, 95%CI 0.001, 0.041), but not by social motives or enhancement motives. The relationship between CM exposure and marijuana-related problems was partially mediated by coping motives (p < .001, 95%CI 0.004, 0.037), but not by conformity, social or enhancement motives.

CONCLUSIONS

The findings support the importance of coping motives as a mediator between CM and problematic substance use across different substances of abuse in South African adolescents, and the role of conformity motives in problematic alcohol use. Future research should explore whether these findings hold across other sociocultural contexts, and the utility of interventions to address coping motives for substance use in adolescence.

Treatment of type 2 diabetes and stress using neuro-emotional technique: case report

This case report presents a novel, non-pharmacological treatment of Type 2 Diabetes in a 46-year-old male, demonstrating improvements in blood chemistry and psychometric markers after 8 treatments using a Mind-Body Intervention (MBI) called Neuro-Emotional Technique (NET). The patient presented with a diagnosis of Type 2 Diabetes (T2D), pain, psychosocial indicators of stress and anxiety, and a score of 4 on the ACE-Q (Adverse Childhood Experiences Questionnaire) that is consistent with a predisposition to chronic disease and autoimmune disorders. Glucose levels for this patient were above normal levels (typically between 10-15mmol/L where optimal range is between 4-10mmol/L) for at least two months prior to the 4-week NET intervention period, despite the standard use of conventional antidiabetic medications (insulin injections). The patient exhibited numerous indictors of chronic stress that were hypothesised to be underlying his medical diagnosis and a series of 8 NET treatments over a period of 4 weeks was recommended. Psychometric tests and glucose measurements were recorded at baseline (prior to treatment), 4 weeks (at the conclusion of treatment) and at 8 weeks (4 weeks following the conclusion of treatment). Results show that glucose levels were reduced, and self-reported measures of depression, anxiety, stress, distress and pain all decreased from high and extreme levels to within normal ranges after 4 weeks, with ongoing improvement at 8 weeks. McEwen described the concept of allostatic load and the disruptive effects that cumulative stress can have on both mental and physical health. It is hypothesized that NET reduces allostatic load thereby fortifying homeostasis and the salutogenic stress response mechanisms involved in recovery from chronic illness, possibly via the Psycho-Immune-Neuroendocrine (PINE) network. Further studies with larger sample sizes are required to establish whether these results could be extrapolated to a wider population, however the results of this case suggest that it may be beneficial to consider co-management of T2D with an MBI such as NET.

Early adversity and prosocial behavior in adolescents from Bogotá: a cross-sectional study

BACKGROUND

The association between Adverse Childhood Experiences (ACEs), prosocial behavior, and depression (like other negative mental health outcomes) has not been thoroughly understood. This study aimed at evaluating their simultaneous association while controlling for key confounding variables.

METHODS

A cross-sectional study was carried-out with 2918 secondary school students from seven charter schools located in low-resourced neighborhoods in Bogota (Colombia), 54.12% were female, and mean age was 13.81 years. The self-report instrument included demographic variables, well-being, mental health, risk behaviors and symptoms of psychopathology. Assessment of ACEs was done by a series of yes/no questions, prosocial behavior was evaluated with the corresponding subscale in the Strengths and Difficulties Questionnaire, and depression was assessed with the Self-Reporting Questionnaire. Associations were tested using the Spearman correlation coefficient, Z tests and Chi-square tests, and all primary outcome analyses were adjusted for potential confounding variables through multivariate logistic regression using depression as outcome.

RESULTS

Mean exposure to ACEs was 3.15 events; those exposed to four or more obtained lower scores in well-being, satisfaction with life and family functioning, and higher scores in symptoms of psychopathology. For the prosocial behavior scores, 64.35% were classified as close to the average, 17.51% as slightly lowered, 11.91% as low, and 6.23% as very low; participants with higher levels of prosocial behavior showed lower scores in symptoms of psychopathology. While ACEs had a positive association with depressive symptoms (Odds Ratio [OR] 2.21, 95% confidence interval [CI] 1.67-2.94), prosocial behavior did not have a significant association with either ACEs or depressive symptoms in multivariate regression models.

CONCLUSIONS

Novel studies should further elucidate the developmental pathways involving positive and negative mental health constructs to better understand the actual effectiveness of interventions that use these constructs in their design.

Associations between adverse childhood experiences and pain in middle-aged and older adults: findings from the China Health and Retirement Longitudinal Study

OBJECTIVE

Adverse childhood experiences (ACEs) have been associated with a range of adverse health outcomes, with pain being potentially one of them. This population-based cross-sectional study aimed to investigate the associations between Adverse Childhood Experiences (ACEs) and pain in Chinese adults and evaluate whether physical activity and demographic and socioeconomic characteristics modify this associations.

METHODS

Cross-sectional data from the China Health and Retirement Longitudinal Study (CHARLS), were utilized in this study. A total of 9923 respondents with information on 12 ACE indicators and 15 self-reported body pains were included. Logistic regression models were used to assess associations of the ACEs and pain. Modification of the associations by physical activity, demographic and socioeconomic characteristics was assessed by stratified analyses and tests for interaction.

RESULTS

Among the 9923 individuals included in the primary analyses, 5098 (51.4%) males and the mean (SD) age was 61.18 (10·.44) years. Compared with individuals with 0 ACEs, those who with ≥ 5 ACEs had increased risk of single pains and multiple pain. A dose-response association was found between the number of ACEs and the risk of pain (e.g. neck pain for ≥ 5 ACEs vs. none: OR, 1.107; 95% CI, 0.903-1.356; p < 0.001 for trend). In the associations of each body pain with each ACE indicator, most ACE indicators were associated with an increased risk of pain. In addition, physical activity, sociodemographic and socioeconomic characteristics, such as age, sex, educational level, area of residence, childhood economic hardship, did not demonstrate a significant modify on the associations between ACEs and pain.

CONCLUSIONS

These findings indicate that cumulative ACE exposure is associated with increased odds of self-reported pain in Chinese adults, regardless of adult physical activity, sociodemographic and socioeconomic characteristics.

Role of the Sibling Relationship to Reduce the Negative Impact of Adverse Childhood Experiences (ACEs) on Wellbeing in Adulthood

Over the past two decades, public health research has demonstrated that Adverse Childhood Experiences (ACEs) are associated with significant and prolonged physical and mental health problems, demanding investigation into the factors that may mitigate the poor outcomes. One potential factor that may attenuate the negative impact of ACEs on individuals' health is social support. An important source of social support, both during and after adverse childhood experiences, is sibling relationships. Consequently, the purpose of the current study was to examine if two components of sibling relationships-perceived warmth and conflict-affect the relationship between ACEs and wellbeing in adulthood. A total of 439 participants (Mage = 35.06, SD = 11.19) completed self-report measures of their ACEs, their perceived warmth and conflict with a living sibling, and their wellbeing. Results revealed that sibling relationships characterized by higher perceived warmth-and, interestingly, higher perceived conflict-attenuated the negative impact of ACEs on wellbeing in adulthood. Findings from the current study provide valuable information about how psychologist, social workers, and other health professionals may use siblings as a source of social support to mitigate the negative effects of ACEs on wellbeing in adulthood.

Bullying Victimization and Adverse Childhood Experiences: Retrospective Reports of Relative Impact on Emotional Distress

The literature suggests that there is a significant overlap in definition, measurement, and outcomes between trauma and bullying victimization, but the relative impact on current emotional distress of these events has not been explored. The goal of the current study was to explore whether traditional and cyber bullying victimization has a similar negative impact on current emotional disrtresss as other adverse childhood experiences which may also lead to a traumatic response. In addition, this study examined whether the association between bullying victimization and emotional distress is exacerbated when individuals also experience additional ACEs. Retrospective reports from a diverse sample of 576 adults were collected via an online survey. When ranked against other ACEs such as viewing family mental health problems or substance abuse, or verbal, physical, emotional, and sexual victimization not from peers, nearly 30% of participants ranked bullying victimization as having the most negative impact on their levels of emotional distress. Multi-group path analyses indicated that experiencing additional ACEs seems to exacerbate distress caused by bullying and cyber bullying victimization. The current study suggests that bullying victimization may be just as detrimental as other types of ACEs that occur in childhood.

Adverse childhood experiences among people with schizophrenia at comprehensive specialized hospitals in Bahir Dar, Ethiopia: a comparative study

Background

People who have encountered adverse childhood experiences (ACEs) are predisposed to developing schizophrenia, experiencing exacerbated symptoms, and facing an elevated risk of disease relapse. It is imperative to evaluate the prevalence of ACEs to comprehend the specific attributes of this condition and enable the implementation of suitable interventions.

Aims

The aim of this study was to assess the prevalence of ACEs and its determinants among people with schizophrenia and the patient attendants in Bahir Dar, Ethiopia.

Method

A comparative cross-sectional study was carried out at the Comprehensive Specialized Hospitals in Bahir Dar, Ethiopia, from April 26 to June 10, 2023. A total of 291 individuals with schizophrenia and 293 individuals from the patient attendants were selected using a systematic random sampling method. A proportional odds model ordinal logistic regression analysis was used to identify the factors associated with ACEs.

Results

The occurrence of at least one ACE among individuals diagnosed with schizophrenia was 69.4%, while patient attendants had a 46.8%, as indicated by the Chi-square test, which showed a significant difference at p <0.05. The study findings indicated that individuals with schizophrenia who have encountered four or more ACEs are more inclined to have lower educational attainment (AOR: 4.69 [1.94 - 11.61]), low resilient coping mechanisms (AOR: 2.07 [1.11 - 3.90]), and poor social support (AOR: 3.93 [2.13 - 7.32]). Conversely, factors such as rural residency, illiteracy, and heightened attachment-related anxiety were found to be notably associated with the patient attendants.

Conclusion

In this study, the substantial prevalence of ACEs emphasized the necessity for ACE screening and the implementation of evidence-based interventions to address and alleviate the overall burden of ACEs.

Prevalence of adverse childhood experiences and their cumulative impact associated lifetime health outcomes in the Emirate of Abu-Dhabi, United Arab Emirates

BACKGROUND

Adverse Childhood Experiences have been associated with poor health outcomes later in life.

OBJECTIVE

The objective of the study was to determine the relationship between cumulative ACEs, risky health behaviors, chronic diseases, and mental health among a large-scale sample from the Emirate of Abu Dhabi.

PARTICIPANTS AND SETTING

A retrospective cross-sectional study was performed with 922 participants over the age of 18, living in Abu Dhabi.

METHODS

The Adverse Childhood Experiences International Questionnaire (ACE-IQ) was used to assess ACEs, alongside a survey of adult health outcomes, mental health outcomes, and risk-taking behaviors.

RESULTS

Logistic regression models examined the association between retrospective ACEs and these outcomes. The respondents reported an average of 1.74 ACEs. The most prevalent ACEs were household violence, parental death or divorce, and community violence. The accumulation of ACEs significantly predicts increases in the risk of a variety of adult-onset health morbidities, all measured mental health morbidities, and all measured risk-taking behaviors, with evidence of thresholds of ACE accumulation dictating risk.

CONCLUSIONS

The baseline presence of ACEs among this Abu Dhabi sample, along with the associated risks of physical and mental health morbidities, and risk-taking behaviors play a significant role in understanding the extent, nature, and associated sequalae of ACEs in this population; providing nuanced context for early intervention. Our findings will inform the planning and implementation of specific prevention and awareness raising programs while promoting safe environments where children are healthy and can thrive.

Adverse childhood experiences and smoking status in children: A systematic review and meta‐analysis

Adverse childhood experiences are a factor that can have a broad impact on different dimensions of health in different eras. This research aimed to investigate the relationship between adverse childhood experiences and smoking in children through a systematic review and meta‐analysis. Three databases, including PubMed, Web of Science and Scopus, were selected for manuscript searches. These three databases were searched until July 2022. This search was limited to English. For this study, the odds ratio or risk ratio and 95% confidence interval were extracted. The odds ratio pool was performed using the random‐effects method reported. An analysis was done based on the types of adverse childhood experiences and an analysis based on sex. The year of publication of the earliest and last publication included in this analysis was, respectively, 2003 and 2022. After screening the manuscripts, finally, 39 studies remained for this study. Adverse childhood experiences are associated with an increased risk of smoking in children [odds ratio 1.69; CI = 1.55–1.85; z = 11.80; p < 0.001; I2 = 92.6%]. Components of adverse childhood experiences, including emotional abuse, emotional neglect, physical abuse, physical maltreatment and physical neglect, were associated with increased smoking. The present study showed that adverse childhood experiences provide a context that increases the possibility of smoking in children. It is necessary to pay attention to the dimensions of health and behaviour in this group.

Outcomes of adverse childhood experience during late adolescence: Evidence from college and community samples

Scant studies have investigated adverse childhood experience (ACE) outcomes and mastery during adolescence in different cultural contexts. This cross-sectional study examines the impact of ACEs on subjective well-being, health complaints, and healthcare utilization during late adolescence, including the mediating role of the sense of mastery in the Saudi context. Adolescents (N = 396) aged 17-21 years were recruited via convenience sampling from colleges and local communities from two regions in Saudi Arabia. Data were collected using a paper-pencil anonymous survey and analyzed using path analysis. Of the sample, 85.5% experienced at least one ACE. ACEs had a direct effect on subjective well-being (p = 0.034), health complaints (p < 0.001), healthcare utilization (p < 0.001), and sense of mastery (p < 0.001). Sense of mastery had an effect on subjective well-being (p < 0.001) and health complaints (p < 0.001), but not on healthcare utilization (p = 0.436). Sense of mastery partially mediated the relationship between ACEs and subjective well-being (p = 0.034) and health complaints (p < 0.001), but not healthcare utilization (p = 0.438). ACEs have detrimental effects on adolescent health. Attention should be paid to primary prevention and early detection to avoid further harm, and interventions that address the role of the sense of mastery should be developed for adolescents.

Adverse Childhood Experiences and Associations with Mental Health, Substance Use, and Violence Perpetration among Young Adults in sub-Saharan Africa

Background

Adverse childhood experiences (ACEs) can have debilitating effects on child well-being, with consequences persisting into adulthood. Most ACE studies have been conducted in high-income countries and show a graded relationship between multiple ACE exposures and adverse health outcomes. Less is known about the types and burden of ACEs in sub-Saharan Africa (SSA).

Objective

To estimate the pooled prevalence of six individual and cumulative ACE exposures (physical, sexual, and emotional violence; orphanhood; witnessing interparental and community violence) and assess their association with mental health outcomes, substance use, and violence perpetration among young adults in SSA.

Participants and setting

Aggregate data from the Violence Against Children and Youth Survey (VACS) in Cote d'Ivoire 2018, Kenya 2019, Lesotho 2018, Mozambique 2019, and Namibia 2019 included a sample of 11,498 young adults aged 18-24 years.

Methods

Cumulative ACEs were defined by an integer count of the total number of individual ACEs (0 to 6). Weighted prevalence and adjusted odds ratios were estimated.

Result

ACEs prevalence ranged from 7.8% (emotional violence) to 55.0% (witnessing community violence). Strong graded relationships between cumulative ACE exposure and all study outcomes for both males and females were observed. Among females, witnessing interparental violence was the only individual ACE risk factor significantly associated with increased odds of substance use; among males, emotional violence was significantly associated with all outcomes.

Conclusion

ACEs are associated with adverse mental health, substance use, and violence perpetration in SSA. Gender-specific and culturally sensitive intervention strategies are needed to effectively mitigate ACEs in this population.

Partitioning the Composition of Adverse Childhood Experiences From Accumulated Adversity: Cross-Sectional Evidence From 2 U.S. Samples

Introduction

Adverse childhood experiences are linked to adult morbidity and mortality. However, it is unknown whether the patterning of adverse childhood experiences, individually and in combination, confer health risk distinct from that of a cumulative adversity score. This study evaluates whether individual and comorbid adverse childhood experience exposures within a cumulative risk score are equally associated with current smoking and lifetime history of depression.

Methods

Cross-sectional analysis of adverse childhood experience assessments in the Behavioral Risk Factor Surveillance System from 21 states in 2019 (n=115,183) and 23 states in 2020 (n=120,416) was performed. We modeled cumulative adverse childhood experience scores and the 5 most common distinct adverse childhood experience components that compose a given adverse childhood experience score, up to a cumulative score of 4. We compared adverse childhood experience components, adjusting for covariates.

Results

Across both samples, 23% and 57%-58% of persons reported 1 adverse childhood experience and 2 or more adverse childhood experiences, respectively. In 2019 smoking prevalence was 10.4% for persons reporting zero adverse childhood experiences and 14.2% for persons reporting 1 adverse childhood experience. When the single adverse childhood experience was experiencing parental divorce, smoking was higher (16.6%) than when the single adverse childhood experience was verbal abuse (11.8%) or living with a mentally ill household member (9.5%). Lifetime depression prevalence was 9.6% and 14.1% across zero and 1 adverse childhood experience, respectively, whereas it was 26.6% if the single adverse childhood experience was living with a mentally ill household member and 11.0% when the adverse childhood experience was experiencing parental divorce. This heterogeneity was replicated in 2020 data. Additional heterogeneity was observed for higher cumulative adverse childhood experience scores.

Conclusions

Cumulative adverse childhood experience scores mask substantial health risk heterogeneity, which can be delineated by examining distinct components of cumulative adverse childhood experience scores.