Adverse childhood experiences and resilience among adult women: A population-based study

Association of social and life threats with symptoms of posttraumatic stress disorder and social anxiety disorder

BACKGROUND

This study examined psychological reactions to perceived threats, viewed within the context of human evolutionary history. We compared the relative weight of perceived threat to life or physical harm versus social threat, i.e., humiliation and/or rejection, in symptoms of posttraumatic stress disorder (PTSD) and social anxiety disorder (SAD).

METHODS

Participants were 50 women with clinically significant posttraumatic stress symptoms (PTSS) and 59 women with little or no PTSS (control group) selected from a large, population-based cohort of women in Iceland, the SAGA Cohort. Participants rated (1) life threat, (2) physical threat, (3) humiliation, and (4) rejection during their worst trauma or stressor.

RESULTS

Rates of both life and social threats were higher in the PTSS than control group. Among the PTSS participants, 4 % (n = 2) reported primarily life threats (vs. 6.8 %, n = 4 in controls), 36 % (n = 18) reported primarily social threats (vs. 33.9 %, n = 20 in controls), and 60 % (n = 30) reported both types of threats (vs. 15.3 %, n = 9 in controls). Those who reported dual life and social threats exhibited elevated PTSS compared to those who experienced a single type of threat. The highest levels of life or physical threat, along with humiliation, predicted PTSS severity, but rejection did not. Nearly half of the PTSS group (approximately 50 %, n = 25) also met criteria for SAD compared to roughly 14 % (n = 8) in the control group, and humiliation predicted SAD symptom severity. Notably, 18 % of the PTSS group (n = 9) linked the onset of their SAD and PTSS to a singular trauma or stressor involving a social threat.

CONCLUSIONS

The findings underscore the role of social threat in PTSD and SAD, with implications for theoretical models of both disorders.

Adverse childhood experiences, mental distress, and autoimmune disease in adult women: findings from two large cohort studies

BACKGROUND

Adverse childhood experiences (ACEs) have been associated with increased risks of autoimmune diseases. However, data are scarce on the role of specific ACEs as well as the potential mediating role of adverse mental health symptoms in this association.

METHODS

A cohort study using the nationwide Icelandic Stress-And-Gene-Analysis (SAGA, 22,423 women) cohort and the UK Biobank (UKB, 86,492 women) was conducted. Participants self-reported on five ACEs. Twelve autoimmune diseases were self-reported in SAGA and identified via hospital records in UKB. Poisson regression was used to assess the cross-sectional association between ACEs and autoimmune diseases in both cohorts. Using longitudinal data on self-reported mental health symptoms in the UKB, we used causal mediation analyses to study potential mediation by depressive, anxiety, and PTSD symptoms in the association between ACEs and autoimmune diseases.

RESULTS

The prevalence of ACEs was 50% in SAGA and 35% in UKB, while the prevalence of autoimmune diseases was 29% (self-reported) and 14% (clinically confirmed), respectively. In both cohorts, ACEs were associated with an increased prevalence ratio (PR) of any studied autoimmune disease in a dose-response manner (PR = 1.10 (95%CI = 1.08-1.12) per ACE), particularly for Sjögrens (PR = 1.34), polymyalgia rheumatica (PR = 1.20), rheumatoid arthritis (PR = 1.14), systemic lupus erythematosus (PR = 1.13), and thyroid disease (PR = 1.11). Sexual abuse and physical and emotional neglect were consistently associated with an elevated prevalence of autoimmune diseases when including all ACEs in the model. Approximately one fourth of the association was mediated through depression, anxiety, and PTSD.

CONCLUSIONS

These findings based on two large cohorts indicate a role of ACEs and corresponding mental health distress in autoimmune diseases among adult women.

Prevalence of Life Stressors and Posttraumatic Stress Disorder Among Women in Iceland

Importance

Comprehensive data on the prevalence of various life stressors and their role in posttraumatic stress disorder (PTSD) among women are lacking.

Objective

To determine the prevalence of a broad range of life stressors and their association with PTSD in a large nationally representative cohort of women.

Design, Setting, and Participants

This cross-sectional analysis used data from the population-based Stress-And-Gene-Analysis, which invited women in Iceland to complete an online survey from March 1, 2018, to July 1, 2019. Participants were a nationally representative sample of women 18 to 69 years of age. This analysis was conducted from January 21, 2022, to September 13, 2024.

Exposures

History of 23 life stressors assessed with the Life Events Checklist for the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) (DSM-5) and additional survey questions.

Main Outcomes and Measures

The main outcome was probable PTSD during the past month assessed for the worst life stressor experienced as evaluated with the PTSD Checklist for DSM-5. Modified Poisson log-linear models were used to assess prevalence ratios (PRs) of PTSD by type of life stressor, adjusting for multiple covariates, including number of life stressors and time since the worst life stressor.

Results

Overall, 28 199 women participated in the study (mean [SD] age, 43.8 [13.7] years). The prevalence of life stressors varied substantially, ranging from 3.3% for war or armed conflict-related events to 66.4% for unwanted sexual experiences. The overall prevalence of probable PTSD was 15.9% and varied substantially across life stressor types. The highest prevalence of probable PTSD was for sexual assault (1427 of 3872 [36.9%]) and lowest for natural disasters (15 of 456 [3.3%]). Interpersonal trauma, specifically sexual assault (adjusted PR [APR], 6.66 [95% CI, 4.01-11.04]), other unwanted sexual experience (APR, 4.33 [95% CI, 2.53-7.42]), and physical assault (APR, 4.44 [95% CI, 2.63-7.49]) were associated with the highest prevalence increase of probable PTSD compared with natural disasters as the reference category.

Conclusions and Relevance

This cross-sectional study of 28 199 women in Iceland, which ranks highest globally in gender equality, found that sexual and physical assaults were among the most common life stressors reported and were associated with the highest prevalence of probable PTSD. The propensity of such trauma to result in PTSD calls for widespread societal efforts to prevent sexual and physical violence and reduce gender-based disparities in mental health.

Adverse Childhood Experiences Are Associated with Mental Health Problems Later in Life: An Umbrella Review of Systematic Review and Meta-Analysis

INTRODUCTION

Evidence suggested a link between early adversity and mental health problems. However, it is unclear how much adverse childhood experiences (ACEs) contribute to mental health problems because researchers have produced inconsistent findings. Therefore, the objective of this umbrella review was to combine the contradictory data regarding the effect of ACEs on the development of mental health problems later in life in the global context.

METHODS

PubMed, Embase, Scopus, Web of Sciences, Cochrane Database of Systematic Reviews, Scopus, and Google Scholar which reported the effect of ACEs on the development of mental health problems was searched. The quality of the included studies was assessed using the Assessment of Multiple Systematic Reviews (AMSTAR). A weighted inverse variance random-effects model was applied to find the pooled estimates. The subgroup analysis, heterogeneity, publication bias, and sensitivity analysis were also assessed.

RESULTS

Forty-three SRM with 14,707,614 study participants were included. The pooled effect of ACEs on the development of mental health problems later in life in the global context is found to be (AOR = 1.66 [1.46, 1.87]). Subgroup analysis based on country revealed (AOR = 1.67 [1.23, 2.11]) in UK, (AOR = 0.61 [0.41, 0.81]) in Canada, (AOR = 1.55 [1.40, 1.69]) in Brazil, (AOR = 5.65 [4.12, 7.18]) in Ethiopia, (AOR = 1.92 [1.45, 2.38]) in USA, (AOR = 2.30 [1.89, 2.72]) in Australia, and (AOR = 1.66 [1.46, 1.87]) in Ireland. While subgroup analysis based on types of adverse childhood adverse experience: domestic violence (AOR = 4.13 [1.96, 6.30]), maltreatment (AOR = 1.5 [0.79, 2.21]), physical abuse (AOR = 1.56 [1.43, 1.63]), sexual abuse (AOR = 2.07 [1.63, 2.51]), child abuse (AOR = 5.66 [4.12, 7.18]), parental mental health problem (AOR = 1.73 [1.39, 2.08]), bullying (AOR = 1.99 [1.69, 2.29], neglect (AOR = 2.11 [1.53, 2.69]), and parental divorce (AOR = 1.66 [1.46, 1.87]). Based on the type of mental health problem, the pooled effect size is 1.87 (1.45, 2.30) for depression and 1.67 (1.22, 2.13) for anxiety.

CONCLUSION

This umbrella review revealed that ACE is significantly associated (with 66% increased risk) with anxiety and depression later in life in a global context. This association is most noticeable when one is subjected to domestic violence, maltreatment, physical abuse, sexual abuse, child abuse, parental mental health problems, bullying, neglect, and parental divorce. Childhood periods are a critical window of opportunity for reducing the risk of developing mental illness in the future and for implementing intervention measures. Preventing childhood maltreatment and addressing psychiatric risk factors can prevent psychopathology. Longitudinal studies are needed to optimize healthcare responses to ACEs. Increased awareness and public health interventions are needed to prevent childhood adversity and prevent mental problems among these victims. To optimize healthcare responses to unfavorable outcomes of childhood adversities, longitudinal and intervention research findings, more public health initiatives, and awareness are required.

Prevalence, subtypes, and risk factors of adverse childhood experiences among Chinese residents: a multicenter cross-sectional study

Background

Addressing the long-term physical and mental health impacts of adverse childhood experiences (ACEs) remains a significant public health challenge. Additionally, ACEs can contribute to intergenerational transmission, affecting future generations. While previous studies have primarily focused on children and adolescents, there is limited data on ACE subtypes and influencing factors among the general adult population, particularly in China. This study aims to explore the prevalence, subtypes, and factors influencing ACEs among Chinese adults.

Method

A total of 1,932 Chinese residents from southwest China (Sichuan, Yunnan, Guizhou provinces, and Chongqing Municipality) participated in the study, consisting of 867 men (44.9%) and 1,065 women (55.1%). Latent class analysis (LCA) was used to identify ACE clusters, and regression analysis examined associations between ACE clusters and demographic factors, physical illness, and mental health outcomes.

Results

The findings revealed that 28.7% of participants had experienced at least one ACE, while 13.2% had experienced three or more ACEs. Three distinct ACE clusters were identified: a low ACE group, a high emotional and physical abuse/family dysfunction group, and a high ACE/sexual abuse group. Regression analysis showed significant associations between childhood adversity and demographic factors (age, education, birthplace), as well as physical and mental health outcomes (anxiety, depression). ANOVA further confirmed significant differences in depression and anxiety scores across the clusters.

Conclusion

These findings offer critical insights for developing targeted public health interventions. Policymakers should consider strategies to reduce childhood ACEs and mitigate their long-term consequences, with particular attention to high-risk groups.

Defining and distinguishing early life stress, trauma, adversity, toxic and chronic stress and allostatic load: a descriptive review

AIMS

Various concepts are used to study the impact of stress on childhood development. These concepts are often used inconsistently or interchangeably. Our main objectives were to determine how selected stress concepts (chronic stress, toxic stress, allostatic load, early life stress, childhood adversity, childhood trauma and adverse childhood experiences; ACEs) are defined, operationalized and described, and to provide a theoretical context to aid the choice for a preferred concept in public health research.

METHODS

For this descriptive review, we systematically searched for literature published before 4 August 2021, on PubMed, Embase and PsycInfo. Two independent reviewers included studies. Exclusion criteria were: no systematic review, not peer reviewed, not published in English, selected stress concepts were no predetermined variable or a substantial topic in the discussion, full text was unobtainable or study described non-human or non-childhood populations. Data extraction forms were used. Descriptives were gathered, publication fields were identified through Journal Citation Reports categories, and verbatim descriptions were ordered in text and Venn diagrams.

RESULTS

Of 264 screened studies, 124 were included. ACEs, childhood adversity and childhood trauma were used most. ACEs were the main concept used most frequently (47.6%). A total of 11 of 14 public and environmental health journals used ACEs. All concepts refer to prolonged, repeated, interpersonal stress from 0 to 18 years, that can alter physiological systems. Four concepts were stressor oriented, two concepts focused on stress response and effect and one on the state of challenged homeostasis.

CONCLUSIONS

ACEs seem most fitting for public health setting, due to their operationalizability, large set of core experiences and widespread use.

Sexual violence in the workplace and associated health outcomes: a nationwide, cross-sectional analysis of women in Iceland

BACKGROUND

Workplace sexual violence against women is a pressing global issue with scarce knowledge on its health implications. Existing research is largely limited to specific occupations, which calls for comprehensive, population-based studies. This study aimed to examine the associations between self-labelled workplace sexual violence and a variety of health outcomes in a nationally representative sample of Icelandic women aged 18-69 years.

METHODS

Participants in this cross-sectional study were women in the Stress-And-Gene-Analysis (SAGA) cohort who answered the question regarding workplace sexual violence, defined in our study as encompassing all work sectors, academic settings, and other school environments. Eligible participants were women, aged 18-69 years, residing in Iceland, who spoke Icelandic and were listed in the Icelandic Population Register or had a contact number registered with the online 1819 service. Poisson and binomial regressions were used to assess the associations between workplace sexual violence and validated measures of current mental and physical health outcomes (eg, probable depression, general anxiety, and severe sleep problems). Multiple imputation was performed to account for missing values in the dataset.

FINDINGS

The study was conducted from March 1, 2018, to July 1, 2019. Of the 113 814 women deemed eligible for study inclusion, 104 197 were invited to take part in the online survey. Of those invited, 30 403 women completed the survey and were included in the SAGA cohort. Among these participants, 15 812 provided answers to the question regarding exposure to workplace sexual harassment or violence. Exposure to sexual violence was associated with an increased prevalence of probable depression (prevalence ratio [PR] 1·50 [95% CI 1·41-1·60]), general anxiety (PR 1·49 [1·40-1·59]), social phobia (PR 1·62 [1·48-1·78]), self-harm (PR 1·86 [1·53-2·28]), suicidal ideation (PR 1·68 [1·44-1·68]), suicide attempts (PR 1·99 [1·62-2·44]), binge drinking (PR 1·10 [1·01-1·20]), sleep problems (PR 1·41 [1·48-1·91]), physical symptoms (PR 1·59 [1·48-1·70]), and sick leave (PR 1·20 [1·12-1·28]). The prevalence of the health outcomes among those exposed show age-related differences: younger women report anxiety or depression more frequently, while older women report sleep problems after experiencing workplace sexual violence.

INTERPRETATION

In this cross-sectional study self-reported experiences of sexual violence in the workplace were associated with several self-reported health outcomes. The findings suggest a need for targeted interventions to promote workplace safety and to mitigate adverse health implications among people who have experienced workplace sexual violence. Future research should explore factors such as the frequency, duration, and relationship dynamics of workplace sexual violence, as well as the effect on different genders and sexual orientations, to deepen our understanding of these experiences and inform effective prevention strategies.

FUNDING

Reykjavík Energy Research Fund, The Icelandic Gender Equality Fund, European Research Council, and Icelandic Center for Research.

Examining relationships between adverse childhood experiences and coping during the cost-of-living crisis using a national cross-sectional survey in Wales, UK

OBJECTIVES

Adverse childhood experiences (ACEs) can affect individuals' resilience to stressors and their vulnerability to mental, physical and social harms. This study explored associations between ACEs, financial coping during the cost-of-living crisis and perceived impacts on health and well-being.

DESIGN

National cross-sectional face-to-face survey. Recruitment used a random quota sample of households stratified by health region and deprivation quintile.

SETTING

Households in Wales, UK.

PARTICIPANTS

1880 Welsh residents aged ≥18 years.

MEASURES

Outcome variables were perceived inability to cope financially during the cost-of-living crisis; rising costs of living causing substantial distress and anxiety; and self-reported negative impact of rising costs of living on mental health, physical health, family relationships, local levels of antisocial behaviour and violence, and community support. Nine ACEs were measured retrospectively. Socioeconomic and demographic variables included low household income, economic inactivity, residential deprivation and activity limitation.

RESULTS

The prevalence of all outcomes increased strongly with ACE count. Perceived inability to cope financially during the cost-of-living crisis increased from 14.0% with 0 ACEs to 51.5% with 4+ ACEs. Relationships with ACEs remained after controlling for socioeconomic and demographic factors. Those with 4+ ACEs (vs 0 ACEs) were over three times more likely to perceive they would be unable to cope financially and, correspondingly, almost three times more likely to report substantial distress and anxiety and over three times more likely to report negative impacts on mental health, physical health and family relationships.

CONCLUSIONS

Socioeconomically deprived populations are recognised to be disproportionately impacted by rising costs of living. Our study identifies a history of ACEs as an additional vulnerability that can affect all socioeconomic groups. Definitions of vulnerability during crises and communications with services on who is most likely to be impacted should consider childhood adversity and history of trauma.

Association between traumatic events with suicidality among adolescents: A large-scale cross-sectional study of 260,423 participants

Traumatic events have significant negative impacts throughout one's life. We aimed to comprehensively examine the early associations between traumatic events and suicidality among adolescents. In a cross-sectional sample of 260,423 adolescents in Deyang, China in September 2021, we assessed individual traumatic events, cumulative types, and patterns, alongside suicide risk scores and ideation, attempts, or plans. Linear and Poisson regression models adjusted for demographic confounders evaluated the association. Robust associations existed between interpersonal violence-related traumatic events and higher suicidality, with physical abuse demonstrating the strongest correlation. Moreover, suicide risk scores displayed a clear trend, indicating a progressively stronger association with suicidality as cumulative traumatic event types increased. Four distinct traumatic patterns emerged, including low traumas, high physical abuse, high death/serious injuries of a loved one, and multiple traumas, with the latter showing the strongest association with suicidality. Notably, the stratified analysis showed these associations were more pronounced in females, urban residents, only children, left-behind children, and those aged 13-15, while weaker in participants from families with intact parental relationships and middle socioeconomic status. Understanding the role of demographic factors and traumatic patterns in identifying at-risk youth can enable early detection and targeted interventions for suicide-related concerns.

Gender differences in adverse childhood experiences, resilience and internet addiction among Tunisian students: Exploring the mediation effect

Adverse Childhood Experiences (ACEs) are a common public health issue with a variety of consequences, including behavioral addiction such as Internet Addiction (IA). Despite widespread recognition of this issue, the underlying mechanisms are not well studied in recent literature. Additionally, studies have indicated gender disparities in the prevalence and manifestation of ACEs and IA. The objective of this study was to investigate the mediating effect of resilience on the link between ACEs and IA among high-school students according to gender in Mahdia city (Tunisia). We conducted a cross-sectional survey for two months (January- February 2020), among 2520 schooled youth in Mahdia city (Tunisia). The Arabic-language edition of the World Health Organisation ACE questionnaire was used. The validated Arabic versions of the Adolescent Psychological Resilience Scale and the Internet Addiction Test were the screening tools for resilience and IA. Data were analyzed according to gender. The majority of youth (97.5%) were exposed to at least one ACE with the most prevalent being emotional neglect (83.2%). Exposure to extra-familial ACEs was also high reaching 86.9% with higher rates among boys for all types of social violence. Internet addiction was common among students (50%) with higher prevalence for boys (54.4% vs 47.7%for girls, p = 0.006). Resilience scores were86.43 ± 9.7 for girls vs 85.54 ± 9.79 for boys. The current study showed that resilience mediated the link between ACEs, especially intrafamilial violence, and internet addiction (%mediated = 15.1). According to gender, resilience had a significant mediating role on internet addiction for girls (%mediated = 17) and no significant role for boys. The mediating effect of resilience in the relationship between ACEs and cyberaddiction among schooled adolescents in the region of Mahdia (Tunisia) has been identified.

Adverse childhood experiences predict internet gaming disorder in university students: the mediating role of resilience

BACKGROUND

To investigate the relationship between adverse childhood experiences and internet gaming disorder (IGD) and the mediating role of resilience in the relationship between these two factors.

METHODS

The adverse childhood experience scale, resilience scale and IGD Scale were administered to 9349 university students. Correlations and mediating effects were calculated among these scores.

RESULTS

After controlling for sex and age, significant correlations among adverse childhood experiences, resilience and IGD were observed; resilience was a partial mediator variable in the relationship between adverse childhood experiences and IGD.

CONCLUSIONS

The more adverse childhood experiences an individual has, the less their mental toughness and the greater their tendency to become addicted to internet games. Adverse childhood experiences can effectively predict IGD, and the risk of becoming addicted to the internet can be decreased by increasing one's mental toughness.

California Stress, Trauma, and Resilience Study (CalSTARS) protocol: A multiomics-based cross-sectional investigation and randomized controlled trial to elucidate the biology of ACEs and test a precision intervention for reducing stress and enhancing resilience

Adverse Childhood Experiences (ACEs) are very common and presently implicated in 9 out of 10 leading causes of death in the United States. Despite this fact, our mechanistic understanding of how ACEs impact health is limited. Moreover, interventions for reducing stress presently use a one-size-fits-all approach that involves no treatment tailoring or precision. To address these issues, we developed a combined cross-sectional study and randomized controlled trial, called the California Stress, Trauma, and Resilience Study (CalSTARS), to (a) characterize how ACEs influence multisystem biological functioning in adults with all levels of ACE burden and current perceived stress, using multiomics and other complementary approaches, and (b) test the efficacy of our new California Precision Intervention for Stress and Resilience (PRECISE) in adults with elevated perceived stress levels who have experienced the full range of ACEs. The primary trial outcome is perceived stress, and the secondary outcomes span a variety of psychological, emotional, biological, and behavioral variables, as assessed using self-report measures, wearable technologies, and extensive biospecimens (i.e. DNA, saliva, blood, urine, & stool) that will be subjected to genomic, transcriptomic, proteomic, metabolomic, lipidomic, immunomic, and metagenomic/microbiome analysis. In this protocol paper, we describe the scientific gaps motivating this study as well as the sample, study design, procedures, measures, and planned analyses. Ultimately, our goal is to leverage the power of cutting-edge tools from psychology, multiomics, precision medicine, and translational bioinformatics to identify social, molecular, and immunological processes that can be targeted to reduce stress-related disease risk and enhance biopsychosocial resilience in individuals and communities worldwide.

Adverse childhood experiences and psychological functioning among women with schizophrenia or bipolar disorder: population-based study

BACKGROUND

Adverse childhood experiences (ACEs) are well-known risk factors for schizophrenia and bipolar disorder.

AIMS

The aim was to study the associations between specific ACEs and psychological functioning in women with schizophrenia or bipolar disorder.

METHOD

Among 29 367 women (mean age 44 years) from the Icelandic Stress-And-Gene-Analysis (SAGA) study, 534 (1.8%, mean age 40) reported having been diagnosed with schizophrenia or bipolar disorder, which were combined to 'severe mental disorders'. Participants reported on 13 types of ACEs, childhood deprivation and psychological functioning (defined as coping ability and current symptoms of depression, anxiety and sleep disturbances). Adjusted Poisson regression calculated prevalence ratios (PRs) between ACEs and severe mental disorders. Linear regression assessed the association between ACEs and psychological functioning among women with a severe mental disorder.

RESULTS

Women with a severe mental disorder reported more ACEs (mean 4.57, s.d. = 2.82) than women without (mean 2.51, s.d. = 2.34) in a dose-dependent manner (fully-adjusted PR = 1.23 per ACE, 95% CI 1.20-1.27). After mutual adjustment for other ACEs, emotional abuse, sexual abuse, mental illness of a household member, emotional neglect, bullying and collective violence were associated with severe mental disorders. Among women with severe mental disorders, a higher number of ACEs was associated with increased symptom burden of depression (β = 2.79, 95% CI = 1.19-4.38) and anxiety (β = 2.04, 95% CI = 0.99-3.09) including poorer sleep quality (β = 0.83, 95% CI = 0.07-1.59). Findings were similar for schizophrenia and bipolar disorder separately.

CONCLUSION

Women with schizophrenia or bipolar disorder show a strong history of ACEs, which may interfere with their psychological functioning and, therefore, need to be addressed as part of their treatment, for example, with trauma-focused psychotherapy.

Association between adverse childhood experiences and perinatal depressive symptoms: a cross-sectional analysis of 16,831 women in Iceland

Emerging data suggest that certain adverse childhood experiences (ACEs) are associated with perinatal depression (PND). However, few studies have comprehensively assessed the cumulative number and types of ACEs and their association to PND. We conducted a cross-sectional analysis among 16,831 female participants from the Stress-And-Gene-Analysis (SAGA) cohort in Iceland, 2018. ACEs were surveyed with the World Health Organization ACE-International questionnaire, while PND symptoms were assessed using the Edinburgh Postnatal Depression Scale (lifetime version). We, while adjusting for confounding factors, estimated the prevalence ratio (PR) of PND in relation to total number of ACEs using the Poisson quasi-likelihood model and further performed analyses for type-specific ACEs. At a mean age of 44 years (SD ± 11.1), 6,201 (36.8%) participants had experienced probable PND. Total number of ACEs was positively associated with PND (PR 1.11 per ACE, 95% CI: 1.10-1.11), also among women without any psychiatric comorbidities (PR 1.13, 95% CI: 1.11-1.14). PRs increased in a dose-response manner with the number of ACEs (P for trend < 0.001); women that endorsed 5 or more ACEs were twice as likely to have experienced PND (PR 2.24, 95% CI: 2.09-2.41). All ACE types (n = 13) were associated with PND, with most pronounced association for emotional neglect by a guardian (PR 1.53, 95% CI: 1.47-1.59). Our findings suggest a positive association between number of ACEs and PND symptoms. If our results are confirmed with prospective data, healthcare providers need to be alert of the risk of PND among expecting mothers with history of ACEs.

Psychiatric comorbidities in women with cardiometabolic conditions with and without ADHD: a population-based study

BACKGROUND

Leveraging a large nationwide study of Icelandic women, we aimed to narrow the evidence gap around female attention-deficit/hyperactivity disorder (ADHD) and cardiometabolic comorbidities by determining the prevalence of obesity, hypertension, type 2 diabetes, and cardiovascular diseases among women with ADHD and examine the association between cardiometabolic conditions and co-occurring ADHD with anxiety and mood disorders, alcoholism/substance use disorder (SUD), self-harm, and suicide attempts.

METHODS

We conducted a cross-sectional analysis of the nationwide, all-female, population-based SAGA Cohort Study (n = 26,668). To ascertain diagnoses and symptoms, we used self-reported history of ADHD diagnoses, selected cardiometabolic conditions and psychiatric disorders, and measured current depressive, anxiety, and PTSD symptoms through appropriate questionnaires (PHQ-9, GAD-7, and PCL-5). We calculated age-adjusted prevalences of cardiometabolic conditions by women's ADHD status and estimated adjusted prevalence ratios (PR) and 95% confidence intervals (CI), using modified Poisson regression models. Similarly, we assessed the association of cardiometabolic conditions and co-occurring ADHD with current psychiatric symptoms and psychiatric disorders, using adjusted PRs and 95% CIs.

RESULTS

We identified 2299 (8.6%) women with a history of ADHD diagnosis. The age-adjusted prevalence of having at least one cardiometabolic condition was higher among women with ADHD (49.5%) than those without (41.7%), (PR = 1.19, 95% CI 1.14-1.25), with higher prevalence of all measured cardiometabolic conditions (myocardial infarctions (PR = 2.53, 95% CI 1.83--3.49), type 2 diabetes (PR = 2.08, 95% CI 1.66-2.61), hypertension (PR = 1.23, 95% CI 1.12-1.34), and obesity (PR = 1.18, 95% CI 1.11-1.25)). Women with cardiometabolic conditions and co-occurring ADHD had, compared with those without ADHD, substantially increased prevalence of (a) all measured mood and anxiety disorders, e.g., depression (PR = 2.38, 95% CI 2.19-2.58), bipolar disorder (PR = 4.81, 95% CI 3.65-6.35), posttraumatic stress disorder (PR = 2.78, 95% CI 2.52-3.07), social phobia (PR = 2.96, 95% CI 2.64-3.32); (b) moderate/severe depressive, anxiety, and PTSD symptoms with PR = 1.76 (95% CI 1.67-1.85), PR = 1.97 (95% CI 1.82-2.12), and PR = 2.01 (95% CI 1.88-2.15), respectively; (c) alcoholism/SUD, PR = 4.79 (95% CI 3.90-5.89); and (d) self-harm, PR = 1.47 (95% CI 1.29-1.67) and suicide attempts, PR = 2.37 (95% CI 2.05-2.73).

CONCLUSIONS

ADHD is overrepresented among women with cardiometabolic conditions and contributes substantially to other psychiatric comorbidities among women with cardiometabolic conditions.

Adverse childhood experiences and sexual dysfunction in midlife women: Is there a link?

BACKGROUND

One in 3 children has had at least 1 adverse childhood experience (ACE), and ACEs have been associated with multiple medical and psychiatric morbidities in women later in life, including greater menopause symptom burden.

AIM

To evaluate the association between ACEs and female sexual dysfunction (FSD) in midlife women.

METHODS

A cross-sectional analysis from DREAMS-the Data Registry on Experiences of Aging, Menopause, and Sexuality-was conducted with questionnaires completed by women aged 40 to 65 years who presented to a women's health clinic at Mayo Clinic in Rochester, Minnesota, from May 2015 to December 2016. History of ACEs was obtained with the validated ACE questionnaire. FSD was assessed by the Female Sexual Function Index and the Female Sexual Distress Scale-Revised.

OUTCOMES

The association between ACEs and FSD (defined as Female Sexual Function Index score ≤26.55 and Female Sexual Distress Scale-Revised score ≥11) was evaluated via a multivariable logistic regression model, adjusting for age, menopause status, hormone therapy use, anxiety, depression, relationship satisfaction, hot flash severity, and history of abuse in the past year.

RESULTS

Women (N = 1572) had a mean age of 53.2 years. Overall 59% reported having at least 1 ACE. When compared with no ACEs, a history of ≥4 ACEs significantly increased the odds of not being sexually active (odds ratio, 1.83; 95% CI, 1.30-2.57; P < .001). Among sexually active women, the proportion of women with FSD increased sequentially as the number of ACEs increased. In the univariate analysis, a history of ≥4 ACEs significantly increased the odds of FSD as compared with no ACEs (odds ratio, 2.12; 95% CI, 1.50-2.99; P < .001). The association remained statistically significant in the multivariable analysis after adjusting for confounders (odds ratio, 1.75; 95% CI, 1.15-2.68; P = .009).

CLINICAL IMPLICATIONS

The findings highlight an opportunity for clinicians to screen for ACEs in women with sexual dysfunction and offer appropriate treatment and counseling as indicated.

STRENGTHS AND LIMITATIONS

Strengths of the study include the large cohort, the use of validated tools for assessment of ACEs and FSD, and the adjustment for multiple potential confounding factors. Limitations include the cross-sectional study design, recall bias in reporting ACEs and recent abuse, and the low representation of racially and ethnically diverse women in the cohort.

CONCLUSION

The study demonstrates an increased risk of sexual inactivity and sexual dysfunction in midlife women who experienced childhood adversity. The sexual dysfunction in women with ACEs seems to be independent of other factors that potentially affect female sexual function in midlife.

Progressive exercise training improves cardiovascular psychophysiological outcomes in young adult women with a history of adverse childhood experiences

Adverse childhood experiences (ACEs) are early-life psychosocial stressors that are associated with poorer mental health and increased cardiovascular disease (CVD) risk in a dose-dependent manner. We examined the feasibility of an 8-wk combined aerobic and resistance exercise training program to improve systolic (SBP) and diastolic blood pressure (DBP), serum endothelin-1 (ET-1), resilience, hope agency, and hope pathways in young women with ACEs. Forty-two healthy women (21 ± 3 yr) with ≥4 (ACE+; n = 28) or 0 ACEs (ACE-; n = 14) participated in this study. Women with ACEs were randomly assigned to an exercise (ACE+EXT; n = 14) or nonexercise control (ACE+CON; n = 14) group, whereas all ACE- participants were assigned to a nonexercise control (n = 14) group. Hope agency and DBP did not change in any group (P ≥ 0.43), but hope pathways improved only in ACE+EXT (means ± SE change; +1.6 ± 0.74 au, P = 0.032, Hedges' g = 0.53). ET-1 decreased in ACE+EXT only (-0.31 ± 0.15 pg/mL, P = 0.043, g = 0.46). Although the interactions for resilience and SBP did not reach significance (P = 0.05-0.06), forced post hoc analyses indicated that resilience improved (+4.9 ± 1.9 au, P = 0.012, g = 0.64) and SBP tended to improve (-4.0 ± 2.0 mmHg, P = 0.053, g = 0.51) in ACE+EXT only. There were significant associations between changes in hope pathways and SBP (ρ = -0.43, P = 0.023) and ET-1 (ρ = -0.53, P = 0.005), and between changes in SBP and ET-1 (ρ = 0.49; P = 0.012) in the ACE+ group. In summary, structured exercise training reduces serum ET-1 levels, improves positive psychological coping, and may improve SBP in young women with ACEs. The relationships among the changes in hope pathways, SBP, and ET-1 suggest a cardiovascular psychophysiological relationship in young women with ACEs.NEW & NOTEWORTHY This randomized controlled pilot trial shows, for the first time, that 8 wk of structured, progressive exercise training lowers serum endothelin-1 (ET-1) and improves positive psychological coping in young women with significant early-life psychosocial stress. Furthermore, the observed associations among changes in psychological attributes, ET-1, and systolic blood pressure signify a potential interplay between positive psychology and cardiovascular disease risk among women with adverse childhood experiences.

Effect of COVID-19 Pandemic Response and Parental Adverse Childhood Experiences on Child Health and Well-Being

Family responses to crises such as COVID-19 are driven by parents' experiences. Parental history of adverse childhood experiences (ACEs) might play an important role in predicting resilience, coping capacity, and parenting practices during the COVID-19 pandemic response. The purpose of this review is to examine the impact of COVID-19 pandemic disruption on child health and well-being as influenced by the previous history of ACEs in the parents. Scopus, Google Scholar, PubMed, and PsychInfo were searched for peer-reviewed articles using the keywords "COVID-19", "Parents or Maternal Adverse Childhood Experiences", and "child health" or "child well-being". Data were extracted using a literature review matrix template. Title, abstract, and full article-level reviews were conducted by two reviewers. The association between COVID-19 disruption, negative parenting, and child behavioral and emotional problems was stronger for parents with younger children with a history of high ACE scores. Parents with high ACE scores were more likely to cope poorly with childcare duties and engage in child neglect, verbal abuse, and reduced feeding frequency, specifically during the COVID-19 pandemic. The review findings support the framework of inadequate resilience and coping skills of adults with a history of ACEs during periods of stress and unpredictability such as the COVID-19 pandemic. The negative effects of these parental stressors on a child's health and well-being are modifiable and could be mitigated by targeted interventions. Trauma-informed care should be adopted to contribute to optimum child health.

Adverse Childhood Experiences and Chronic Diseases: Identifying a Cut-Point for ACE Scores

Adverse Childhood Experiences (ACEs) contribute to many negative physiological, psychological, and behavioral health consequences. However, a cut-point for adverse childhood experience (ACE) scores, as it pertains to health outcomes, has not been clearly identified. This ambiguity has led to the use of different cut-points to define high scores. The aim of this study is to clarify a cut-point at which ACEs are significantly associated with negative chronic health outcomes. To accomplish this aim, a secondary analysis using data from a cross-sectional study was conducted. The Adverse Childhood Experiences-International Questionnaire (ACE-IQ) was used for data collection. Descriptive statistics, nonparametric regression, and logistic regression analyses were performed on a sample of 10,047 adults. Data from demographic and self-report health measures were included. The results showed that a cut-point of four or more ACEs was significantly associated with increased rates of chronic disease. Participants with at least one chronic disease were almost 3 times more likely (OR = 2.8) to be in the high ACE group. A standardized cut-point for ACE scores will assist in future research examining the impact of high ACEs across cultures to study the effect of childhood experiences on health.

Association between Adverse Childhood Experiences and Multiple Sclerosis in Icelandic Women-A Population-Based Cohort Study

BACKGROUND

A growing literature, mostly based on selected populations, indicates that traumas may be associated with autoimmune diseases, yet few studies exist on adverse childhood experiences (ACEs) and multiple sclerosis (MS) in the general population.

OBJECTIVE

We assessed cross-sectional associations between self-reported ACEs and MS among Icelandic women in the population-based Stress-And-Gene-Analysis (SAGA) cohort.

METHODS

Participants (n = 27,870; mean age 44.9 years) answered a web-based survey that included the ACE-International Questionnaire and a question about MS diagnosis. Log-linear Poisson regression models estimated MS prevalence ratios and 95% confidence intervals for ACEs adjusted for covariates.

RESULTS

214 women reported having been diagnosed with MS (crude prevalence = 7.7 per 1000). Compared to women without MS, women with MS reported more fatigue, body pain and bladder problems. The average cumulative number of ACEs was 2.1. After adjustment for age, education, childhood deprivation, smoking and depressive symptoms, MS prevalence did not increase with increasing ACEs exposure (PR = 1.00, 95% CI = 0.92, 1.09). Thirteen ACE categories, including abuse, neglect, household dysfunction and violence were not individually or independently associated with MS.

CONCLUSION

Limited by self-reported data and cross-sectional design, results do not consistently support associations between ACEs in the development of MS among adult Icelandic women.

Risk factors for workplace sexual harassment and violence among a national cohort of women in Iceland: a cross-sectional study

BACKGROUND

Sexual harassment and violence in the workplace are a serious public health concern for women worldwide with substantial costs due to sick leave and personnel turnover. Yet little is known about the prevalence of sexual harassment and violence at a population level, especially across work sectors. The aim of this study was to investigate the prevalence of workplace sexual harassment and violence by demographic factors and work sectors among Icelandic women.

METHODS

For this cross-sectional study we analysed nationally representative, de-identified individual-level data from women who had responded to an online survey item about self-labelled current and lifetime workplace sexual harassment or violence as part of the Stress and Gene Analysis (SAGA) study, a cross-sectional nationally representative study done from March 1, 2018, to July 1, 2019. Eligible participants were women who resided in Iceland, were aged between 18 and 69 years, spoke Icelandic, and had a registered address from the Icelandic Population Register or a telephone number from the online 1819 service. We used binomial and Poisson regression analysis to study the cross-sectional association between workplace sexual harassment and violence and demographic factors (eg, age, sexual orientation, and education) and factors relating to the workplace (eg, work schedule), across works sectors.

FINDINGS

Of 113 814 eligible women, 104 197 were invited to complete the online survey, of whom 30 403 women responded and were included in the SAGA cohort. 15 799 women answered the item about exposure to workplace sexual harassment or violence. 11 286 [71·4%] of 15 799 women answered the question about sexual orientation that were included in the survey from June, 2018. 5291 (33·5%) of 15 799 of participants reported having experienced workplace sexual harassment or violence during their lifetime, and 1178 (7·5%) in their current workplace. Such exposure in the current workplace was most common among women who were young (age 18-24 years: prevalence ratio [PR] 3·89 [95% CI 2·66-5·71]; age 25-34 years: 3·66 [2·53-5·31]), single (1·27 [1·12-1·43]), and worked shifts (2·32 [2·02-2·67]), with the highest prevalence rates observed among women in work sectors of public figures (15·67 [9·34-25·12]), tourism (15·01 [11·01-20·13]), and the legal system and security (13·56 [7·00-24·66]). Lifetime exposure to workplace sexual harassment or violence was more common among women who belonged to sexual minorities than among heterosexual women (PR 1·35 [1·24-1·46]).

INTERPRETATION

Lifetime exposure to workplace sexual harassment or violence seems common among women in a Nordic welfare state. These findings provide nuanced targets for prevention and for public policies aimed at promoting women's safety in the work environment.

FUNDING

Icelandic Gender Equality Fund, European Research Council, and Icelandic Centre for Research.

Sleep disturbances among women in a Subarctic region: a nationwide study

STUDY OBJECTIVES

To date, few studies have assessed sleep problems among women residing in Subarctic regions. Therefore, the aim of this large-scale population-based study was to assess the prevalence of severe sleep problems and associated factors among Icelandic women, living at 63-66°N.

METHODS

Participants were 29 681 women (18-69 years old) who took part in the Icelandic Stress-And-Gene-Analysis study in 2018-2019. Background information, health-related behavior, and mental health symptoms were assessed with an online questionnaire. The Pittsburgh Sleep Quality Index (PSQI) was used to assess severe sleep problems during the past month. Adjusting for age, marital status, number of children, education, personal income, work schedule, region, and response period, we used modified Poisson log-linear models to obtain prevalence ratios (PRs) with 95% confidence intervals (CIs).

RESULTS

Overall, 24.2% of women reported severe sleep problems (PSQI >10). Women responding in the winter presented with an overall higher prevalence of severe sleep problems, compared to those responding in the summer (PR 1.21; 95% CI, 1.15 to 1.28). Severe sleep problems were more prevalent among young and late-midlife women, those who were single, had children, socio-economic challenges, worked shifts, and flexible hours. Furthermore, obesity, suboptimal health behaviors, excessive screen time, and mental health problems were associated with severe sleep problems.

CONCLUSION

Severe sleep problems are more common among women in Subarctic regions than elsewhere, particularly during winter. These findings motivate the development of preventive strategies and interventions for women in the Subarctic who suffer from sleep problems.