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Fitzgerald M, Hall H. Does it add up? Educational achievement mediates child maltreatment subtypes to allostatic load. CHILD ABUSE & NEGLECT 2024; 149:106630. [PMID: 38301586 DOI: 10.1016/j.chiabu.2023.106630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 12/05/2023] [Accepted: 12/31/2023] [Indexed: 02/03/2024]
Abstract
BACKGROUND Childhood maltreatment (CM) has been linked to higher levels of allostatic load (AL) and educational achievement is a possible pathway and may differ across gender. It is also critical to determine if CM severity or specific subtypes of CM are more or less influential. OBJECTIVE This study examined educational achievement as a mediator linking cumulative and individual types of CM to AL and examined gender as a moderator. PARTICIPANTS AND SETTING Using two waves of data, 897 adults from the study Midlife in the United States were analyzed. METHODS Multiple group structural equation models stratified across gender to test were used cumulative maltreatment and maltreatment subtypes to AL and test gender as a moderator. RESULTS Overall CM was associated with educational achievement (β = -0.12, p < .01) and AL (β = 0.11, p < .05) and education was inversely associated with AL (β = -0.17, p < .001) in men but not women. The subtypes model revealed that physical abuse predicted lower level of education achievement (β = -0.20, p < .001) and among men. Educational achievement, in turn, was associated with lower levels of AL (β = -0.02, p = .002). Educational achievement was a possible pathway linking physical abuse to AL (β = 0.02, 95 % CI [0.001, 0.040]) among men but was non-significant in women. Gender did not moderate any of the pathways. CONCLUSIONS Educational achievement is a potentially modifiable social determinant of health that can be a focus of prevention and intervention efforts among men who were maltreated, particularly for those who experienced physical abuse.
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Affiliation(s)
- Michael Fitzgerald
- 337 Nancy Randolph Davis, Oklahoma State University, Stillwater, OK 74078, USA.
| | - Haley Hall
- 337 Nancy Randolph Davis, Oklahoma State University, Stillwater, OK 74078, USA.
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Dodge KA. How a defensive mindset develops from early adverse experiences and guides antisocial outcomes. Dev Psychopathol 2024:1-7. [PMID: 38426350 DOI: 10.1017/s0954579424000348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
Dante Cicchetti has had a lasting impact on our understanding of the development of externalizing psychopathology through at least two seminal contributions, including establishment of the field of developmental psychopathology and assertion of the hypothesis that early physical abuse and neglect trigger a cascade of maladaptive outcomes across the life course. These ideas have guided a program of research on children's deviant social information processing and defensive mindset as the psychological mechanisms through which early physical abuse leads to long-term psychopathology. Longitudinal studies following children from early life through mid-adulthood show that physical abuse in the first five years of life leads children to adopt a defensive mindset that, in turn, cascades into long-term outcomes of externalizing psychopathology, incarceration, and dysfunction. Cicchetti's ideas have also guided the development of preventive interventions to interrupt this life course.
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Yeo G, Lansford JE, Hirshberg MJ, Tong EMW. Associations of childhood adversity with emotional well-being and educational achievement: A review and meta-analysis. J Affect Disord 2024; 347:387-398. [PMID: 38000469 DOI: 10.1016/j.jad.2023.11.083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 11/18/2023] [Accepted: 11/20/2023] [Indexed: 11/26/2023]
Abstract
BACKGROUND Profound negative implications of adverse childhood experiences (ACEs) have raised public health concern worldwide. METHOD This systematic review and meta-analysis examined associations of three types of ACEs (abuse, neglect, and household dysfunctions) with experiential (emotional quality of momentary and everyday experiences) and reflective (judgments about life satisfaction, sense of meaning, and ability to pursue goals that can include and extend beyond the self) facets of emotional well-being (EWB) and educational achievement. The systematic review yielded 100 studies with 176 effect sizes that met criteria for inclusion in the meta-analysis. RESULTS ACEs were related particularly strongly to lower EWB, r = -0.32, p < .001; [95 % CI: -0.44 to 0.01], but also to lower educational achievement, r = -0.18, p < .001; [95 % CI: -0.21 to -0.05]. Associations were stronger for abuse and composite indicators of ACEs than for household dysfunctions. Associations of ACEs with EWB and educational achievement were stronger in childhood and adolescence than in emerging or later adulthood. Associations did not differ for males and females or for Eastern versus Western cultural groups. Analyses provided evidence for the causal role of ACEs in the development of lower EWB and academic achievement as well as their reciprocal associations. LIMITATIONS There is no standard conceptualization of well-being and studies are not always clear about the types of ACEs examined, with limited research on educational achievement. CONCLUSION Findings have important implications for mental health professionals, policy makers and social service agencies in developing resources and intervention services that target ACEs to protect individuals and promote well-being and academic achievement.
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Affiliation(s)
- GeckHong Yeo
- Social Service Research Center, National University of Singapore, Singapore.
| | | | | | - Eddie M W Tong
- Social Service Research Center, National University of Singapore, Singapore
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Yu RA, Goulter N, Godwin JW, McMahon RJ. Child and Adolescent Psychopathology and Subsequent Harmful Behaviors Associated with Premature Mortality: A Selective Review and Future Directions. Clin Child Fam Psychol Rev 2023; 26:1008-1024. [PMID: 37819404 DOI: 10.1007/s10567-023-00459-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2023] [Indexed: 10/13/2023]
Abstract
In the United States (U.S.), premature mortality in adulthood from suicide, alcohol-related disease, and substance overdoses has increased steadily over the past two decades. To better understand these trends, it is necessary to first examine the harmful behaviors that often precede these preventable deaths (i.e., suicidal ideation and attempts, and harmful alcohol and substance use). Representing critical developmental periods in which psychopathology is most likely to emerge, childhood and adolescence provide an informative lens through which to investigate susceptibility to harmful behaviors. This article synthesizes current evidence describing these rising U.S. mortality rates and the prevalence rates of harmful behaviors linked to these types of mortality. A brief selective review of longitudinal research on harmful behaviors in relation to the most relevant categories of child and adolescent psychopathology is then provided. Finally, recommendations for future research and implications for prevention are discussed.
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Affiliation(s)
- Rachelle A Yu
- Simon Fraser University and B.C. Children's Hospital, Burnaby, Canada.
| | | | | | - Robert J McMahon
- Simon Fraser University and B.C. Children's Hospital, Burnaby, Canada
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Zhao M, He X, Li T, Shao H, Huo Q, Li Y. Early-Life Factors and Multimorbidity Risk Later in Older Age: Evidence Based on CHARLS. Gerontology 2023; 69:1347-1357. [PMID: 37725916 DOI: 10.1159/000532060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 07/17/2023] [Indexed: 09/21/2023] Open
Abstract
INTRODUCTION Early-life factors were reported to exert influence on the health condition of individuals in the long-term. However, limited research explored the connection between early-life factors and multimorbidity in later years. METHODS We utilized the data from the China Health and Retirement Longitudinal Study to assess this possible association in the present cross-sectional study. Multimorbidity was determined based on 14 common chronic diseases included in the study. Logistic regression was employed to examine the link between early-life factors and subsequent multimorbidity. RESULTS Out of 7,578 participants who met the inclusion criteria for analysis, 3,765 (49.68%) were females. The mean age was 68.25 ± 6.70 years. Participants who rated their health during childhood as average (odds ratio [OR] 0.78, 95% confidence interval [CI] 0.63-0.96) or better [OR 0.72, 95% CI 0.57-0.91] were significantly less likely to experience multimorbidity in older life. By contrast, experiencing violence from two of the family members was significantly associated with future multimorbidity (OR [95% CI], 1.29 [1.04-1.60]). A superior family financial situation was also negatively associated with multimorbidity, with average (OR [95% CI], 0.72 [0.63-0.83]) and better off than average (OR [95% CI], 0.76 [0.62-0.93]). DISCUSSION Individuals with poor health status, inferior family socioeconomic status, or experienced violence from family members in childhood were more likely to suffer from multimorbidity in later life. Enhanced social monitoring of potentially adverse conditions in youngsters and targeted interventions could help mitigate the progression of multimorbidity in later life.
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Affiliation(s)
- Minjun Zhao
- Department of Geriatrics, The First People's Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China,
| | - Xu He
- Department of Geriatrics, The First People's Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
| | - Tianrong Li
- Department of Geriatrics, The First People's Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
| | - Heng Shao
- Department of Geriatrics, The First People's Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
| | - Qian Huo
- Department of Geriatrics, The First People's Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
| | - Yan Li
- Department of Geriatrics, The First People's Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
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Baba K, Kataoka Y. An E-Learning Program for Continuing Midwifery Education on Handling High-Risk Abuse Cases: A Pretest-Posttest Design. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6317. [PMID: 37444164 PMCID: PMC10341969 DOI: 10.3390/ijerph20136317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 06/07/2023] [Accepted: 07/06/2023] [Indexed: 07/15/2023]
Abstract
It is essential to equip midwives and nurses working in the perinatal period with comprehensive knowledge and awareness regarding child abuse prevention. However, most midwives and nurses in Japan do not have the opportunity to learn about abuse prevention during their basic education. We aimed to develop an e-learning program to assist obstetric midwives and nurses in acquiring the knowledge needed to provide support and handle cases with a high risk of abuse, as well as to assess the program's usefulness. This study employed a single-group pre-post design; e-learning served as the intervention. Seventy-one obstetric midwives and nurses were recruited. The program's usefulness was the difference between the participants' pretest and post-test knowledge and efficacy scores. The score data were analyzed using the t-test. A paired t-test revealed that the post-test scores of knowledge and efficacy were significantly higher than those of the pretest, with a large effect size (d = 1.71). Platforms where basic knowledge on how to respond to high-risk abuse cases are lacking in nursing education; thus, this e-learning program is recommended for nurses working in the perinatal field throughout Japan. This educational opportunity for perinatal midwives and nurses will increase awareness and contribute to abuse prevention.
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Affiliation(s)
- Kaori Baba
- Research Center for Social Science & Medicine, Tokyo Metropolitan Institute of Medical Science, Tokyo 156-8506, Japan
| | - Yaeko Kataoka
- Graduate School of Nursing Science, St Luke’s International University, Tokyo 104-0044, Japan;
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Walper S, Ulrich SM, Kindler H. [Family stressors on young children's emotional development]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2023:10.1007/s00103-023-03730-3. [PMID: 37402949 DOI: 10.1007/s00103-023-03730-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 05/26/2023] [Indexed: 07/06/2023]
Abstract
BACKGROUND Adverse childhood experiences (ACE) have been pointed out as risk factors for physical and mental health, with consequences extending from childhood into adulthood. Based on research regarding the effects of selected ACE as well as the accumulation of ACE, this article investigates how different types of family stressors are linked to children's negative emotionality in infancy and early childhood. METHODS Data are from the KiD 0-3 study (N = 5583) and the follow-up of a subsample after 2 years (n = 681). Based on 14 stress factors, we distinguish families with no/little stressors, socioeconomic stressors, parenting stressors, and multiple stressors. RESULTS Children in multiply stressed families have the highest risk of high negative emotionality (compared to unstressed families: Odds Ratios [OR] ranging from 13.00 to 6.81), controlling for demographic characteristics, child-related stress factors (e.g., excessive crying), and caregiver childhood stress. Children in families primarily characterized by parenting stress also showed a significantly increased risk of high negative emotionality (OR ranging from 8.31 to 6.95), whereas this did not hold for children from socioeconomically stressed families (without parenting stress) compared to those from unstressed families. Longitudinal analyses of the follow-up subsample showed that changes in the number of stressors were also associated with parallel changes in children's negative emotionality. DISCUSSION These results confirm findings from international research on ACE in Germany and for early childhood. They underline the importance of a well-developed early intervention system.
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Affiliation(s)
- Sabine Walper
- Deutsches Jugendinstitut, Nockherstr. 2, 81541, München, Deutschland.
| | - Susanne M Ulrich
- Deutsches Jugendinstitut, Nockherstr. 2, 81541, München, Deutschland
| | - Heinz Kindler
- Deutsches Jugendinstitut, Nockherstr. 2, 81541, München, Deutschland
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Infant Stimulation Induced a Rapid Increase in Maternal Salivary Oxytocin. Brain Sci 2022; 12:brainsci12091246. [PMID: 36138982 PMCID: PMC9497188 DOI: 10.3390/brainsci12091246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 09/07/2022] [Accepted: 09/09/2022] [Indexed: 11/16/2022] Open
Abstract
Oxytocin (OT) is a neuropeptide involved in human social behaviors and reproduction. Non-invasive OT levels in saliva have recently roused interest as it does not require a specialized medical setting. Here, we observed one woman’s basal serum and saliva OT from pregnancy to 1 year postpartum to track OT concentration changes over this period. We examined the changes in salivary OT levels over time in response to maternal physiological and behavioral responses. The fluctuation of saliva OT levels is well correlated with serum OT during pregnancy and breastfeeding. However, while salivary OT increased rapidly during direct interaction (social interaction tests) with the infant and/or when the mother was watching her own infant’s video (video tests), no increase was observed in serum. We used social interaction and video tests on a group of mothers (nine mothers for social interaction and six for the video test) to clarify these single-subject results. In both tests, the mothers had increased OT in their saliva but not serum. Our study may suggest that salivary samples reflect not only the physical but also the emotional state and that saliva samples may be useful for monitoring women’s OT levels during pre- and postpartum periods. Further studies with larger sample numbers are necessary to confirm the rapid changes in salivary OT levels in response to maternal physiological and behavioral responses.
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Masiano SP, Yu X, Tembo T, Wetzel E, Mphande M, Khama I, Mkandawire A, Chitani M, Liwimbi O, Udedi M, Mazenga A, Nyasulu P, Abrams E, Ahmed S, Kim MH. The relationship between adverse childhood experiences and common mental disorders among pregnant women living with HIV in Malawi. J Affect Disord 2022; 312:159-168. [PMID: 35752220 PMCID: PMC9892657 DOI: 10.1016/j.jad.2022.06.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 05/28/2022] [Accepted: 06/16/2022] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Adverse childhood experiences (ACEs) have been linked to common mental disorders (CMDs) such as anxiety and depressive thoughts. We examined the prevalence of ACEs and their association with CMDs among pregnant women living with HIV (PWLHIV) in Malawi-an HIV endemic resource-limited setting. METHODS This is a cross-sectional study of 798 PWLHIV enrolled in the VITAL Start trial in Malawi (10/2018 to 06/2021) (NCT03654898). ACE histories were assessed using WHO's Adverse Childhood Experiences International Questionnaire (ACE-IQ) tool. Depressive symptoms (somatic complaints, reduced vital energy, anxiety, and depressive thoughts) were assessed using WHO's Self Reporting Questionnaire 20-Item (SRQ-20) tool. Log-binomial regressions were used to examine the association between cumulative ACEs and each depressive symptom, as well as identify ACEs driving this association. RESULTS The mean age of our sample was 27.5 years. Over 95 % reported having experienced ≥1 ACE. On average, each participant reported four ACEs; 11 % reported sexual abuse. About 52 % and 44 % reported anxiety and depressive thoughts, respectively. In regressions, cumulative ACE scores were significantly associated with depressive symptoms-even after adjusting for multiple testing. This association was primarily driven by reports of sexual abuse. LIMITATIONS Data on maternal ACEs were self-reported and could suffer from measurement error because of recall bias. CONCLUSIONS ACEs are widespread and have a graded relationship with depressive symptoms in motherhood. Sexual abuse was found to be a primary driver of this association. Earlier recognition of ACEs and provision of trauma-informed interventions to improve care in PWLHIV may reduce negative mental health sequelae.
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Affiliation(s)
- Steven P Masiano
- Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi; Healthcare Delivery and Implementation Science Center, Cleveland Clinic, Cleveland, OH, USA; Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA.
| | - Xiaoying Yu
- Department of Biostatistics & Data Science, School of Public Health and Population Health, University of Texas Medical Branch, Galveston, TX, USA
| | - Tapiwa Tembo
- Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi
| | - Elizabeth Wetzel
- Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi; Baylor International Pediatric AIDS Initiative at Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Mtisunge Mphande
- Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi
| | - Innocent Khama
- Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi
| | - Angella Mkandawire
- Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi
| | - Mike Chitani
- Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi
| | - Olive Liwimbi
- Ministry of Health, Zomba Mental Hospital, Zomba, Malawi
| | - Michael Udedi
- Ministry of Health, NCDs and Mental Health Unit, Lilongwe, Malawi; University of North Carolina at Chapel Hill, Department of Epidemiology, Chapel Hill, NC, USA
| | - Alick Mazenga
- Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi
| | - Phoebe Nyasulu
- Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi
| | - Elaine Abrams
- ICAP at Columbia University, Mailman School of Public Health, Columbia University, New York, NY, USA; Department of Pediatrics, Vagelos College of Physicians & Surgeons, Columbia University, New York, NY, USA
| | - Saeed Ahmed
- Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi; Baylor International Pediatric AIDS Initiative at Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Maria H Kim
- Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi; Baylor International Pediatric AIDS Initiative at Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
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Keeshin BR, Monson E. Assessing and Responding to the Trauma of Child Maltreatment. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2022; 20:176-183. [PMID: 37153127 PMCID: PMC10153498 DOI: 10.1176/appi.focus.20210033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Child maltreatment is a significant risk factor for severe psychiatric outcomes in childhood and contributes to problematic symptoms that direct parents, teachers, or other invested parties to seek psychiatric intervention. With ongoing workforce shortages, much of the pediatric psychiatric care to this population is delivered by generalists. Child maltreatment and trauma can critically alter a child's development trajectory, affecting potential success in school and other important life pursuits. In addition, child maltreatment and resultant traumatic stress can dramatically disrupt child and adolescent development of healthy emotional regulation, distress tolerance, and the ability to form effective interpersonal relationships. Such disruption can lead to presentations within children and adolescents that mimic other symptoms of psychopathology but that typically respond poorly to traditional psychopharmacology. Ineffective treatment trials can lead to increased risk of polypharmacy and inaccurate expectations for treatment benefits. Such treatment efforts may impede addressing important environmental contributors and delay indicated therapeutic strategies. This article seeks to review child maltreatment-including core features and prevalence, overlap of child maltreatment with adverse childhood experiences, developmental impacts of exposure and resultant traumatic stress, guidance for appropriate assessment, and evidence-based interventions-and provide basic deprescribing guidelines to reduce polypharmacy burden.
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Affiliation(s)
- Brooks R Keeshin
- Department of Pediatrics (Keeshin) and Department of Psychiatry (Monson), Huntsman Mental Health Institute, University of Utah, Salt Lake City
| | - Eric Monson
- Department of Pediatrics (Keeshin) and Department of Psychiatry (Monson), Huntsman Mental Health Institute, University of Utah, Salt Lake City
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Cubillo A. Neurobiological correlates of the social and emotional impact of peer victimization: A review. Front Psychiatry 2022; 13:866926. [PMID: 35978845 PMCID: PMC9376443 DOI: 10.3389/fpsyt.2022.866926] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 07/12/2022] [Indexed: 12/21/2022] Open
Abstract
Peer victimization is very common during late childhood and adolescence. Despite the relatively reduced number of studies, the neurobiological underpinnings of the negative impact of peer victimization experiences have received increasing attention in recent years. The present selective review summarizes the most recent available evidence and provides a general overview of the impact of peer victimization experiences on social processing and decision-making at the neurobiological level, highlighting the most pressing areas requiring further research. Three key cognitive areas show a clear negative impact of peer victimization and bullying experiences: social valuation processing, reward and reinforcement learning and self-regulation processes. Victims show enhanced activation in key regions of the limbic system including the amygdala, rostral and dorsal anterior cingulate cortices, suggestive of enhanced sensitivity to social stimuli. They also show enhanced recruitment of lateral prefrontal regions crucially involved in cognitive and emotional regulation processes, and abnormal reward-related striatal function. The presence of psychopathology is a complex factor, increased as a consequence of peer victimization, but that also constitutes vulnerability to such experiences.
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Affiliation(s)
- Ana Cubillo
- Jacobs Center for Productive Youth Development, Zurich Center for Neuroeconomics, University of Zürich, Zurich, Switzerland.,Department of Child and Adolescent Psychiatry, University Psychiatric Clinic Basel, Basel, Switzerland
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Singh TK, Khan M, Tansley G, Chan H, Brubacher JR, Staples JA. Neighborhood Socioeconomic Deprivation and Youth Assault Injuries in Vancouver, Canada. J Pediatr 2022; 240:199-205.e13. [PMID: 34480918 DOI: 10.1016/j.jpeds.2021.08.073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 07/12/2021] [Accepted: 08/05/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To examine the degree to which neighborhood socioeconomic deprivation influences the risk of youth assault injury. STUDY DESIGN Population-based retrospective study of youth aged 10-24 years seeking emergency medical care between 2012 and 2019 at 14 hospitals in Vancouver, Canada. Neighborhood material and social deprivation were examined as independent predictors of assault injury, accounting for spatial autocorrelation and controlling for neighborhood drinking establishment density. RESULTS Our data included 4166 assault injuries among 3817 youth. Male sex, substance use, and mental health disorders were common among victims of assault. Relative to the least deprived quintile of neighborhoods, assault injury risk was 2-fold higher in the most materially deprived quintile of neighborhoods (incidence rate ratio per quintile increase, 1.17; 95% CI 1.06-1.30; P < .05), and risk in the most socially deprived quintile was more than 3-fold greater than in the least deprived quintile (incidence rate ratio per quintile increase, 1.35; 95% CI 1.21-1.50; P < .001). Assault risk was 147-fold greater between 2 and 3 AM on Saturday relative to the safest hours of the week. CONCLUSIONS Neighborhood socioeconomic deprivation substantially increases the risk of youth assault injury. Youth violence prevention efforts should target socioeconomically deprived neighborhoods.
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Affiliation(s)
- Tanjot K Singh
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mayesha Khan
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Gavin Tansley
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Herbert Chan
- Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jeffrey R Brubacher
- Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Centre for Clinical Epidemiology & Evaluation, Vancouver, British Columbia, Canada
| | - John A Staples
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Centre for Clinical Epidemiology & Evaluation, Vancouver, British Columbia, Canada.
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Herrenkohl TI, Fedina L, Hong SH, Lee JO, Saba S. Associations between prospective and retrospective measures of child abuse and self-reported adult health at midlife. CHILD ABUSE & NEGLECT 2021; 120:105203. [PMID: 34280710 PMCID: PMC9851424 DOI: 10.1016/j.chiabu.2021.105203] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 06/28/2021] [Accepted: 07/03/2021] [Indexed: 06/07/2023]
Abstract
BACKGROUND The long-term health effects of physical child abuse are well documented in self-report, retrospective studies. However, there have been few longitudinal, multimethod studies on physiological responses to stress and the onset of chronic disease, thereby slowing the advancement of prevention and intervention programs. OBJECTIVES This study used survey data from an extended longitudinal study to examine prospective and retrospective associations between measures of physical child abuse and adult health in the 40s. PARTICIPANTS AND SETTING Data are from an ongoing longitudinal study of the correlates and consequences of child maltreatment that began in the 1970s with a sample of 457 children. METHODS Bivariate correlations and multiple regression models with covariates were used to assess associations between measures of physical child abuse and outcomes of self-reported health in adulthood. RESULTS Physical child abuse, measured retrospectively, was moderately related to reports of overall health, as well as a number of adult health problems and conditions, such as back and chest pain, hypertension, and certain forms of cancer. Associations were also observed for lifetime alcohol problems and past-year doctor and emergency room visits. Fewer associations between prospective parent self-report measures of physical child abuse and adult health were identified, although child welfare (official record) reports performed similarly to retrospective measures. CONCLUSIONS This study adds important information on the long-term health effects of child physical abuse, as well as measurement differences in the prediction of adult health outcomes. Conclusions drawn from prospective and retrospective studies of abuse are at best inconsistent, and possibly incompatible.
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Affiliation(s)
- Todd I Herrenkohl
- University of Michigan School of Social Work, United States of America.
| | - Lisa Fedina
- University of Michigan School of Social Work, United States of America
| | - Sunghyun H Hong
- University of Michigan School of Social Work, United States of America
| | - Jungeun Olivia Lee
- University of Southern California Suzanne Dworak-Peck School of Social Work, United States of America
| | - Shaddy Saba
- University of Southern California Suzanne Dworak-Peck School of Social Work, United States of America
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Hansen J, Terreros A, Sherman A, Donaldson A, Anderst J. A System-Wide Hospital Child Maltreatment Patient Safety Program. Pediatrics 2021; 148:peds.2021-050555. [PMID: 34426531 DOI: 10.1542/peds.2021-050555] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/13/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Hospital-wide patient safety programs have been used to ensure appropriate provision of care. Similar approaches have not been widely applied to child maltreatment. In this study, we describe a hospital-system child maltreatment safety program by characterizing the frequency of patients needing further intervention, associations between the age of patient and location of care and need for further intervention, and patients who require immediate intervention. METHODS For all staff concerns for child maltreatment, a social worker completed a patient at risk (PAR) form. All PAR forms were reviewed within 24 hours by the child abuse team and categorized on the basis of 6 types of interventions, most significantly an "immediate callback." Wilcoxon rank and χ2 tests were used for group comparisons. RESULTS Over a 30-month period, program interventions occurred in 2061 of 7698 PARs (26.8%). The most common reason for a PAR form was physical abuse (32.5%). Subjects requiring an intervention were no different in age than those who did not (median age: 5.6 vs 5.2 years). PAR forms performed in the emergency departments or urgent care were more likely to require an intervention than inpatient (odds ratio: 4.4; 95% confidence interval 3.6-5.3) or clinic (odds ratio: 2.0; 95% confidence interval 1.7-2.3) PAR forms. Of the 53 immediate callbacks, potential diagnostic errors and safe discharge concerns occurred in nearly one-half, and >40% involved subjects with bruising. Immediate follow-up in the child abuse pediatrician clinic occurred in 87% (46 of 53) of cases, resulting in a new or changed diagnosis in 57% of such cases. CONCLUSIONS A child maltreatment safety program encompassing a health system can identify and address medical errors.
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Affiliation(s)
- Jennifer Hansen
- Department of Pediatrics, Children's Mercy Hospital and School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri
| | - Amy Terreros
- Department of Pediatrics, Children's Mercy Hospital and School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri
| | - Ashley Sherman
- Department of Pediatrics, Children's Mercy Hospital and School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri
| | | | - James Anderst
- Department of Pediatrics, Children's Mercy Hospital and School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri
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Nationwide evidence that education disrupts the intergenerational transmission of disadvantage. Proc Natl Acad Sci U S A 2021; 118:2103896118. [PMID: 34312230 PMCID: PMC8346897 DOI: 10.1073/pnas.2103896118] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
We leveraged a three-generation approach in 2.1 million Danes to measure the transmission and disruption of multiple health and social disadvantages: poor physical health, poor mental health, social welfare dependency, criminal offending, and protective services involvement. Health and social disadvantages clustered within a small segment of families: Adults who relied disproportionately on multiple, different health and social services tended to have parents who relied disproportionately on multiple, different health and social services and tended to have children who appeared in protective services records. Education disrupted these statistical associations between and within generations and between and within families. If associations are causal, investing in young people’s education potential could interrupt the multigenerational cycle of disadvantage and reduce health and social inequalities. Despite overall improvements in health and living standards in the Western world, health and social disadvantages persist across generations. Using nationwide administrative databases linked for 2.1 million Danish citizens, we leveraged a three-generation approach to test whether multiple, different health and social disadvantages—poor physical health, poor mental health, social welfare dependency, criminal offending, and Child Protective Services involvement—were transmitted within families and whether education disrupted these statistical associations. Health and social disadvantages concentrated, aggregated, and accumulated within a small, high-need segment of families: Adults who relied disproportionately on multiple, different health and social services tended to have parents who relied disproportionately on multiple, different health and social services and tended to have children who evidenced risk for disadvantage at an early age, through appearance in protective services records. Intra- and intergenerational comparisons were consistent with the possibility that education disrupted this transmission. Within families, siblings who obtained more education were at a reduced risk for later-life disadvantage compared with their cosiblings who obtained less education, despite shared family background. Supporting the education potential of the most vulnerable citizens might mitigate the multigenerational transmission of multiple disadvantages and reduce health and social disparities.
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Substance Use Outcomes from Two Formats of a Cognitive-Behavioral Intervention for Aggressive Children: Moderating Roles of Inhibitory Control and Intervention Engagement. Brain Sci 2021; 11:brainsci11070950. [PMID: 34356184 PMCID: PMC8304631 DOI: 10.3390/brainsci11070950] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 07/07/2021] [Accepted: 07/14/2021] [Indexed: 11/17/2022] Open
Abstract
Although cognitive-behavioral interventions have reduced the risk of substance use, little is known about moderating factors in children with disruptive behaviors. This study examined whether aggressive preadolescents’ inhibitory control and intervention engagement moderates the effect of group versus individual delivery on their substance use. Following screening for aggression in 4th grade, 360 children were randomly assigned to receive the Coping Power intervention in either group or individual formats. The sample was primarily African American (78%) and male (65%). Assessments were made of children’s self-reported substance use from preintervention through a six-year follow-up after intervention, parent-reported inhibitory control at preintervention, and observed behavioral engagement in the group intervention. Multilevel growth modeling found lower increases in substance use slopes for children with low inhibitory control receiving individual intervention, and for children with higher inhibitory control receiving group intervention. Children with low inhibitory control but who displayed more positive behavioral engagement in the group sessions had slower increases in their substance use than did similar children without positive engagement. Aggressive children’s level of inhibitory control can lead to tailoring of group versus individual delivery of intervention. Children’s positive behavioral engagement in group sessions is a protective factor for children with low inhibitory control.
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Abstract
Child physical abuse is an important cause of pediatric morbidity and mortality and is associated with major physical and mental health problems that can extend into adulthood. Pediatricians are in a unique position to identify and prevent child abuse, and this clinical report provides guidance to the practitioner regarding indicators and evaluation of suspected physical abuse of children. The role of the physician may include identifying abused children with suspicious injuries who present for care, reporting suspected abuse to the child protection agency for investigation, supporting families who are affected by child abuse, coordinating with other professionals and community agencies to provide immediate and long-term treatment to victimized children, providing court testimony when necessary, providing preventive care and anticipatory guidance in the office, and advocating for policies and programs that support families and protect vulnerable children.
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