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Erato G, Shreffler KM, Ciciolla L, Quigley A, Addante S. Maternal childhood adversity and pregnancy intentions as predictors of pregnancy happiness. J Reprod Infant Psychol 2024; 42:180-193. [PMID: 35819014 PMCID: PMC9834437 DOI: 10.1080/02646838.2022.2097208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 06/28/2022] [Indexed: 01/14/2023]
Abstract
OBJECTIVES Nearly half of all pregnancies in the U.S. are classified as unintended (e.g. unplanned, mistimed, or unwanted), which have been linked to numerous adverse consequences for maternal and child outcomes. Recent evidence suggests that happiness about a pregnancy is often a better predictor of maternal and infant health outcomes than pregnancy intentions, but few studies have examined maternal predictors of pregnancy happiness. METHODS Using a clinic-based sample of pregnant women (n = 177), we apply multiple regression analysis to examine the association between maternal adverse childhood experiences and pregnancy happiness, as well as the moderating role of pregnancy intentions. RESULTS Women with more childhood adversity and pregnancies that were unplanned and mistimed or unwanted reported lower levels of pregnancy happiness, compared with women with less childhood adversity and intended pregnancies. However, pregnancy intentions did not moderate the relationship between maternal adverse childhood experiences and pregnancy happiness. CONCLUSION Our results suggest that pregnancy happiness is lower among mothers with a history of childhood adversity and pregnancies classified as unplanned and mistimed or unwanted. Understanding the factors that impact pregnancy happiness is critical to inform prenatal clinical practice and health policy, particularly when caring for those with a history of adversity.
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Affiliation(s)
- Gina Erato
- Department of Psychology, Oklahoma State University
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2
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Şanli ME, Çiçek İ, Yıldırım M, Çeri V. Positive childhood experiences as predictors of anxiety and depression in a large sample from Turkey. Acta Psychol (Amst) 2024; 243:104170. [PMID: 38301406 DOI: 10.1016/j.actpsy.2024.104170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 01/24/2024] [Accepted: 01/29/2024] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND Positive childhood experiences positively influence one's adult life, while the absence of such positive experiences can potentially yield mental health problems throughout the lifespan. OBJECTIVE This study aimed to investigate the role of positive childhood experiences on depression and anxiety levels. PARTICIPANTS AND SETTING 3090 (2059 women) young adults participated in this research. They ranged in age between 18 and 68 years (M = 28.78, SD = 9.44) and completed the self-report measures including the Positive Childhood Experiences Scale, Beck Depression and Anxiety Scales and Personal Information Forms. METHOD A cross-sectional research design was used to collect the data through social media platforms. We conducted a regression analysis to examine how positive childhood experiences contribute to depression and anxiety. RESULTS The results of correlation analysis indicated that positive childhood experiences were significantly negatively related to depression and anxiety. Regression analysis revealed that positive childhood experiences explained a significant amount of variance in the prediction of depression (10 %) and anxiety (8 %) after controlling for demographic factors. CONCLUSIONS The results suggest that the frequency of positive experiences lived during childhood might significantly reduce anxiety and depression, and positive childhood experiences might positively affect them.
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Affiliation(s)
| | - İlhan Çiçek
- Health College, Batman University, Batman, Turkey
| | - Murat Yıldırım
- Department of Psychology, Faculty of Science and Letters, Ağrı İbrahim Çeçen University, Ağrı, Turkey; Department of Social and Educational Sciences, Lebanese American University, Beirut, Lebanon.
| | - Veysi Çeri
- Department of Psychology, Faculty of Economics, Administrative and Social Sciences, Antalya Bilim University, Antalya, Turkey
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3
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Hinojosa MS, Hinojosa R. Positive and adverse childhood experiences and mental health outcomes of children. Child Abuse Negl 2024; 149:106603. [PMID: 38141478 DOI: 10.1016/j.chiabu.2023.106603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 11/07/2023] [Accepted: 12/11/2023] [Indexed: 12/25/2023]
Abstract
OBJECTIVE Researchers and policymakers have identified adverse childhood experiences (ACEs) like abuse, neglect, and household dysfunction as a contributing factor to poor mental health outcomes for children. Positive childhood experiences (PCEs) like open family communication styles, having the ability to live and play in a safe, stable, and protective environment, having constructive opportunities for social engagement, and receiving mentorship from adults have been found to improve the mental health of children. PURPOSE This paper explores the role of ACEs and PCEs on the mental health outcomes of children. METHOD A sample of 22,628 children ages 6-17 from the National Survey of Children's Health (2017-2020) was used to explore the relationship between PCEs and ACEs and the mental health of children. Logistic regression analysis is used to model the effect of PCEs and ACEs on the odds of child mental health diagnoses. RESULTS Findings indicate that with each additional ACE, there was a significant increase in the odds of reporting a MH condition (OR = 1.25, 95 % CI 1.09-1.43). Conversely, with each additional PCE, there is a significant decrease in the odds or reporting a MH condition (OR = 0.76, 95 % CI 0.68-0.84). There was also evidence that PCEs moderate the relationship between ACEs and reports of mental health conditions. When counts of ACEs are low, PCEs provide a protective effect on reports of mental health. But when the count of ACEs are high, children with higher numbers of PCEs have similar reports of mental health conditions. SUMMARY This study provides information about the moderating effect of PCEs on the relationship between ACEs and child mental health diagnosis with the goal of informing policies and interventions focused on ameliorating the growing crisis of children's negative mental health and well-being. WHAT IS KNOWN?: Adverse childhood events (ACEs) like abuse, neglect and household dysfunction are known to negatively impact the mental health and well-being of children. Positive childhood experiences (PCEs), on the other hand, can positively influence the mental health and well-being of children. WHAT DOES THIS ARTICLE ADD?: This study examines the association between adverse and positive childhood experiences to understand how they impact the mental health outcomes of children ages 6-17. Findings indicate that when ACEs are lower, the impact of PCEs are positive, but when ACEs are higher, PCEs do not make much difference in reports of mental health problems.
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Affiliation(s)
- Melanie Sberna Hinojosa
- University of Central Florida, College of Sciences, Department of Sociology, 4297 Andromeda Loop N., Orlando, FL 32816, United States of America.
| | - Ramon Hinojosa
- University of Central Florida, College of Sciences, Department of Sociology, 4297 Andromeda Loop N., Orlando, FL 32816, United States of America.
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Verma H, Verma A, Bettag J, Kolli S, Kurashima K, Manithody C, Jain A. Role of Effective Policy and Screening in Managing Pediatric Nutritional Insecurity as the Most Important Social Determinant of Health Influencing Health Outcomes. Nutrients 2023; 16:5. [PMID: 38201835 PMCID: PMC10780641 DOI: 10.3390/nu16010005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 12/11/2023] [Accepted: 12/13/2023] [Indexed: 01/12/2024] Open
Abstract
Social Determinants of Health (SDOH) impact nearly half of health outcomes, surpassing the influence of human behavior, clinical care, and the physical environment. SDOH has five domains: Economic Stability, Education Access and Quality, Health Care Access and Quality, Neighborhood and Built Environment, and Social and Community Context. Any adversity arising out of these interlinked domains predominantly affects children due to their greater susceptibility, and the adverse outcomes may span generations. Unfavorable SDOH may cause food insecurity, malnutrition, unbalanced gut microbiome, acute and chronic illnesses, inadequate education, unemployment, and lower life expectancy. Systematic screening by health care workers and physicians utilizing currently available tools and questionnaires can identify children susceptible to adverse childhood experiences, but there is a deficiency with respect to streamlined approach and institutional support. Additionally, current ameliorating supplemental food programs fall short of pediatric nutritional requirements. We propose a nutrition-based Surveillance, Screening, Referral, and Reevaluation (SSRR) plan encompassing a holistic approach to SDOH with a core emphasis on food insecurity, coupled with standardizing outcome-based interventions. We also propose more inclusive use of Food Prescription Programs, tailored to individual children's needs, with emphasis on education and access to healthy food.
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Affiliation(s)
- Hema Verma
- SLU College for Public Health and Social Justice, Saint Louis University, Saint Louis, MO 63104, USA
| | - Arun Verma
- Department of Pediatrics, Saint Louis University School of Medicine, Saint Louis, MO 63103, USA; (A.V.); (J.B.); (S.K.)
| | - Jeffery Bettag
- Department of Pediatrics, Saint Louis University School of Medicine, Saint Louis, MO 63103, USA; (A.V.); (J.B.); (S.K.)
| | - Sree Kolli
- Department of Pediatrics, Saint Louis University School of Medicine, Saint Louis, MO 63103, USA; (A.V.); (J.B.); (S.K.)
| | - Kento Kurashima
- Department of Pediatrics, Saint Louis University School of Medicine, Saint Louis, MO 63103, USA; (A.V.); (J.B.); (S.K.)
| | - Chandrashekhara Manithody
- Department of Pediatrics, Saint Louis University School of Medicine, Saint Louis, MO 63103, USA; (A.V.); (J.B.); (S.K.)
| | - Ajay Jain
- Department of Pediatrics, Saint Louis University School of Medicine, Saint Louis, MO 63103, USA; (A.V.); (J.B.); (S.K.)
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Rhodes CA, Thomas N, O'Hara KL, Hita L, Blake A, Wolchik SA, Fisher B, Freeman M, Chen D, Berkel C. Enhancing the Focus: How Does Parental Incarceration Fit into the Overall Picture of Adverse Childhood Experiences (ACEs) and Positive Childhood Experiences (PCEs)? Res Child Adolesc Psychopathol 2023; 51:1933-1944. [PMID: 37875642 PMCID: PMC11008286 DOI: 10.1007/s10802-023-01142-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2023] [Indexed: 10/26/2023]
Abstract
Despite the five million children in the U.S. with an incarcerated parent, there is limited research on risk and protective factors for this population. We analyzed data from the National Survey for Children's Health (2018) to: (1) examine associations among parental incarceration and other adverse childhood experiences (ACEs), (2) characterize the association between parental incarceration and youth mental health outcomes, (3) examine differences in positive childhood experiences (PCEs; collective socialization, community engagement, neighborhood amenities, and family problem solving) by parental incarceration status, (4) examine whether PCEs were protective against mental health problems and if there was an interaction with parental incarceration status, and (5) examine the interaction between PCEs, parental incarceration, and ACEs on mental health problems. Results revealed that children with incarcerated parents had higher odds of experiencing other ACEs, higher odds of having mental health problems, and experienced fewer PCEs compared to children without incarcerated parents. Further, although PCEs were associated with a lower odds of mental health problems for both children with and without incarcerated parents, they did not mitigate the negative impact of parental incarceration on mental health outcomes. While PCEs attenuated the association between ACEs and mental health, parental incarceration status did not significantly moderate the interaction. These results highlight vulnerabilities and potential protective factors for children with incarcerated parents and have important implications for the development of multilevel intervention strategies that seek to promote resilience and reduce risk for this population.
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Affiliation(s)
| | - N Thomas
- Arizona State University, Tempe, USA
| | | | - L Hita
- Arizona State University, Tempe, USA
| | - A Blake
- Arizona State University, Tempe, USA
| | | | - B Fisher
- Arizona State University, Tempe, USA
| | - M Freeman
- Arizona State University, Tempe, USA
| | - D Chen
- Arizona State University, Tempe, USA
| | - C Berkel
- Arizona State University, Tempe, USA
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Bränn E, Vaina A, Daníelsdóttir HB, Thordardottir EB, Yang Q, Jakobsdóttir J, Aspelund T, Hauksdóttir A, Valdimarsdóttir UA, Lu D. Association between adverse childhood experiences and perinatal depressive symptoms: a cross-sectional analysis of 16,831 women in Iceland. Arch Womens Ment Health 2023; 26:839-849. [PMID: 37726573 PMCID: PMC10632282 DOI: 10.1007/s00737-023-01369-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 09/05/2023] [Indexed: 09/21/2023]
Abstract
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.
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Affiliation(s)
- Emma Bränn
- Institute of Environmental Medicine, Unit of Integrative Epidemiology, Karolinska Institutet, Stockholm, Sweden.
| | - Alexandra Vaina
- Institute of Environmental Medicine, Unit of Integrative Epidemiology, Karolinska Institutet, Stockholm, Sweden
| | | | - Edda Bjork Thordardottir
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavík, Iceland
- Mental Health Services, Landspitali, The National University Hospital of Iceland, Reykjavik, Iceland
| | - Qian Yang
- Department of Medicine, Unit of Clinical Epidemiology, Karolinska Institutet, Stockholm, Sweden
| | - Jóhanna Jakobsdóttir
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavík, Iceland
| | - Thor Aspelund
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavík, Iceland
| | - Arna Hauksdóttir
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavík, Iceland
| | - Unnur A Valdimarsdóttir
- Institute of Environmental Medicine, Unit of Integrative Epidemiology, Karolinska Institutet, Stockholm, Sweden
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavík, Iceland
| | - Donghao Lu
- Institute of Environmental Medicine, Unit of Integrative Epidemiology, Karolinska Institutet, Stockholm, Sweden
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Han D, Dieujuste N, Doom JR, Narayan AJ. A systematic review of positive childhood experiences and adult outcomes: Promotive and protective processes for resilience in the context of childhood adversity. Child Abuse Negl 2023; 144:106346. [PMID: 37473619 PMCID: PMC10528145 DOI: 10.1016/j.chiabu.2023.106346] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 06/06/2023] [Accepted: 07/07/2023] [Indexed: 07/22/2023]
Abstract
BACKGROUND Research on positive childhood experiences (PCEs) as counterparts to childhood adversity has surged in the last five years. A systematic review of the additive and interactive effects of childhood adversity and PCEs across adult outcomes is needed that contextualizes the long-term correlates of childhood experiences within a developmental perspective. OBJECTIVE The current review synthesizes the empirical evidence for PCEs as resilience factors for a range of adult outcomes. METHODS Articles published until May 2023 were systematically identified according to PRISMA Guidelines through PubMed and PsycINFO databases and references of included articles. Then, 131 records were screened, and 58 studies were included. RESULTS Higher levels of PCEs were significantly but modestly associated with lower levels of childhood adversity. Higher levels of PCEs were associated with outcomes reflecting mental health, psychosocial functioning, physical health and health behaviors, and psychosocial stress. Most studies found direct, promotive effects of PCEs for more favorable outcomes. Few studies found significant interaction effects between childhood adversity and PCEs on outcomes, suggesting that PCEs may more frequently directly promote positive outcomes rather than moderate the effects of adversity on outcomes. CONCLUSIONS Individuals' childhood adversity and PCEs are somewhat independent sets of experiences; many individuals experience both, and the presence of one does not preclude the other. PCEs predict more favorable outcomes independent of childhood adversity more often than they interact with and moderate the effects of adversity on outcomes. Although the literature base is steadily growing, more research on PCEs in diverse and international samples is needed.
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Affiliation(s)
- Deborah Han
- University of Denver, 2155 S. Race St., Denver, CO, United States, 80210.
| | - Nathalie Dieujuste
- University of Denver, 2155 S. Race St., Denver, CO, United States, 80210.
| | - Jenalee R Doom
- University of Denver, 2155 S. Race St., Denver, CO, United States, 80210.
| | - Angela J Narayan
- University of Denver, 2155 S. Race St., Denver, CO, United States, 80210.
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8
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Abstract
OBJECTIVES Adverse childhood experiences (ACEs) can drive poor adult mental and physical health, but the impact of early life protective factors should not be overlooked. Positive childhood experiences (PCEs) measures quantify protective factors, but evidence is lacking on their link to health conditions independent of ACEs in nationally representative studies. This study examines associations between composite PCE score and adult health, adjusting for ACEs. METHODS The most recent 2017 wave of the Panel Study of Income Dynamics, a nationally representative study and its 2014 Childhood Retrospective Circumstances supplement (n = 7496) collected adult health outcomes, PCEs, and ACEs. Multivariable logistic regression assessed associations between PCE score and adult self-rated health or condition diagnosis, with and without ACEs adjustment. Cox proportional hazards models examined relationships between PCEs, ACEs, and annual risk of diagnosis. RESULTS Adults with 5 to 6 PCEs had 75% (95% confidence interval [CI], 0.58-0.93) of the risk of fair/poor overall health and 74% of the risk of any psychiatric diagnosis (CI, 0.59-0.89) compared with those with 0 to 2 PCEs, independent of ACEs. In survival analysis models accounting for PCEs and ACEs, reporting 5 to 6 PCEs was associated with a 16% lower annual hazard of developing any adult psychiatric or physical condition (hazard ratio, 0.84; CI, 0.75-0.94); reporting 3+ ACEs was associated with a 42% higher annual hazard (CI, 1.27-1.59). CONCLUSIONS PCEs were independently associated with lower risks of fair or poor adult health, adult mental health problems, and developing any physical or mental health condition at any given age after adjusting for ACEs.
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Affiliation(s)
- Cher X. Huang
- David Geffen School of Medicine at UCLA, Los Angeles, California
- Department of Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Neal Halfon
- Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles,California
- Department of Health Policy & Management, UCLA Fielding School of Public Health, Los Angeles, California
| | - Narayan Sastry
- Institute for Social Research, University of Michigan, Ann Arbor, Michigan
| | - Paul J. Chung
- Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles,California
- Department of Health Policy & Management, UCLA Fielding School of Public Health, Los Angeles, California
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California
| | - Adam Schickedanz
- Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles,California
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Borg LE, Alhusen JL. A Review of Factors that Serve to Protect Pregnant and Post-partum Women from Negative Outcomes Associated with Adverse Childhood Experiences. Matern Child Health J 2023:10.1007/s10995-023-03689-2. [PMID: 37294463 DOI: 10.1007/s10995-023-03689-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2023] [Indexed: 06/10/2023]
Abstract
PURPOSE The objective of this review is to examine factors, during the perinatal period, that serve to protect women and infants from poor mental or physical outcomes most commonly associated with maternal adverse childhood experiences (ACEs). METHODS The electronic databases of PubMed, Ovid MEDLINE, CINAHL and Web of Science were searched. The searches were conducted using the following mesh terms and keywords: ('adverse childhood experiences' or 'ACEs') and ('protective factor' or 'social support' or 'buffer' or 'resilience') and ('pregnan*' or 'prenatal' or 'postpartum' or 'maternal' or 'antenatal'). Studies that examined the association of maternal ACEs and protective factors during the perinatal period were included. A total of 317d articles were screened and 19 are included in this review. The quality of the articles was evaluated with the Newcastle-Ottawa-Scale (NOS). RESULTS AND CONCLUSION This review indicates a positive association between maternal ACEs and protective perinatal factors including social support, resiliency and positive childhood experiences.
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Affiliation(s)
- Lori E Borg
- School of Nursing, University of Virginia, 225 Jeanette Lancaster Way, Charlottesville, VA, 22903, USA.
| | - Jeanne L Alhusen
- School of Nursing, University of Virginia, 225 Jeanette Lancaster Way, Charlottesville, VA, 22903, USA
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Arnold R, Ahmed F, Clarke A, Quinn N, Beenstock J, Holland P. The relationship between parental adverse childhood experiences and the health, well-being and development outcomes of their children: a systematic review. Public Health 2023; 219:146-153. [PMID: 37186980 DOI: 10.1016/j.puhe.2023.03.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 03/21/2023] [Accepted: 03/29/2023] [Indexed: 05/17/2023]
Abstract
OBJECTIVES A growing body of research is emerging regarding the relationship between parental adverse childhood experiences (ACEs) and negative health, well-being and developmental outcomes in their children. This systematic review seeks to understand the relationship between parental ACEs and the health, well-being and developmental outcomes of their children and whether the relationships differ according to the number and type of parental ACEs. STUDY DESIGN Systematic review. METHOD The review includes articles published between 2000 and 2021 from studies using quantitative longitudinal methods and multivariate analysis to investigate the relationship between parental ACEs and their offspring's outcomes. Relevant studies were identified through a systematic search of five databases and findings synthesised using a narrative synthesis. This review was registered on PROSPERO (CRD42021274068). RESULTS Nineteen studies met the inclusion criteria and were included in the review. This resulted in a combined population sample of 124,043 parents and 128,400 children. Diversity in measurement of parental ACE exposure and in the type of ACEs measured within the studies precluded a meta-analysis. Offspring of parents exposed to ACEs had a higher risk of a range of negative health, well-being and developmental outcomes. This relationship differs according to the number and type of parental ACEs, with a positive relationship observed between the number of parental ACEs and the risk of negative health, well-being and development outcomes in their children. CONCLUSIONS These findings indicate that screening for parental ACEs by health visitors, midwives and other health or social care staff may identify an at-risk population of infants, children and adolescents and improve child outcomes.
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Affiliation(s)
- R Arnold
- Cheshire and Wirral Partnership NHS Foundation Trust, Chester, England, UK.
| | - F Ahmed
- Division of Health Research, Lancaster University, UK
| | - A Clarke
- Lancashire & South Cumbria NHS Foundation Trust, Preston, England, UK; Save the Children UK, London, England, UK
| | - N Quinn
- Lancashire & South Cumbria NHS Foundation Trust, Preston, England, UK
| | - J Beenstock
- Lancashire & South Cumbria NHS Foundation Trust, Preston, England, UK
| | - P Holland
- Division of Health Research, Lancaster University, UK
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Swedo EA, D'Angelo DV, Fasula AM, Clayton HB, Ports KA. Associations of Adverse Childhood Experiences With Pregnancy and Infant Health. Am J Prev Med 2023; 64:512-524. [PMID: 36697281 PMCID: PMC10033436 DOI: 10.1016/j.amepre.2022.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 10/25/2022] [Accepted: 10/27/2022] [Indexed: 01/25/2023]
Abstract
INTRODUCTION Adverse childhood experiences are associated with a host of negative outcomes; however, few have studied cumulative adverse childhood experiences in the context of pregnancy and infant health. This study examines state-level prevalence of adverse childhood experiences and associations with pregnancy- and infant health‒related indicators. METHODS The study used 2016-2018 Pregnancy Risk Assessment Monitoring System population-based data from 5 states. Analyses were conducted for individual states and grouped states using similar adverse childhood experience items. Thirteen adverse childhood experience measures were included across 3 domains: abuse, neglect, and household challenges. Adverse childhood experience scores were calculated for the number of adverse childhood experiences experienced (0, 1, 2, ≥3) on the basis of available state measures. Fourteen pregnancy- and infant health‒related indicators were examined, including unwanted pregnancy, adequate prenatal care, experiences during pregnancy (e.g., smoking, abuse, depression), gestational diabetes, hypertensive disorders of pregnancy, birth outcomes (e.g., preterm birth), and breastfeeding. Adjusting for demographics, parity, health insurance status, and educational attainment, prevalence ratios and 95% CIs were calculated to examine the associations between pregnancy- and infant health‒related indicators and adverse childhood experience scores. RESULTS Over 50% of respondents reported at least 1 adverse childhood experience and 13%-31% reported ≥3 adverse childhood experiences, depending on the state. Significant associations were identified in all adjusted models between adverse childhood experiences and unwanted pregnancy, smoking, physical abuse, and depression during pregnancy. CONCLUSIONS Adverse childhood experiences are associated with risk factors that impact pregnancy and infant health. Preventing and mitigating adverse childhood experiences is an important strategy to improve pregnancy- and infant health‒related indicators.
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Affiliation(s)
- Elizabeth A Swedo
- From the Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia.
| | - Denise V D'Angelo
- From the Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Amy M Fasula
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Heather B Clayton
- From the Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Katie A Ports
- and the Health Equity Research Applied, Albuquerque, New Mexico
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Clark HM, Hankin BL, Narayan AJ, Davis EP. Risk and resilience factors for psychopathology during pregnancy: An application of the Hierarchical Taxonomy of Psychopathology (HiTOP). Dev Psychopathol 2023:1-17. [PMID: 36734236 PMCID: PMC10397364 DOI: 10.1017/s0954579422001390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Pregnancy is a time of increased vulnerability to psychopathology, yet limited work has investigated the extent to which variation in psychopathology during pregnancy is shared and unshared across syndromes and symptoms. Understanding the structure of psychopathology during pregnancy, including associations with childhood experiences, may elucidate risk and resilience factors that are transdiagnostic and/or specific to particular psychopathology phenotypes. Participants were 292 pregnant individuals assessed using multiple measures of psychopathology. Confirmatory factor analyses found evidence for a structure of psychopathology consistent with the Hierarchical Taxonomy of Psychopathology (HiTOP). A common transdiagnostic factor accounted for most variation in psychopathology, and both adverse and benevolent childhood experiences (ACEs and BCEs) were associated with this transdiagnostic factor. Furthermore, pregnancy-specific anxiety symptoms most closely reflected the dimension of Fear, which may suggest shared variation with manifestations of fear that are not pregnancy-specific. ACEs and BCEs also linked to specific prenatal psychopathology involving thought problems, detachment, and internalizing, externalizing, antagonistic, and antisocial behavior. These findings extend the dimensional and hierarchical HiTOP model to pregnant individuals and show how maternal childhood risk and resilience factors relate to common and specific forms of psychopathology during pregnancy as a period of enhanced vulnerability.
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Affiliation(s)
- Hannah M Clark
- Department of Psychology, Brandeis University, 415 South St., Waltham, MA, 02453, USA
| | - Benjamin L Hankin
- Department of Psychology, University of Illinois at Urbana-Champaign, 603 East Daniel St., Champaign, IL, 61820, USA
| | - Angela J Narayan
- Department of Psychology, University of Denver, 2155 South Race St., Denver, CO, 80208, USA
| | - Elysia Poggi Davis
- Department of Psychology, University of Denver, 2155 South Race St., Denver, CO, 80208, USA
- Department of Pediatrics, University of California, Irvine, 3028 Hewitt Hall, Irvine, CA, 92697, USA
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Fields K, Shreffler KM, Ciciolla L, Baraldi AN, Anderson M. Maternal childhood adversity and prenatal depression: the protective role of father support. Arch Womens Ment Health 2023; 26:89-97. [PMID: 36401128 DOI: 10.1007/s00737-022-01278-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 11/07/2022] [Indexed: 11/21/2022]
Abstract
Depression during pregnancy is common, and previous research suggests childhood adversity may increase the risk for prenatal depression. Support during pregnancy can buffer these risks, and paternal support is associated with improved maternal well-being during pregnancy. There is evidence to suggest that increased support from fathers may be particularly helpful in combatting depressive symptoms for mothers with adverse childhood experiences. The study aims to explore the role of biological father support as a protective factor against the risks associated with childhood adversity for maternal prenatal depression. Sample included 133 pregnant women recruited from two university-affiliated OB-GYN clinics serving diverse and low-income patients. Participants completed measures on childhood adversity, prenatal depressive symptoms, and father support. Results showed a significant moderating effect of father support on the relation between maternal ACEs and prenatal depressive symptoms, suggesting that higher levels of father support are protective against prenatal depressive symptoms, specifically in mothers with low-to-moderate ACEs. These results highlight the positive impact of paternal support for maternal well-being during pregnancy. Although mothers with low-to-moderate ACEs experience a buffering effect of father support, mothers with high levels of childhood adversity remain at elevated risk for prenatal depressive symptoms even with high father support. As such, screening mothers for ACEs in addition to father support may help identify those at higher risk of prenatal depression.
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Affiliation(s)
- Kristin Fields
- Department of Psychology, Oklahoma State University, 116 The Psychology Building, Stillwater, OK, 74078, USA.
| | - Karina M Shreffler
- Fran and Earl Ziegler College of Nursing, University of Oklahoma Health Sciences Center, 1100 N. Stonewall Ave., Oklahoma City, OK, 73117, USA
| | - Lucia Ciciolla
- Department of Psychology, Oklahoma State University, 116 The Psychology Building, Stillwater, OK, 74078, USA
| | - Amanda N Baraldi
- Department of Psychology, Oklahoma State University, 116 The Psychology Building, Stillwater, OK, 74078, USA
| | - Machele Anderson
- Edson College of Nursing and Health Innovation, Arizona State University, 550 N. 3rd Street, Phoenix, AZ, 85004, USA
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14
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Lombardi BN, Jensen TM, Parisi AB, Jenkins M, Bledsoe SE. The Relationship Between a Lifetime History of Sexual Victimization and Perinatal Depression: A Systematic Review and Meta-Analysis. Trauma Violence Abuse 2023; 24:139-155. [PMID: 34132148 PMCID: PMC9660263 DOI: 10.1177/15248380211021611] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND The association between a lifetime history of sexual victimization and the well-being of women during the perinatal period has received increasing attention. However, research investigating this relationship has yet to be systematically reviewed or quantitatively synthesized. AIM This systematic review and meta-analysis aims to calculate the pooled effect size estimate of the statistical association between a lifetime history of sexual victimization and perinatal depression (PND). METHOD Four bibliographic databases were systematically searched, and reference harvesting was conducted to identify peer-reviewed articles that empirically examined associations between a lifetime history of sexual victimization and PND. A random effects model was used to ascertain an overall pooled effect size estimate in the form of an odds ratio and corresponding 95% confidence intervals (CIs). Subgroup analyses were also conducted to assess whether particular study features and sample characteristic (e.g., race and ethnicity) influenced the magnitude of effect size estimates. RESULTS This review included 36 studies, with 45 effect size estimates available for meta-analysis. Women with a lifetime history of sexual victimization had 51% greater odds of experiencing PND relative to women with no history of sexual victimization (OR = 1.51, 95% CI [1.35, 1.67]). Effect size estimates varied considerably according to the PND instrument used in each study and the racial/ethnic composition of each sample. CONCLUSION Findings provide compelling evidence for an association between a lifetime history of sexual victimization and PND. Future research should focus on screening practices and interventions that identify and support survivors of sexual victimization perinatally.
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Affiliation(s)
- Brooke N. Lombardi
- School of Social Work, University of North Carolina at Chapel Hill,
NC, USA
| | - Todd M. Jensen
- School of Social Work, University of North Carolina at Chapel Hill,
NC, USA
| | - Anna B. Parisi
- School of Social Work, University of North Carolina at Chapel Hill,
NC, USA
| | - Melissa Jenkins
- School of Social Work, University of North Carolina at Chapel Hill,
NC, USA
| | - Sarah E. Bledsoe
- School of Social Work, University of North Carolina at Chapel Hill,
NC, USA
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15
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Chasson M, Taubman – Ben-Ari O. The contribution of childhood experiences, maternal disintegrative responses, and self-compassion to maternal self-efficacy and role satisfaction: a prospective study. Curr Psychol 2022. [DOI: 10.1007/s12144-022-04085-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
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16
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Nowak AL, Braungart-Rieker JM, Kuo PX. Social support moderates the relation between childhood trauma and prenatal depressive symptoms in adolescent mothers. J Reprod Infant Psychol 2022; 40:644-658. [PMID: 34120538 PMCID: PMC8665937 DOI: 10.1080/02646838.2021.1938980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 05/31/2021] [Indexed: 01/04/2023]
Abstract
BACKGROUND Depression is a concern during pregnancy, but it is especially prevalent for pregnant adolescents. Because prenatal depression is a strong predictor of postpartum depression and other forms of psychopathology in both mothers and children, it is important to understand potential risk and protective factors for prenatal depression. OBJECTIVES The present study examined whether social support buffered the impact of childhood trauma on prenatal depression, and whether social support exerted a stronger buffering effect for adolescents compared to adults. METHOD Self-reported levels of childhood trauma, social support, and prenatal depression were collected in a racially and ethnically diverse sample of 682 first-time mothers, 58% were adolescents (n = 396; Mage = 17.38 years) and 42% were adults (n = 286; Mage = 26.29 years). RESULTS Using multi-group moderation analyses, we found that pregnant adolescents with more social support were buffered from the effects of childhood trauma on prenatal depression symptoms, but pregnant adults with more social support were not. CONCLUSION Findings support the stress-buffering model in that those with more stressors may benefit more from social support than those with fewer stressors. These results highlight the importance of social support and inform prenatal depression prevention/intervention strategies particularly with pregnant adolescents.
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Affiliation(s)
- Amanda L. Nowak
- College of Arts & Sciences, University of Maine at Augusta, Augusta, United States
| | - Julia M. Braungart-Rieker
- Department of Human Development and Family Studies, Colorado State University, Fort Collins, United States
| | - Patty X. Kuo
- Department of Child, Youth, and Family Studies, University of Nebraska–Lincoln, Lincoln, United States
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Yu Z, Wang L, Chen W, Zhang J, Bettencourt AF. Positive Childhood Experiences Associate with Adult Flourishing Amidst Adversity: A Cross Sectional Survey Study with a National Sample of Young Adults. Int J Environ Res Public Health 2022; 19:14956. [PMID: 36429674 PMCID: PMC9690672 DOI: 10.3390/ijerph192214956] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 11/02/2022] [Accepted: 11/05/2022] [Indexed: 06/16/2023]
Abstract
The purpose of this study was to examine the prevalence of PCEs among young adults in Mainland China and the extent to which the cumulative number of PCEs moderates the associations between ACEs and flourishing in adulthood. Between August and November 2020, we used convenience and snowball sampling to recruit 9468 young adults, ages 18-35, enrolled in undergraduate or graduate programs at universities in Mainland China to participate in a survey, which included measures on flourishing, exposure to ACEs and PCEs, and demographic characteristics. Approximately 92% of participants reported experiencing seven to nine PCEs, with harmonious family relationships (96.9%), feeling supported by friends (96.8%) and being treated fairly at school (96.3%) being the most common PCEs reported. Results of the multiple regression indicated that the cumulative number of PCEs statistically significantly moderated the relation between the cumulative number of ACEs and flourishing (interaction term b = -0.060 [-0.071, -0.049], p < 0.001, adjusted R2 = 0.183); as the number of ACEs increased up through eight ACEs, decreases in flourishing were smaller among those with higher numbers of PCEs. PCEs are common among young adults from Mainland China and serve a potential buffering effect against exposure to ACEs.
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Affiliation(s)
- Zhiyuan Yu
- School of Nursing, Johns Hopkins University, Baltimore, MD 21205, USA
| | - Lin Wang
- School of Nursing, Shanghai Jiao Tong University, Shanghai 200025, China
| | - Wenyi Chen
- School of Nursing, Johns Hopkins University, Baltimore, MD 21205, USA
| | - Juan Zhang
- International Peace Maternity and Children Hospital of China Welfare Institution, Departments of Nursing, School of Medicine, Shanghai Jiao Tong University, Shanghai 200025, China
| | - Amie F. Bettencourt
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Johns Hopkins University, Baltimore, MD 21205, USA
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18
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Corona K, Chavez T, Stewart K, Toledo-Corral CM, Farzan SF, Habre R, Grubbs B, Al-Marayati L, Lurvey N, Lerner D, Eckel SP, Lagomasino I, Breton CV, Bastain TM. Adverse childhood experiences and prenatal depression in the maternal and development risks from environmental and social stressors pregnancy cohort. J OBSTET GYNAECOL 2022; 42:3014-3020. [PMID: 36178435 PMCID: PMC9851371 DOI: 10.1080/01443615.2022.2125298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
The aim of this study was to examine the association between adverse childhood experiences (ACEs) and risk for depression among 480 predominantly low-income Hispanic/Latina women in the Maternal and Development Risks from Environmental and Social Stressors pregnancy cohort. Models were fitted to evaluate associations between ACEs and prenatal probable depression measured by the Center for Epidemiologic Studies-Depression Scale adjusting for recruitment site, age, income, race/ethnicity, marital status and parity. The ACEs Questionnaire parameterised experiences as counts (0-10), categories (0, 1-3 and 4+ ACEs) and domains. Participants had a significantly higher likelihood of prenatal probable depression per unit increase in ACEs count or if they reported 4+ ACEs relative to 0 ACEs. Higher likelihood of probable depression was also associated with higher counts of each ACEs domains: abuse, neglect and household dysfunction. Findings suggest systematic screening for depressive symptoms in those with a history of childhood adversities may be important in prenatal care practice.Impact StatementWhat is already known on this subject? Experiencing depression during pregnancy has been associated with later adverse maternal mental and physical health outcomes. Emerging studies indicate that adverse childhood experiences (ACEs) may maintain or increase the predisposition to prenatal depression.What do the results of this study add? Although prenatal depressive symptoms are prevalent among racial/ethnic minority samples including Hispanic/Latinas, research determining whether the association between ACEs and prenatal depression varies by nativity is scarce. Overall, ACEs were common among Maternal and Developmental Risks from Environmental and Social Stressors (MADRES) participants and were associated with a higher likelihood of probable depression during pregnancy. These patterns did not significantly differ among the foreign-born versus U.S.-born Hispanic/Latina women, although the associations were stronger among U.S.-born Hispanic/Latina women.What are the implications of these findings for clinical practice and/or further research? Research should continue to focus on the effects of ACEs in communities that have been historically excluded in perinatal mental health services such as pregnant women from racial and ethnic minority groups. It may be important for clinicians to routinely screen for mental health during pregnancy as an adverse, psychological environment may impact both women and children. These findings suggest a need for improvement in systematic screening for depressive symptoms in those with a history of childhood adversities.
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Affiliation(s)
- Karina Corona
- Department of Population and Public Health Sciences, University of Southern California
| | - Thomas Chavez
- Department of Population and Public Health Sciences, University of Southern California
| | - Kennedy Stewart
- Department of Health Sciences, California State University, Northridge
| | - Claudia M. Toledo-Corral
- Department of Population and Public Health Sciences, University of Southern California
- Department of Health Sciences, California State University, Northridge
| | - Shohreh F. Farzan
- Department of Population and Public Health Sciences, University of Southern California
| | - Rima Habre
- Department of Population and Public Health Sciences, University of Southern California
| | - Brendan Grubbs
- Department of Obstetrics and Gynecology, University of Southern California
| | - Laila Al-Marayati
- Department of Obstetrics and Gynecology, University of Southern California
| | | | | | - Sandrah P. Eckel
- Department of Population and Public Health Sciences, University of Southern California
| | - Isabel Lagomasino
- Department of Psychiatry and Behavioral Sciences, University of Southern California
| | - Carrie V. Breton
- Department of Population and Public Health Sciences, University of Southern California
| | - Theresa M. Bastain
- Department of Population and Public Health Sciences, University of Southern California
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Ishikawa K, Azuma N, Ohka M. Intergenerational Transmission of Maternal Adverse Childhood Experiences on Next Generation's Development: A Mini-Review. Front Psychol 2022; 13:852467. [PMID: 35645853 PMCID: PMC9131025 DOI: 10.3389/fpsyg.2022.852467] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 04/01/2022] [Indexed: 11/13/2022] Open
Abstract
(Adverse childhood experiences (ACEs) have extremely harmful impacts on an individual’s physical, social and mental health throughout their life-span. Recently, it has been reported that maternal ACEs increase the risk of developmental delay in the offspring across generations. This mini review focuses on the direct relationship between maternal ACEs and child developmental delay, and potential mediators/moderators that associate their relationship. Six studies were identified using three search engines. The results indicated that four out of six studies reported at least one significant direct association between maternal ACEs and child development. Additionally, maternal biological, psychological, and social factors were identified as mediators or moderators. In summary, we identified that maternal ACEs increased the risk of developmental delay in children via biological and psychosocial pathways. Future research should examine potential buffering factors and identify when it is crucial to break the intergenerational transmission.
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Affiliation(s)
- Keita Ishikawa
- Department of Clinical Psychology, Graduate School of Education, The University of Tokyo, Tokyo, Japan
| | - Natsuko Azuma
- Department of Clinical Psychology, Graduate School of Education, The University of Tokyo, Tokyo, Japan
| | - Mai Ohka
- Department of Clinical Psychology, Graduate School of Education, The University of Tokyo, Tokyo, Japan
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20
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Cárdenas EF, Kujawa A, Humphreys KL. Benevolent Childhood Experiences and Childhood Maltreatment History: Examining their Roles in Depressive Symptoms Across the Peripartum Period. Advers Resil Sci 2022; 3:169-179. [PMID: 37113656 PMCID: PMC10128865 DOI: 10.1007/s42844-022-00062-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/05/2022] [Indexed: 04/29/2023]
Abstract
Peripartum depressive symptoms are associated with a range of adverse outcomes for offspring and mothers. Childhood experiences, both negative and positive, may impact peripartum depression risk. Longitudinal studies are needed to examine trajectories of change in depression across the peripartum and predictors of symptoms across time. We examined the associations between women's reports of specific childhood experiences and trajectories of depressive symptoms across the peripartum period. Participants were 208 pregnant women (Mage=30.31, SD=5.45, range=20-45 years) at the prenatal session. Participants completed follow up sessions approximately 1 month and 6 months postpartum. At baseline, participants completed questionnaire measures of benevolent childhood experiences, childhood maltreatment, and depressive symptoms. Greater benevolent childhood experiences were associated with lower depressive symptoms across the peripartum period. The association with postpartum symptoms remained significant even when covarying antepartum depressive symptoms, indicating that benevolent childhood experiences may protect against postpartum depressive symptoms even after accounting for earlier symptoms. We did not find significant associations between childhood maltreatment and depressive symptoms. These findings extend previous research on benevolent childhood experiences by offering insight into unique associations with symptoms across the peripartum period.
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Affiliation(s)
- Emilia F Cárdenas
- Vanderbilt University, Department of Psychology and Human Development
| | - Autumn Kujawa
- Vanderbilt University, Department of Psychology and Human Development
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21
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Jasthi DL, Nagle-Yang S, Frank S, Masotya M, Huth-Bocks A. Associations Between Adverse Childhood Experiences and Prenatal Mental Health and Substance Use Among Urban, Low-Income Women. Community Ment Health J 2022; 58:595-605. [PMID: 34184153 DOI: 10.1007/s10597-021-00862-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 06/10/2021] [Indexed: 10/21/2022]
Abstract
This study examined associations between Adverse Childhood Experiences (ACEs) and perinatal mental health and substance use among 98 low-income women (mean age 25.4 years; 93% Black/African American) referred to a mental health care manager in an urban women's clinic. Self-report and retrospective chart review data were utilized. Chi-squared and Fisher's Exact tests were performed to assess bivariate relationships between ACEs and mental health and substance use outcomes. Multivariate logistic regressions were used to examine the impact of ACEs on mental health and substance use, adjusting for marital status, education, and age. Findings indicate high levels of childhood adversity, specifically childhood abuse, are associated with negative perinatal mental health and substance use outcomes, including suicidal thoughts, anxiety, mood dysregulation, and tobacco and marijuana use. Inquiring about ACEs during prenatal care and/or in community health clinics may help identify patients' overall risk and provide opportunities for intervention for mothers and their infants.
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22
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Hou H, Zhang C, Tang J, Wang J, Xu J, Zhou Q, Yan W, Gao X, Wang W. Childhood Experiences and Psychological Distress: Can Benevolent Childhood Experiences Counteract the Negative Effects of Adverse Childhood Experiences? Front Psychol 2022; 13:800871. [PMID: 35282200 PMCID: PMC8914177 DOI: 10.3389/fpsyg.2022.800871] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 01/17/2022] [Indexed: 11/13/2022] Open
Abstract
Background Childhood experiences can exert a huge impact on adult psychological conditions. Previous studies have confirmed the effects of adverse childhood experiences (ACEs) and benevolent childhood experiences (BCEs) on psychological distress (e.g., stress, depression, and suicidal ideation) separately, but few studies explored a combined effect of ACEs and BCEs on psychological distress. The aim of this study was to explore a combined effect of ACEs and BCEs on psychological distress among Chinese undergraduates. Methods Participants were undergraduates aged 17–24 years (N = 1,816) and completed a self-reported questionnaire. A series of regression analyses were conducted to examine the association between childhood experiences and psychological distress. Results A total of 65.7% of undergraduates had BCEs, 27.1% of undergraduates had ACEs, and 12.9% of undergraduates had ACEs and BCEs simultaneously. Logistic regression analysis indicated that undergraduates who experienced high ACEs were more likely to have a high risk of psychological distress [odds ratio (ORs) = 1.46, 1.84, and 3.15 for uncertainty stress, depressive symptoms, and suicidal ideation, respectively], while undergraduates who experienced High BCEs were less likely to have psychological distress (ORs = 0.33, 0.22, and 0.32 for uncertainty stress, depressive symptoms, and suicidal ideation, respectively) compared with Low-Both group. The combined effect of ACEs and BCEs (High-Both group) could also play as a protective factor in uncertainty stress (OR = 0.56) and depressive symptoms (OR = 0.47). Conclusion Our findings suggested that ACEs and BCEs could not only predict the psychological distress independently, but also BCEs could counteract the negative effect of ACEs in psychological problems. There is an even greater need to identify and support the victims of ACEs and to increase BCEs in early childhood.
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Affiliation(s)
- Hao Hou
- Department of Community and Health Education, School of Public Health, Xuzhou Medical University, Xuzhou, China
| | - Caochen Zhang
- Department of Community and Health Education, School of Public Health, Xuzhou Medical University, Xuzhou, China
| | - Jie Tang
- Department of Community and Health Education, School of Public Health, Xuzhou Medical University, Xuzhou, China
| | - Jingjing Wang
- Department of Community and Health Education, School of Public Health, Xuzhou Medical University, Xuzhou, China
| | - Jiaqi Xu
- School of Medical Technology, Xuzhou Medical University, Xuzhou, China
| | - Qin Zhou
- The Affiliated Xuzhou Oriental Hospital of Xuzhou Medical University, Xuzhou, China
| | - Wenjun Yan
- Department of Community and Health Education, School of Public Health, Xuzhou Medical University, Xuzhou, China
| | - Xiuyin Gao
- Department of Community and Health Education, School of Public Health, Xuzhou Medical University, Xuzhou, China
| | - Wei Wang
- Department of Community and Health Education, School of Public Health, Xuzhou Medical University, Xuzhou, China
- Center for Medical Statistics and Data Analysis, Xuzhou Medical University, Xuzhou, China
- Key Laboratory of Human Genetics and Environmental Medicine, Xuzhou Medical University, Xuzhou, China
- *Correspondence: Wei Wang,
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Abstract
Background: Adverse childhood experiences (ACEs) are potentially traumatic events, which can have long-term, negative consequences. Few studies have examined ACEs' relationship to marijuana use. Objectives: We examined the association between ACEs and past-month marijuana use among adults and the pathways between childhood adversity and marijuana use. Methods: Adults from five states (n = 22,991) who responded to the 2019 Behavioral Risk Factors Surveillance System were included. We examined the prevalence of ACEs and marijuana use. We employed generalized structural equation modeling to assess the relationship between ACEs and marijuana use and the role of depression and poor mental and physical health as possible mediators. Results: Overall, 65.0% of the population reported 1+ ACE. Heavy marijuana use and past-month marijuana use prevalence rates were 10.3% and 5.0%, respectively. We found mediation effects for depression and poor mental health but not poor physical health. The number of ACEs was associated with a statistically significant increase in any past-month marijuana use-indirect effects ranged from 1.0 (95% CI, 1.0-1.0) to 1.4 (95% CI, 1.2-1.7), direct effects ranged from 1.1 (95% CI, 07-1.7) to 5.3 (95% CI 3.2-8.8), and total effects ranged from 1.1 (95% CI, 0.7-1.7) to 5.9 (95% CI, 3.6-9.8). Women, married persons, and middle aged and older adults had a lower odds of marijuana use. Reporting at least one HIV risk behavior was associated with an increased odds of marijuana use. Conclusion: ACE exposure was positively associated with marijuana use. Depression and poor mental health separately mediated this relationship.
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Affiliation(s)
- Ellen T Kurtzman
- School of Nursing, The George Washington University, Washington, DC, USA
| | - Jessica Greene
- Marxe School of Public and International Affairs, Baruch College, City University of New York, New York, New York, USA
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Xu Z, Zhang D, Ding H, Zheng X, Lee RCM, Yang Z, Mo PKH, Lee EKP, Wong SYS. Association of positive and adverse childhood experiences with risky behaviours and mental health indicators among Chinese university students in Hong Kong: an exploratory study. Eur J Psychotraumatol 2022; 13:2065429. [PMID: 35646294 PMCID: PMC9135422 DOI: 10.1080/20008198.2022.2065429] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Different childhood experiences may affect adult health differently. OBJECTIVE To explore the association of different types of positive childhood experiences(PCEs) and adverse childhood experiences (ACEs) with risky behaviours and mental health indicators, andhow PCEs and ACEs are associated with health outcomes in the context of each other. METHOD This was an exploratory cross-sectional online survey including 332 university students in Hong Kong. ACEs (abuse and household challenges), PCEs (perceived safety, positive quality of life, and interpersonal support), risky behaviours (smoking, binge drinking, and sexual initiation), and mental health indicators(depression, anxiety, loneliness, self-rated health, multimorbidity, meaning in life, and life satisfaction)were measured. RESULTS The multivariable logistic regression analysis indicated cumulative effects of PCEs in lowered risks of depression, anxiety, loneliness, as well as better self-rated health, life satisfaction, and meaning in life (p < .05), after adjusting for ACEs. Results also indicated that ACEs had an increasing relationship with poorer mental health indicators, such as anxiety, loneliness, and life satisfaction (p < .05), after adjusting for PCEs. There was also an adverse association between having ≥4 ACEs with smoking and binge drinking. In addition, each type of PCE and ACE was significantly associated with one or more risky behaviours and mental health indicators. Stratified results showed that PCEs had stronger associations with mental health indicators in participants with fewer ACEs. Furthermore, ACEs had stronger associations with mental health indicators in participants with more PCEs than in those with fewer PCEs. CONCLUSIONS In this study, PCE was proven to be an independent protective factor against poor mental health after accounting for ACE. ACE was also proven to be an independent risk factor for poor mental health and risky behaviours. These findings suggest a crucial need for the active promotion of PCEs and the prevention of child maltreatment. The results of subtypes and stratifications can be taken into consideration when developing targeted interventions in the future. HIGHLIGHTS PCE is an independent protective factor against poor mental health after accounting for ACE. ACE is an independent risk factor for poor mental health and risky behaviours.PCEs and ACEs have different associations with health outcomes in the context of one another.
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Affiliation(s)
- Zijun Xu
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, People's Republic of China
| | - Dexing Zhang
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, People's Republic of China
| | - Hanyue Ding
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, People's Republic of China
| | - Xiaoxiang Zheng
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, People's Republic of China
| | - Rym Chung-Man Lee
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, People's Republic of China
| | - Zuyao Yang
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, People's Republic of China
| | - Phoenix Kit-Han Mo
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, People's Republic of China
| | - Eric Kam-Pui Lee
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, People's Republic of China
| | - Samuel Yeung-Shan Wong
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, People's Republic of China
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Evans MG, Theall KP, Jackson C, Drury S. Racial Differences in the Risk of Prenatal Depression Among Women Experiencing Childhood and Adult Stressors. Matern Child Health J 2021. [PMID: 34854028 DOI: 10.1007/s10995-021-03322-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Stress exposure during a woman's own childhood and adulthood likely elevate risk of prenatal depression (PND). However, most PND screening tools fail to assess for events prior to conception. This study examined the differential effects of adverse childhood experiences (ACE) and adult life stressors on PND. METHODS This cross-sectional study was conducted among 199 racially diverse pregnant women, ages 18 to 43, recruited from clinics and ongoing university-based studies between 2012 and 2018. The ACE Scale assessed maternal childhood trauma exposure. Validated scales examining subjective stressors assessed for chronic adult stressors. PND was assessed with the Edinburgh Depression Scale, with the Rini Pregnancy-Related Anxiety Scale as a covariate. Associations were measured using multivariable linear regression modeling. Results were stratified by self-identified Black or white race. RESULTS Among 199 participants, mean age was 26.8 years and 67.8% were Black. Controlling for age, race, education, and prenatal anxiety, all participants reporting both childhood trauma and adult stressors were at increased risk for PND (p < 0.0001). PND risk was increased among Black women with childhood stressors (p < 0.01) or three or more adult stressors (p < 0.0001) and among White women following any number of adult stressors (p < 0.001). DISCUSSION These findings highlight the importance of cumulative exposure to stress and trauma across the life span as indicators of risk for PND. Black and white participants had differential development of risk, depending on timing and number of exposures. Prenatal depression risk screening during routine prenatal care should include an assessment of current and historical trauma and stressors.
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Kornfield SL, White LK, Waller R, Njoroge W, Barzilay R, Chaiyachati BH, Himes MM, Rodriguez Y, Riis V, Simonette K, Elovitz MA, Gur RE. Risk And Resilience Factors Influencing Postpartum Depression And Mother-Infant Bonding During COVID-19. Health Aff (Millwood) 2021; 40:1566-1574. [PMID: 34606353 DOI: 10.1377/hlthaff.2021.00803] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Acute stress during pregnancy can have adverse effects on maternal health and increase the risk for postpartum depression and impaired mother-infant bonding. The COVID-19 pandemic represents an acute environmental stressor during which it is possible to explore risk and resilience factors that contribute to postpartum outcomes. To investigate prenatal risk and resilience factors as predictors of postpartum depression and impaired mother-infant bonding, this study recruited a diverse cohort of 833 pregnant women from an urban medical center in Philadelphia, Pennsylvania, and assessed them once during pregnancy in the early phase of the COVID-19 pandemic (April-July 2020) and again at approximately twelve weeks postpartum. Adverse childhood experiences, prenatal depression and anxiety, and COVID-19-related distress predicted a greater likelihood of postpartum depression. Prenatal depression was the only unique predictor of impaired maternal-infant bonding after postpartum depression was controlled for. Women reporting greater emotion regulation, self-reliance, and nonhostile relationships had healthier postpartum outcomes. Policies to increase the number of nonspecialty providers providing perinatal mental health services as well as reimbursement for integrated care and access to mental health screening and care are needed to improve lifelong outcomes for women and their children.
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Affiliation(s)
- Sara L Kornfield
- Sara L. Kornfield is an assistant professor in the Penn Center for Women's Behavioral Wellness, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, in Philadelphia, Pennsylvania. Kornfield and Lauren K. White are co-first authors
| | - Lauren K White
- Lauren K. White is a research scientist in the Lifespan Brain Institute, Children's Hospital of Philadelphia and Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania. White and Sara L. Kornfield are co-first authors
| | - Rebecca Waller
- Rebecca Waller is an assistant professor in the Department of Psychology, University of Pennsylvania
| | - Wanjiku Njoroge
- Wanjiku Njoroge is an assistant professor in the Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania
| | - Ran Barzilay
- Ran Barzilay is an assistant professor in the Lifespan Brain Institute, Children's Hospital of Philadelphia and Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania
| | - Barbara H Chaiyachati
- Barbara H. Chaiyachati is an associate fellow in the Lifespan Brain Institute, Children's Hospital of Philadelphia and Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania
| | - Megan M Himes
- Megan M. Himes is a research assistant in the Lifespan Brain Institute, Children's Hospital of Philadelphia and Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania
| | - Yuheiry Rodriguez
- Yuheiry Rodriguez is a study coordinator in the Department of Psychology, University of Pennsylvania
| | - Valerie Riis
- Valerie Riis is the director of operations, Maternal and Child Health Research Center, Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania
| | - Keri Simonette
- Keri Simonette is a clinical research coordinator at Jefferson Health, in Philadelphia, Pennsylania. She was a project manager with the Maternal Child Health Research Center, Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, when this work was performed
| | - Michal A Elovitz
- Michal A. Elovitz is a professor in the Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania
| | - Raquel E Gur
- Raquel E. Gur is a professor in the Lifespan Brain Institute, Children's Hospital of Philadelphia and Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania
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Crandall A, Magnusson BM, Hanson CL, Leavitt B. The effects of adverse and advantageous childhood experiences on adult health in a low-income sample. Acta Psychol (Amst) 2021; 220:103430. [PMID: 34662773 DOI: 10.1016/j.actpsy.2021.103430] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 08/03/2021] [Accepted: 10/13/2021] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND Previous studies have indicated the advantageous childhood experiences (counter-ACEs) may improve health in adulthood regardless of adverse childhood experiences (ACEs) scores. However, these studies have primarily been conducted in low-risk communities, and little is known whether the results are similar in low-income settings. OBJECTIVE The purpose of this study was to examine the effects of ACEs and counter-ACEs on mental and physical health in a low-income sample. A secondary objective was to assess the effects of repeated and prolonged exposure to ACEs on later health. PARTICIPANTS AND SETTING The sample included 206 low-income adults living in the western United States who completed a survey about their childhood experiences and adult health. METHODS A series of logistic regression analyses were performed to examine the effects of ACEs and counter-ACEs on adult health. RESULTS Irrespective of ACEs, counter-ACEs were associated with lower odds of having two or more emotional and cognitive health problems and lower odds of suicidality in the past 12 months. When accounting for counter-ACEs, ACEs were associated with higher odds of having ever smoked and suicidality in the past 12 months, though these odds were attenuated compared to the unadjusted models. In the presence of repeated or prolonged ACEs exposure, counter-ACEs were associated with lower odds of having ever smoked and emotional and cognitive health problems. CONCLUSIONS The findings suggest that helping children develop healthy relationships within their family, community, and school may lead to improved health in adulthood even in the presence of poverty and childhood adversity.
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Sosnowski DW, Musci RJ, Johnson SB. Positive Functioning Moderates the Association between Classes of Adverse Childhood Experiences and Adolescent Depressive Symptoms. ACTA ACUST UNITED AC 2021; 2:157-68. [PMID: 34532713 DOI: 10.1007/s42844-021-00033-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Adverse childhood experiences (ACEs) are associated with short- and long-term psychological health, but most research, to date, relies on retrospective self-reports during adulthood to test this association. Moreover, there is limited evidence on how ACEs group together and differentially influence mental health, as well as factors that promote positive outcomes in the context of ACEs. The present study used secondary data of children and their biological parents from the Fragile Families and Child Wellbeing Study (N = 3,487; M age = 9.30, SD = .40 years; 52% male) to test if meaningful subgroups of ACE exposure existed at age 9, and if positive adolescent functioning moderated the association between ACE exposure class membership at age 9 and adolescent depressive symptoms at age 15. Results revealed three distinct classes: an impoverished and interpersonally abused class, a single-parent and impoverished class, and a low adversity class. Positive adolescent functioning moderated the association between class membership and depressive symptoms. Specifically, individuals in the impoverished and interpersonally abused and low adversity classes had the highest levels of depressive symptoms at low levels of positive functioning, and the lowest levels of depressive symptoms at high levels of positive functioning. Results support prior evidence that children experiencing interpersonal abuse group together into a latent class and provide a nuanced perspective on factors that promote positive functioning in the context of various constellations of ACEs.
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Doom JR, Seok D, Narayan AJ, Fox KR. Adverse and Benevolent Childhood Experiences Predict Mental Health During the COVID-19 Pandemic. ACTA ACUST UNITED AC 2021; 2:193-204. [PMID: 33907733 PMCID: PMC8062213 DOI: 10.1007/s42844-021-00038-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2021] [Indexed: 11/24/2022]
Abstract
Adverse childhood experiences (ACEs) are associated with poorer adult mental health, and benevolent childhood experiences (BCEs) are associated with better adult mental health. This study aims to test whether ACEs and BCEs predict adult mental health above and beyond current stress and social support during the COVID-19 pandemic. We analyzed data from undergraduate and graduate students (N = 502) at an urban private university in the Western United States. An online survey was conducted to assess ACEs and BCEs, current stress and social support, depressive and anxiety symptoms, perceived stress, and loneliness in May 2020. Higher levels of ACEs were associated with higher levels of depressive symptoms, β = 0.45, p = 0.002. Higher levels of BCEs were associated with lower depressive symptoms, β = −0.39, p = 0.03; lower perceived stress, β = −0.26, p = 0.002; and less loneliness, β = −0.12, p = 0.04. These associations held while controlling for current stress, social support, and socioeconomic status. Childhood experiences are associated with mental health during the COVID-19 pandemic. BCEs should be considered an important promotive factor, independent of ACEs, for psychological well-being during a global public health crisis. BCEs should be included along with ACEs in future research, assessment, and screening with distressed and vulnerable populations.
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Affiliation(s)
- Jenalee R Doom
- Department of Psychology, University of Denver, 2155 S. Race St, Denver, CO 80210 USA
| | - Deborah Seok
- Department of Psychology, University of Denver, 2155 S. Race St, Denver, CO 80210 USA
| | - Angela J Narayan
- Department of Psychology, University of Denver, 2155 S. Race St, Denver, CO 80210 USA
| | - Kathryn R Fox
- Department of Psychology, University of Denver, 2155 S. Race St, Denver, CO 80210 USA
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Goldstein BL, Briggs-Gowan M, Grasso DJ. The effects of Intimate Partner Violence and a history of Childhood Abuse on Mental Health and Stress during Pregnancy. J Fam Violence 2021; 36:337-346. [PMID: 34113060 PMCID: PMC8186840 DOI: 10.1007/s10896-020-00149-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
PURPOSE Maternal adverse childhood experiences (ACEs) and intimate partner violence (IPV) are temporally distinct risk factors that negatively impact mothers and their offspring. Risk associated with ACEs and IPV begin during pregnancy, a period of increased physical and psychological demands. The current study examined a person-centered method to empirically identify profiles of pregnant women based on type and severity of ACEs and past-year IPV. Profiles were then differentiated on psychosocial functioning indicators. METHODS A primarily Latinx, low socioeconomic sample of women (n = 225) completed measures assessing ACEs and past-year IPV, perceived and experienced stress, emotion regulation, and trauma-related symptoms during their third trimester. Latent profile analysis (LPA) was used to identify unique profiles of women based on seven dimensional indicators reflecting threat- and deprivation-based ACEs and IPV. RESULTS A 4-class solution best fit the data: (1) low probability of ACEs or IPV (64.9%), (2) childhood neglect-only (20.4%), (3) childhood abuse/neglect (10.2%), and (4) polytrauma characterized by a combination of childhood abuse, neglect, and IPV (4.4%). Women with the "childhood abuse/neglect" or "polytrauma" profiles reported more stress and symptoms than women with the "low exposure" profile. Women in the "childhood neglect-only" profile were generally similar to women in the "low exposure" profile, but did report greater difficulties in emotion regulation. CONCLUSIONS These results suggest that childhood abuse and IPV, exposure types involving threat, are potent correlates of stress, emotion regulation, and mental health difficulties during pregnancy. However, exposure characterized by deprivation alone generally did not increase difficulties.
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Affiliation(s)
| | | | - Damion J Grasso
- Department of Psychiatry, University of Connecticut School of Medicine
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Zhang L, Fang J, Zhang D, Wan Y, Gong C, Su P, Tao F, Sun Y. Poly-victimization and psychopathological symptoms in adolescence: Examining the potential buffering effect of positive childhood experiences. J Affect Disord 2021; 282:1308-1314. [PMID: 33601709 DOI: 10.1016/j.jad.2021.01.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 12/16/2020] [Accepted: 01/04/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Childhood maltreatment are well-established risk factors for adolescent psychopathology. Positive childhood experiences (PCEs) known protective factors. However, few studies have simultaneously investigated childhood maltreatment and PCEs in the context of longitudinal study. The aim of this paper was to assess the buffering effect of PCEs in adolescence in the association between chronic childhood maltreatment and psychological symptoms in adolescence. METHODS Data were from an ongoing longitudinal study with 2288 children aged 8.15 y at baseline who were recruited from 3 large elementary schools in China. Participants were followed up for four waves across 6 years. The associations between re-victimization and poly-victimization with adolescent psychopathological symptoms across different PCEs contexts were explored. RESULTS Poly-victimization was highly predictive of depressive symptoms, oppositional defiant disorder and conduct disorder. PCEs may mitigate the negative effect of chronic childhood maltreatment on adolescent psychopathology in a dose-response manner. For adolescents with 4-5 PCEs, psychopathological symptoms score decreased significantly and showed similar level with those low/no-victimization comparison peers. While experiencing multiple PCEs does decrease the risk of psychopathological symptoms, certain PCEs, such as parental warmth and peer support, appear to entailed protective effect on all the three psychopathological symptoms. LIMITATIONS It is not clear whether the patterns of effects would vary across developmental periods. CONCLUSIONS A focus of interventions should be not only on ameliorating childhood maltreatment, but also on expanding the availability of social support related PCEs, which may help inform suitable strategies for providing intervention and support to best help reduce the psychopathology burden for children.
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Affiliation(s)
- Lei Zhang
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, 81th Meishan Road, Hefei 230032, Anhui, China; Anhui Provincial Key Laboratory of Population Health & Aristogenics, Anhui Medical University, Hefei, Anhui, China
| | - Jiao Fang
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, 81th Meishan Road, Hefei 230032, Anhui, China; Anhui Provincial Key Laboratory of Population Health & Aristogenics, Anhui Medical University, Hefei, Anhui, China
| | - Dandan Zhang
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, 81th Meishan Road, Hefei 230032, Anhui, China; Anhui Provincial Key Laboratory of Population Health & Aristogenics, Anhui Medical University, Hefei, Anhui, China
| | - Yuhui Wan
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, 81th Meishan Road, Hefei 230032, Anhui, China; Anhui Provincial Key Laboratory of Population Health & Aristogenics, Anhui Medical University, Hefei, Anhui, China
| | - Chun Gong
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, 81th Meishan Road, Hefei 230032, Anhui, China; Anhui Provincial Key Laboratory of Population Health & Aristogenics, Anhui Medical University, Hefei, Anhui, China
| | - Puyu Su
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, 81th Meishan Road, Hefei 230032, Anhui, China; Anhui Provincial Key Laboratory of Population Health & Aristogenics, Anhui Medical University, Hefei, Anhui, China
| | - Fangbiao Tao
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, 81th Meishan Road, Hefei 230032, Anhui, China; Anhui Provincial Key Laboratory of Population Health & Aristogenics, Anhui Medical University, Hefei, Anhui, China
| | - Ying Sun
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, 81th Meishan Road, Hefei 230032, Anhui, China; Anhui Provincial Key Laboratory of Population Health & Aristogenics, Anhui Medical University, Hefei, Anhui, China.
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Narayan AJ, Lieberman AF, Masten AS. Intergenerational transmission and prevention of adverse childhood experiences (ACEs). Clin Psychol Rev 2021; 85:101997. [PMID: 33689982 DOI: 10.1016/j.cpr.2021.101997] [Citation(s) in RCA: 89] [Impact Index Per Article: 29.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 02/05/2021] [Accepted: 02/23/2021] [Indexed: 12/29/2022]
Abstract
In recent years, research and practice on adverse childhood experiences (ACEs) have shifted from delineating effects of ACEs on adulthood health problems to preventing ACEs in children. Nonetheless, little attention has focused on how parents' own childhood experiences, adverse or positive, may influence the transmission of ACEs across generations. Children's risk for ACEs and potential for resilience may be linked to the early child-rearing experiences of their parents carried forward into parenting practices. Additionally, parents with multiple ACEs may have PTSD symptoms, an under-recognized mediator of risk in the intergenerational transmission of ACEs. Guided by developmental psychopathology and attachment theory with an emphasis on risk and resilience, we argue that a more comprehensive understanding of parents' childhood experiences is needed to inform prevention of ACEs in their children. Part I of this review applies risk and resilience concepts to pathways of intergenerational ACEs, highlighting parental PTSD symptoms as a key mediator, and promotive or protective processes that buffer children against intergenerational risk. Part II examines empirical findings indicating that parents' positive childhood experiences counteract intergenerational ACEs. Part III recommends clinically-sensitive screening of ACEs and positive childhood experiences in parents and children. Part IV addresses tertiary prevention strategies that mitigate intergenerational ACEs and promote positive parent-child relationships.
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Affiliation(s)
- Angela J Narayan
- Department of Psychology, University of Denver, United States of America; Department of Psychiatry and Child Trauma Research Program, University of California, San Francisco, United States of America.
| | - Alicia F Lieberman
- Department of Psychiatry and Child Trauma Research Program, University of California, San Francisco, United States of America
| | - Ann S Masten
- Institute of Child Development, University of Minnesota, Twin Cities, United States of America
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LeMasters K, Bates LM, Chung EO, Gallis JA, Hagaman A, Scherer E, Sikander S, Staley BS, Zalla LC, Zivich PN, Maselko J. Adverse childhood experiences and depression among women in rural Pakistan. BMC Public Health 2021; 21:400. [PMID: 33632175 PMCID: PMC7905421 DOI: 10.1186/s12889-021-10409-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 02/08/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Adverse Childhood Experiences (ACEs) are a common pathway to adult depression. This pathway is particularly important during the perinatal period when women are at an elevated risk for depression. However, this relationship has not been explored in South Asia. This study estimates the association between ACEs and women's (N = 889) depression at 36 months postpartum in rural Pakistan. METHOD Data come from the Bachpan Cohort study. To capture ACEs, an adapted version of the ACE-International Questionnaire was used. Women's depression was measured using both major depressive episodes (MDE) and depressive symptom severity. To assess the relationship between ACEs and depression, log-Poisson models were used for MDE and linear regression models for symptom severity. RESULTS The majority (58%) of women experienced at least one ACE domain, most commonly home violence (38.3%), followed by neglect (20.1%). Women experiencing four or more ACEs had the most pronounced elevation of symptom severity (β = 3.90; 95% CL = 2.13, 5.67) and MDE (PR = 2.43; 95% CL = 1.37, 4.32). Symptom severity (β = 2.88; 95% CL = 1.46, 4.31), and MDE (PR = 2.01; 95% CL = 1.27, 3.18) were greater for those experiencing community violence or family distress (β = 2.04; 95%; CL = 0.83, 3.25) (PR = 1.77; 95% CL = 1.12, 2.79). CONCLUSIONS Findings suggest that ACEs are substantively distinct and have unique relationships to depression. They signal a need to address women's ACEs as part of perinatal mental health interventions and highlight women's lifelong experiences as important factors to understanding current mental health. TRIAL REGISTRATION NCT02111915 . Registered 11 April 2014. NCT02658994 . Registered 22 January 2016. Both trials were prospectively registered.
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Affiliation(s)
- Katherine LeMasters
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, McGavran-Greenberg Hall, CB# 7435, Chapel Hill, NC, 27599, USA.
- Carolina Population Center, Chapel Hill, North Carolina, USA.
| | - Lisa M Bates
- Department of Epidemiology,Mailman School of Public Health, Columbia University Medical Center, 722 West 168th Street, New York, NY, 10032, USA
| | - Esther O Chung
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, McGavran-Greenberg Hall, CB# 7435, Chapel Hill, NC, 27599, USA
- Carolina Population Center, Chapel Hill, North Carolina, USA
| | - John A Gallis
- Department of Biostatistics and Bioinformatics, Duke University, 2424 Erwin Road, Durham, NC, 27705, USA
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Ashley Hagaman
- Department of Social and Behavioral Sciences, Yale School of Public Health, Yale University, 135 College St., Suite 200, Room 230, New Haven, CT, 06510, USA
| | - Elissa Scherer
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, McGavran-Greenberg Hall, CB# 7435, Chapel Hill, NC, 27599, USA
- RTI International, 3040 E Cornwallis Rd, Durham, NC, 27709, USA
| | - Siham Sikander
- Human Development Research Foundation, H 06, Street 55, Sector F-7/4, Islamabad, 44000, Pakistan
- Health Services Academy, Islamabad, Pakistan
| | - Brooke S Staley
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, McGavran-Greenberg Hall, CB# 7435, Chapel Hill, NC, 27599, USA
| | - Lauren C Zalla
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, McGavran-Greenberg Hall, CB# 7435, Chapel Hill, NC, 27599, USA
| | - Paul N Zivich
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, McGavran-Greenberg Hall, CB# 7435, Chapel Hill, NC, 27599, USA
- Carolina Population Center, Chapel Hill, North Carolina, USA
| | - Joanna Maselko
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, McGavran-Greenberg Hall, CB# 7435, Chapel Hill, NC, 27599, USA
- Carolina Population Center, Chapel Hill, North Carolina, USA
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Shin SH, Ksinan Jiskrova G, Kimbrough T, Dina KT, Lee EO, Ayers CE. Maternal adverse childhood experiences and postpartum depressive symptoms in young, low-income women. Psychiatry Res 2021; 296:113679. [PMID: 33385783 DOI: 10.1016/j.psychres.2020.113679] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 12/22/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVES Exposure to adverse childhood experiences (ACEs), such as child maltreatment and family dysfunction, is highly prevalent. Previous research has shown an association between ACEs and adult depression. The aim of the current study was to expand the existing literature by testing the association between ACEs and postpartum depression (PPD) symptoms in an urban, ethnically diverse sample of women. METHODS Participants (N = 746; ages 18-47; mean age = 27.3) were recruited at a large, urban university medical center as part of the Longitudinal Infant and Family Environment (LIFE) study. The association between ACEs and PPD symptoms were tested via hierarchical linear regression models. RESULTS The majority of the participants (61%) reported experiencing at least one type of ACEs prior to age 18. ACEs were positively associated with PPD symptoms (β = .29, p < .001), controlling for maternal race/ethnicity, age, educational attainment, marital status, household income, and infant gender and birth order. CONCLUSIONS The results showed that exposure to ACEs was related to PPD symptoms among low-income women. Screenings for ACEs during prenatal checkups may help identify women at risk of depression and facilitate timely prevention and treatment efforts.
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Bomysoad RN, Francis LA. Associations between parental incarceration and youth mental health conditions: The mitigating effects of adolescent resilience and positive coping strategies. Curr Psychol 2021. [DOI: 10.1007/s12144-021-01351-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Abstract
Background: Many studies demonstrated the relationship between adverse childhood experiences (ACEs) and diminished health functioning in adulthood. A growing literature has shown that positive childhood experiences (PCEs) co-occurring with ACEs reduce the risks for negative outcomes. Objective: The aim was to investigate how ACEs and PCEs are simultaneously associated with health outcomes in adulthood, including self-rated health, physical and mental health outcomes, and health-risk behaviours. Methods: A panel sample of 4,847 Slovenian adults was used and the data were weighted to closely resemble the Slovenian population. A series of logistic regression analyses were performed to examine how ACEs and PCEs predict the risk of various health outcomes. Results: Significant associations, as measured by adjusted odds ratios, were found between higher ACEs exposure and each of the 16 health outcomes evaluated. Adjusting for above median PCEs attenuated the association between ACEs and 6 health outcomes (poor self-rated physical and mental health, depression, anxiety, suicide attempt, physical inactivity; OR for ≥ 4 vs. 0 ACEs, 1.48-9.34). Mirroring these findings, above median PCEs were associated with lowered odds of these 6 health outcomes after adjusting for ACEs (OR for above vs. below median PCEs, 0.46-0.67), but not with odds of physical health outcomes and most of the health-risk behaviours. Stratified analyses by ACEs exposure level showed that the association between PCEs and self-rated health remained stable across ACEs exposure levels, while the association between PCEs and mental health outcomes and physical inactivity varied across ACEs exposure levels. Conclusions: Our results suggest that above median PCEs attenuate the association between ACEs and poor self-rated health, mental health problems, and physical inactivity in later life, and are negatively associated with these health problems even in the concurrent presence of ACEs. Interventions to promote PCEs can help to reduce unfavourable long-term health outcomes following childhood adversity.
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Affiliation(s)
- Metka Kuhar
- Faculty of Social Sciences, University of Ljubljana, Ljubljana, Slovenia
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Doom JR, Seok D, Narayan AJ, Fox KR. Adverse and Benevolent Childhood Experiences Predict Mental Health During the COVID-19 Pandemic. Advers Resil Sci 2021; 2:193-204. [PMID: 33907733 DOI: 10.31234/osf.io/vr5jd] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/16/2021] [Indexed: 05/20/2023]
Abstract
Adverse childhood experiences (ACEs) are associated with poorer adult mental health, and benevolent childhood experiences (BCEs) are associated with better adult mental health. This study aims to test whether ACEs and BCEs predict adult mental health above and beyond current stress and social support during the COVID-19 pandemic. We analyzed data from undergraduate and graduate students (N = 502) at an urban private university in the Western United States. An online survey was conducted to assess ACEs and BCEs, current stress and social support, depressive and anxiety symptoms, perceived stress, and loneliness in May 2020. Higher levels of ACEs were associated with higher levels of depressive symptoms, β = 0.45, p = 0.002. Higher levels of BCEs were associated with lower depressive symptoms, β = -0.39, p = 0.03; lower perceived stress, β = -0.26, p = 0.002; and less loneliness, β = -0.12, p = 0.04. These associations held while controlling for current stress, social support, and socioeconomic status. Childhood experiences are associated with mental health during the COVID-19 pandemic. BCEs should be considered an important promotive factor, independent of ACEs, for psychological well-being during a global public health crisis. BCEs should be included along with ACEs in future research, assessment, and screening with distressed and vulnerable populations.
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Affiliation(s)
- Jenalee R Doom
- Department of Psychology, University of Denver, 2155 S. Race St, Denver, CO 80210 USA
| | - Deborah Seok
- Department of Psychology, University of Denver, 2155 S. Race St, Denver, CO 80210 USA
| | - Angela J Narayan
- Department of Psychology, University of Denver, 2155 S. Race St, Denver, CO 80210 USA
| | - Kathryn R Fox
- Department of Psychology, University of Denver, 2155 S. Race St, Denver, CO 80210 USA
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Abstract
BACKGROUND Several studies have indicated that positive childhood experiences (PCEs) might have important protective effects on adulthood mental health. However, the instruments to assess PCEs are scarce. OBJECTIVE In this study, we assessed the validity and reliability of the Benevolent Childhood Experiences (BCEs) scale, a new instrument of PCEs, in a large sample of Chinese adults. Furthermore, we examined associations of PCEs with symptoms of posttraumatic stress disorder (PTSD) and depression, as well as, prosocial behaviours across different levels of trauma. METHOD Participants were 6929 adults (33% male; mean age 38.04 years, SD = 7.81, ranging from 18 to 81.) recruited from Jiangxi and Hunan provinces in China. Self-administrated questionnaires were used to measure PCEs, childhood trauma, lifetime trauma, PTSD, depression, and prosocial behaviours. Multiple linear regression models were conducted to examine the interdependent and interactive effects of PCEs, lifetime trauma, childhood trauma on symptoms of PTSD and depression and prosocial behaviours. RESULTS In the current sample, the Cronbach's α of the BCEs scale was 0.70. PCEs were not related to lifetime trauma, while modestly associated with childhood trauma, demonstrating excellent discriminant validity. PCEs were negatively correlated with severity of PTSD and depression, while positively correlated with prosocial behaviours, indicating good predictive validity. PCEs, lifetime trauma and childhood trauma were independently associated with severity of PTSD and depression and prosocial behaviours. Moreover, the interaction of PCEs and lifetime trauma negatively predicted severity of PTSD and depression, while the interaction of PCEs and childhood trauma negatively predicted prosocial behaviours. PCEs had a protective effect on PTSD and depression in high level of lifetime trauma, and showed a reduced positive effect on prosocial behaviours in high level of childhood trauma. CONCLUSIONS The Chinese BCEs scale is a reliable and valid instrument. PCEs can buffer adversity and foster positive outcomes in adulthood.
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Affiliation(s)
- Nalan Zhan
- School of Psychology, Jiangxi Normal University, Nanchang, P.R.China
| | - Dongjie Xie
- Hangzhou College of Preschool Teacher Education, Zhejiang Normal University, Hangzhou, P.R.China
| | - Jiaqi Zou
- School of Psychology, Jiangxi Normal University, Nanchang, P.R.China
| | - Jian Wang
- Shenzhen Mental Health Center, Shenzhen Kangning Hospital, Shenzhen, P.R.China
| | - Fulei Geng
- School of Psychology, Jiangxi Normal University, Nanchang, P.R.China
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Abstract
CONTEXT Given the wide-ranging health impacts of justice system involvement, we examined evidence for the association between adverse childhood experiences (ACEs) and justice system contact in the United States. OBJECTIVE To synthesize epidemiological evidence for the association between ACEs and justice system contact. DATA SOURCES We searched 5 databases for studies conducted through January 2020. The search term used for each database was as follows: ("aces" OR "childhood adversities") AND ("delinquency" OR "crime" OR "juvenile" OR criminal* OR offend*). STUDY SELECTION We included all observational studies assessing the association between ACEs and justice system contact conducted in the United States. DATA EXTRACTION Data extracted from each eligible study included information about the study design, study population, sample size, exposure and outcome measures, and key findings. Study quality was assessed by using the Newcastle-Ottawa Scale for nonrandomized trials. RESULTS In total, 10 of 11 studies reviewed were conducted in juvenile population groups. Elevated ACE scores were associated with increased risk of juvenile justice system contact. Estimates of the adjusted odds ratio of justice system contact per 1-point increase in ACE score ranged from 0.91 to 1.68. Results were consistent across multiple types of justice system contact and across geographic regions. LIMITATIONS Most studies reviewed were conducted in juvenile justice-involved populations with follow-up limited to adolescence or early adulthood. CONCLUSIONS ACEs are positively associated with juvenile justice system contact in a dose-response fashion. ACE prevention programs may help reduce juvenile justice system contacts and improve child and adolescent health.
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Affiliation(s)
| | - Stanford Chihuri
- Department of Anesthesiology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York; and
| | | | - Guohua Li
- Department of Epidemiology, Mailman School of Public Health and
- Department of Anesthesiology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York; and
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Abstract
The pregnancy period represents a unique window of opportunity to identify risks to both the fetus and mother and to deter the intergenerational transmission of adversity and mental health problems. Although the maternal-fetal dyad is especially vulnerable to the effects of stress during pregnancy, less is known about how the dyad is also receptive to salutary, resilience-promoting influences. The present review adopts life span and intergenerational perspectives to review four key areas of research. The first part describes how pregnancy is a sensitive period for both the mother and fetus. In the second part, the focus is on antecedents of maternal prenatal risks pertaining to prenatal stress response systems and mental health. The third part then turns to elucidating how these alterations in prenatal stress physiology and mental health problems may affect infant and child outcomes. The fourth part underscores how pregnancy is also a time of heightened fetal receptivity to maternal and environmental signals, with profound implications for adaptation. This section also reviews empirical evidence of promotive and protective factors that buffer the mother and fetus from developmental and adaptational problems and covers a sample of rigorous evidence-based prenatal interventions that prevent maladaptation in the maternal-fetal dyad before babies are born. Finally, recommendations elaborate on how to further strengthen understanding of pregnancy as a period of multilevel risk and resilience, enhance comprehensive prenatal screening, and expand on prenatal interventions to promote maternal-fetal adaptation before birth.
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Affiliation(s)
- Elysia Poggi Davis
- Department of Psychology, University of Denver, Denver, CO, USA
- Department of Psychiatry and Human Behavior, University of California, Irvine, CA, USA
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Young-Wolff KC, Wei J, Varnado N, Rios N, Staunton M, Watson C. Adverse Childhood Experiences and Pregnancy Intentions among Pregnant Women Seeking Prenatal Care. Womens Health Issues 2020; 31:100-106. [PMID: 33032888 DOI: 10.1016/j.whi.2020.08.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 08/12/2020] [Accepted: 08/26/2020] [Indexed: 01/18/2023]
Abstract
BACKGROUND This study examined whether adverse childhood experiences (ACEs) are associated with increased risk of having an unwanted or mistimed pregnancy. METHODS Women in two medical centers within an integrated health system were screened for ACEs during standard prenatal care (N = 745). Multinomial multivariable logistic regression analyses examined the associations of ACEs (count and type) with pregnancy intentions, adjusting for covariates. RESULTS Overall, 58.3% of pregnant women reported no ACEs, 19.1% reported one ACE, and 22.7% reported two or more ACEs; 76.2% reported wanting to get pregnant, 18.5% reported wanting to get pregnant but not at this time (i.e., mistimed pregnancy), and 5.2% reported not wanting to get pregnant at all (i.e., unwanted pregnancy). Having two or more (vs. 0) ACEs was associated with higher odds of an unwanted pregnancy (odds ratio, 2.60; 95% confidence interval, 1.19-5.68). Further, childhood loss of parent (odds ratio, 2.20; 95% confidence interval, 1.03-4.71) and neglect (odds ratio, 5.67; 95% confidence interval, 1.72-18.72) were each associated with higher odds of an unwanted pregnancy in separate analyses. ACEs count and type were not significantly associated with having a mistimed pregnancy. CONCLUSIONS Among women screened for ACEs during standard prenatal care, ACEs were associated with increased odds of having an unwanted pregnancy, but not a mistimed pregnancy. Additional research is needed to better understand the mechanisms through which ACEs and other individual, social, and contextual factors impact pregnancy intentions to better support women and provide appropriate resources to help prevent unintended pregnancies.
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Affiliation(s)
- Kelly C Young-Wolff
- Division of Research, Kaiser Permanente Northern California, Oakland, California.
| | - Julia Wei
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Nicole Varnado
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Normelena Rios
- Obstetrics and Gynecology, Kaiser Pleasanton Medical Center, Pleasanton, California
| | - Mary Staunton
- Psychiatry, Kaiser Walnut Creek Medical Center, Walnut Creek, California
| | - Carey Watson
- Obstetrics and Gynecology, Kaiser Antioch Medical Center, Antioch, California
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Nidey N, Bowers K, Ammerman RT, Shah AN, Phelan KJ, Clark MJ, Van Ginkel JB, Folger AT. Combinations of adverse childhood events and risk of postpartum depression among mothers enrolled in a home visiting program. Ann Epidemiol 2020; 52:26-34. [PMID: 33010417 DOI: 10.1016/j.annepidem.2020.09.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 07/30/2020] [Accepted: 09/13/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE The purpose of this study was to examine how combinations of adverse childhood events (ACEs) contribute to the risk of postpartum depression and the mediating role of prenatal social support. METHODS The Adverse Childhood Experiences Scale Questionnaire and the Edinburgh Postnatal Depression Scale Questionnaire were used to measure the study's exposure and outcome. Among a cohort of 419 mothers enrolled in a home visiting (HV) program, latent class analyses were used to identify classes of ACEs exposure. General linear models assessed the risk of postpartum depression, and prenatal social support was examined as a mediator. RESULTS Four distinct classes of ACE exposure were identified. On the Edinburgh Postnatal Depression scale, mothers who were classified in Classes 1-3 scored higher by 2.6-4.4 points compared with women in Class 0. ACE class was found to be indirectly associated with postpartum depression scores through prenatal social support. CONCLUSIONS Identifying combinations of ACEs in an HV program has the potential to improve the characterization of ACEs among low-income perinatal women in the United States. Elucidating how these combinations contribute to the risk of postpartum depression has the potential to identify women at increased risk, which can help HV programs prioritize prevention efforts.
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Affiliation(s)
- Nichole Nidey
- Cincinnati Children's Hospital Medical Center, Division of Biostatistics and Epidemiology, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH; Division of Developmental and Behavioral Pediatrics, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Katherine Bowers
- Cincinnati Children's Hospital Medical Center, Division of Biostatistics and Epidemiology, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Robert T Ammerman
- Cincinnati Children's Hospital Medical Center, Division of Behavioral Medicine and Clinical Psychology, University of Cincinnati College of Medicine, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH; Cincinnati Children's Hospital Medical Center, Every Child Succeeds Program, Cincinnati, OH
| | - Anita N Shah
- Cincinnati Children's Hospital Medical Center, Division of Hospital Medicine, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Kieran J Phelan
- The Permanente Medical Group, Kaiser Permanente Pediatrics, San Rafael, CA
| | - Margaret J Clark
- Cincinnati Children's Hospital Medical Center, Every Child Succeeds Program, Cincinnati, OH
| | - Judith B Van Ginkel
- Cincinnati Children's Hospital Medical Center, Every Child Succeeds Program, Cincinnati, OH
| | - Alonzo T Folger
- Cincinnati Children's Hospital Medical Center, Division of Biostatistics and Epidemiology, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH; Cincinnati Children's Hospital Medical Center, Every Child Succeeds Program, Cincinnati, OH.
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LaNoue MD, Cunningham AT, Kenny LC, Abatemarco D, Helitzer D. What Do Adults Think About Their Adverse Childhood Experiences (ACEs), and Does It Matter? Community Ment Health J 2020; 56:1255-61. [PMID: 32065317 DOI: 10.1007/s10597-020-00580-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 02/11/2020] [Indexed: 10/25/2022]
Abstract
We examined the self-reported adulthood impact of adverse childhood experiences (ACE's), including both the amount (magnitude) and type (valence positive or negative) of impact reported, in order to characterize variability in impact ratings, as well as to quantify their predictive ability with respect to health outcomes. We descriptively characterized impact by type of event and analyzed associations between impact ratings and demographic characteristics of respondents to explore resilience. We also analyzed the relationships between impact ratings and health outcomes. We found that, while there was wide variability in impact ratings, emotional abuse was rated as the most impactful in magnitude, and sexual and emotional abuse were rated as the most negatively impactful in terms of valence. We further found that impact ratings are predictive of adult health outcomes above and beyond the experience of the events alone. We conclude that perceived impact is a potentially important variable to include when self-reported ACEs are assessed.
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Russotti J, Handley ED, Rogosch FA, Toth SL, Cicchetti D. The Interactive Effects of Child Maltreatment and Adolescent Pregnancy on Late-Adolescent Depressive Symptoms. J Abnorm Child Psychol 2020; 48:1223-1237. [PMID: 32594294 PMCID: PMC7395875 DOI: 10.1007/s10802-020-00669-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Adolescent females are disproportionately at risk for depression, which is expected to represent the leading cause of disability in 2030 (National Institute of Mental Health [NIMH] 2019). Although prior research has suggested that both child maltreatment and adolescent pregnancy increase the risk for depressive symptoms, less is known about how these two interact to influence depression in late adolescence. The present study tested the unique and interactive effects of adolescent pregnancy and child maltreatment on late-adolescent depressive symptomatology (N = 186) with a prospective, longitudinal design that utilized documented records of maltreatment and included demographically comparable (i.e., economically disadvantaged), nonmaltreated and non-pregnant comparisons. Participants were assessed at ages 10-12 and 18-21. Structural equation modeling was used to test whether adolescent pregnancy amplified the effect of child maltreatment on late-adolescent depressive symptoms. In the context of economic disadvantage, results indicated that the effect of child maltreatment on late-adolescent depressive symptoms was significantly enhanced for those who experienced an adolescent pregnancy. This effect remained after controlling for prior depressive symptoms, peer and maternal relationship quality, and romantic relationship violence. The findings are translated to preliminary guidance for practitioners regarding precision depression screening and tailored preventive interventions..
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Affiliation(s)
- Justin Russotti
- Mt. Hope Family Center, University of Rochester, 187 Edinburgh Street, Rochester, NY, 14608, USA.
| | - Elizabeth D Handley
- Mt. Hope Family Center, University of Rochester, 187 Edinburgh Street, Rochester, NY, 14608, USA
| | - Fred A Rogosch
- Mt. Hope Family Center, University of Rochester, 187 Edinburgh Street, Rochester, NY, 14608, USA
| | - Sheree L Toth
- Mt. Hope Family Center, University of Rochester, 187 Edinburgh Street, Rochester, NY, 14608, USA
| | - Dante Cicchetti
- Mt. Hope Family Center, University of Rochester, 187 Edinburgh Street, Rochester, NY, 14608, USA
- Institute of Child Development, University of Minnesota, Minneapolis, MN, USA
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Elmore AL, Crouch E, Kabir Chowdhury MA. The Interaction of Adverse Childhood Experiences and Resiliency on the Outcome of Depression Among Children and Youth, 8-17 year olds. Child Abuse Negl 2020; 107:104616. [PMID: 32645587 PMCID: PMC7494539 DOI: 10.1016/j.chiabu.2020.104616] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 06/18/2020] [Accepted: 06/22/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Adverse childhood experiences (ACEs) are common among children. Little is known on how resilience factors and positive childhood experiences (PCEs) may moderate the relationship between ACEs and childhood depression. OBJECTIVE Our study fills this gap by providing recent, nationally representative estimates of ACE and PCE exposure for ages 8-17 and examines the associations between ACE exposure and PCEs on the outcome of depression. PARTICIPANTS AND SETTING Data were drawn from the nationally representative 2016-2017 National Survey of Children's Health (NSCH) and included a total sample of 40,302 children and adolescents. METHODS Chi square analysis and multivariate logistic regressions were performed to assess associations of depression with 9 ACE and 6 PCE exposures. Additive and multiplicative interactions were examined between ACE exposure and PCEs (resiliency measures) on depression. Survey sampling weights and SAS survey procedures were used. RESULTS Our study found that 4% of children had current depression and those with an ACE count greater than four had increased odds (aOR: 2.29; CI: 1.74-3.02). Multivariate regressions demonstrated associations between depression and low resiliency as well as significant interactions between ACE exposure and three PCEs. Children who were exposed to greater than four ACEs and did not exhibit resilience had 8.75 higher odds of depression (CI: 5.23-14.65) compared to those with less than four ACEs and some resilience. CONCLUSIONS These findings illustrate the need for the promotion of PCEs and the building of resiliency for combatting depression and reducing the impact of trauma in children and adolescents.
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Affiliation(s)
- Amanda L Elmore
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC 29208, USA.
| | - Elizabeth Crouch
- Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, 220 Stoneridge Drive, Suite 204, Columbia, SC 29210, USA
| | - Mohiuddin Ahsanul Kabir Chowdhury
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC 29208, USA
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Karatzias T, Shevlin M, Fyvie C, Grandison G, Garozi M, Latham E, Sinclair M, Ho GWK, McAnee G, Ford JD, Hyland P. Adverse and benevolent childhood experiences in Posttraumatic Stress Disorder (PTSD) and Complex PTSD (CPTSD): implications for trauma-focused therapies. Eur J Psychotraumatol 2020; 11:1793599. [PMID: 33029328 PMCID: PMC7473238 DOI: 10.1080/20008198.2020.1793599] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND There is very little work on the role of positive or benevolent childhood experiences and how such events might offer protection from the insidious effects of adverse experiences in childhood or later in life. OBJECTIVES We set out to test, using latent variable modelling, whether adverse and benevolent childhood experiences could be best described as a single continuum or two correlated constructs. We also modelled the relationship between adverse and benevolent childhood experiences and ICD-11 PTSD and Complex PTSD (CPTSD) symptoms and explored if these associations were indirect via psychological trauma. METHODS Data were collected from a trauma-exposed sample (N = 275) attending a specialist trauma care centre in the UK. Participants completed measures of childhood adverse and benevolent experiences, traumatic exposure, and PTSD and CPTSD symptoms. RESULTS Findings suggested that adverse childhood experiences operate only indirectly on PTSD and CPTSD symptoms through lifetime trauma exposure, and with a stronger effect for PTSD. Benevolent childhood experiences directly predicted only CPTSD symptoms. CONCLUSIONS Benevolent and traumatic experiences seem to form unique associations with PTSD and CPTSD symptoms. Future research is needed to explore how benevolent experiences can be integrated within existing psychological interventions to maximise recovery from traumatic stress.
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Affiliation(s)
- Thanos Karatzias
- School of Health & Social Care, Edinburgh Napier University, Edinburgh, UK.,Rivers Centre for Traumatic Stress, NHS Lothian, Edinburgh, UK
| | - Mark Shevlin
- School of Psychology, Ulster University, Derry, Northern Ireland
| | - Claire Fyvie
- Rivers Centre for Traumatic Stress, NHS Lothian, Edinburgh, UK
| | | | - Maria Garozi
- Rivers Centre for Traumatic Stress, NHS Lothian, Edinburgh, UK
| | - Emma Latham
- Rivers Centre for Traumatic Stress, NHS Lothian, Edinburgh, UK
| | | | - Grace Wing Ka Ho
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, Hong Kong
| | - Grainne McAnee
- School of Psychology, Ulster University, Derry, Northern Ireland
| | - Julian D Ford
- Schools of Medicine and Law, University of Connecticut, Farmington, CT, USA
| | - Philip Hyland
- Department of Psychology, Maynooth University, Kildare, Ireland.,Centre for Global Health, Trinity College Dublin, Dublin, Ireland
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Merrick JS, Narayan AJ. Assessment and screening of positive childhood experiences along with childhood adversity in research, practice, and policy. ACTA ACUST UNITED AC 2020. [DOI: 10.1080/10796126.2020.1799338] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Bethell C, Jones J, Gombojav N, Linkenbach J, Sege R. Positive Childhood Experiences and Adult Mental and Relational Health in a Statewide Sample: Associations Across Adverse Childhood Experiences Levels. JAMA Pediatr 2019; 173:e193007. [PMID: 31498386 PMCID: PMC6735495 DOI: 10.1001/jamapediatrics.2019.3007] [Citation(s) in RCA: 228] [Impact Index Per Article: 45.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 06/14/2019] [Indexed: 01/08/2023]
Abstract
IMPORTANCE Associations between adverse childhood experiences (ACEs) and risks for adult depression, poor mental health, and insufficient social and emotional support have been documented. Less is known about how positive childhood experiences (PCEs) co-occur with and may modulate the effect of ACEs on adult mental and relational health. OBJECTIVE To evaluate associations between adult-reported PCEs and (1) adult depression and/or poor mental health (D/PMH) and (2) adult-reported social and emotional support (ARSES) across ACEs exposure levels. DESIGN, SETTING, AND PARTICIPANTS Data were from the cross-sectional 2015 Wisconsin Behavioral Risk Factor Survey, a random digit-dial telephone survey of noninstitutionalized Wisconsin adults 18 years and older (n = 6188). Data were weighted to be representative of the entire population of Wisconsin adults in 2015. Data were analyzed between September 2016 and January 2019. MAIN OUTCOMES AND MEASURES The definition of D/PMH includes adults with a depression diagnosis (ever) and/or 14 or more poor mental health days in the past month. The definition of PCEs includes 7 positive interpersonal experiences with family, friends, and in school/the community. Standard Behavioral Risk Factor Survey ACEs and ARSES variables were used. RESULTS In the 2015 Wisconsin Behavioral Risk Factor Survey sample of adults (50.7% women; 84.9% white), the adjusted odds of D/PMH were 72% lower (OR, 0.28; 95% CI, 0.21-0.39) for adults reporting 6 to 7 vs 0 to 2 PCEs (12.6% vs 48.2%). Odds were 50% lower (OR, 0.50; 95% CI, 0.36-0.69) for those reporting 3 to 5 vs 0 to 2 PCEs (25.1% vs 48.2%). Associations were similar in magnitude for adults reporting 1, 2 to 3, or 4 to 8 ACEs. The adjusted odds that adults reported "always" on the ARSES variable were 3.53 times (95% CI, 2.60-4.80) greater for adults with 6 to 7 vs 0 to 2 PCEs. Associations for 3 to 5 PCEs were not significant. The PCE associations with D/PMH remained stable across each ACEs exposure level when controlling for ARSES. CONCLUSIONS AND RELEVANCE Positive childhood experiences show dose-response associations with D/PMH and ARSES after accounting for exposure to ACEs. The proactive promotion of PCEs for children may reduce risk for adult D/PMH and promote adult relational health. Joint assessment of PCEs and ACEs may better target needs and interventions and enable a focus on building strengths to promote well-being. Findings support prioritizing possibilities to foster safe, stable nurturing relationships for children that consider the health outcomes of positive experiences.
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Affiliation(s)
- Christina Bethell
- Johns Hopkins Bloomberg School of Public Health and Child and Adolescent Health Measurement Initiative, Baltimore, Maryland
| | - Jennifer Jones
- Alliance for Strong Families and Communities, Milwaukee, Wisconsin
| | - Narangerel Gombojav
- Johns Hopkins Bloomberg School of Public Health and Child and Adolescent Health Measurement Initiative, Baltimore, Maryland
| | | | - Robert Sege
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts
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Zilversmit Pao L, Harville EW, Wickliffe JK, Shankar A, Buekens P. The Cumulative Risk of Chemical and Nonchemical Exposures on Birth Outcomes in Healthy Women: The Fetal Growth Study. Int J Environ Res Public Health 2019; 16:E3700. [PMID: 31581440 DOI: 10.3390/ijerph16193700] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Revised: 09/23/2019] [Accepted: 09/26/2019] [Indexed: 02/06/2023]
Abstract
Metals, stress, and sociodemographics are commonly studied separately for their effects on birth outcomes, yet often jointly contribute to adverse outcomes. This study analyzes two methods for measuring cumulative risk to understand how maternal chemical and nonchemical stressors may contribute to small for gestational age (SGA). SGA was calculated using sex-specific fetal growth curves for infants of pregnant mothers (n = 2562) enrolled in the National Institute of Child Health and Human Development (NICHD) Fetal Growth Study. The exposures (maternal lead, mercury, cadmium, Cohen’s perceived stress, Edinburgh depression scores, race/ethnicity, income, and education) were grouped into three domains: metals, psychosocial stress, and sociodemographics. In Method 1 we created cumulative risk scores using tertiles. Method 2 employed weighted quantile sum (WQS) regression. For each method, logistic models were built with three exposure domains individually and race/ethnicity, adjusting for age, parity, pregnancy weight gain, and marital status. The adjusted effect of overall cumulative risk with three domains, was also modeled using each method. Sociodemographics was the only exposure associated with SGA in unadjusted models ((odds ratio) OR: 1.35, 95% (confidence interval) CI: 1.08, 1.68). The three cumulative variables in adjusted models were not significant individually, but the overall index was associated with SGA (OR: 1.17, 95% CI: 1.02, 1.35). In the WQS model, only the sociodemographics domain was significantly associated with SGA. Sociodemographics tended to be the strongest risk factor for SGA in both risk score and WQS models.
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Allen H, Wright BJ, Vartanian K, Dulacki K, Li HF. Examining the Prevalence of Adverse Childhood Experiences and Associated Cardiovascular Disease Risk Factors Among Low-Income Uninsured Adults. Circ Cardiovasc Qual Outcomes 2019; 12:e004391. [DOI: 10.1161/circoutcomes.117.004391] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Background:
Adverse childhood experiences (ACEs) are linked to poor adult health outcomes, including cardiovascular disease. However, little is known about its prevalence, specifically in low-income populations. The objective of this study was to estimate the extent of ACEs in a low-income, nonclinical, uninsured adult population and assess the relationship between ACEs and cardiovascular disease risk factors.
Methods and Results:
This study leverages the OHIE’s (Oregon Health Insurance Experiment) study population, uninsured adults who were randomly selected to apply for Medicaid, and data collected through in-person health screenings. We objectively measured obesity, cholesterol, blood pressure, and blood sugar. Smoking, physical activity, and history of chronic disease were self-reported. Independent variables were the 10-item ACEs questions covering neglect, abuse, and household dysfunction. The sample consisted of 12 229 low-income, nonelderly uninsured adults who participated in the OHIE health screenings from 2009 to 2010. A total of 5929 (48%) returned a follow-up survey reporting ACEs in 2012. ACEs were more prevalent in low-income adults compared with previous estimates in a general clinical population, with notably high rates of emotional abuse, emotional neglect, and household dysfunction. ACEs were statistically associated with higher rates of obesity, smoking, and physical inactivity, but not high cholesterol or diabetes mellitus. We detected a strong relationship between ACEs and a self-reported history of a hypertension diagnosis but no statistically significant differences in being hypertensive.
Conclusions:
This study design allowed us to assess the prevalence of ACEs among uninsured low-income adults and the association between ACEs and clinical indicators of cardiovascular disease risk that are difficult to ordinarily observe. Low-income adults have high rates of ACEs than previous prevalence estimates and ACEs were associated with higher rates of multiple cardiovascular disease risk factors. As states continue to expand Medicaid to the previously uninsured, providers may want to consider incorporating trauma-based approaches to care delivery.
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Affiliation(s)
- Heidi Allen
- Columbia University School of Social Work, NY (H.A.)
| | - Bill J. Wright
- Center for Outcomes Research and Education (CORE), Providence Health & Services, Portland, OR (B.J.W., K.V., K.D.)
| | - Keri Vartanian
- Center for Outcomes Research and Education (CORE), Providence Health & Services, Portland, OR (B.J.W., K.V., K.D.)
| | - Kristen Dulacki
- Center for Outcomes Research and Education (CORE), Providence Health & Services, Portland, OR (B.J.W., K.V., K.D.)
| | - Hsin-Fang Li
- Providence Health & Services, Portland, OR (H.-F.L.)
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