Evaluation of an intervention promoting emotion regulation skills for adults with persisting distress due to adverse childhood experiences

A meta-analysis of cognitive reappraisal and personal resilience

Cognitive reappraisal, an adaptive emotion regulation strategy that involves subjectively reinterpreting stressful and adverse experiences in a more positive manner, can enhance personal resilience. Personal resilience is a constellation of attributes that facilitate successful coping and an expeditious return to adaptive functioning after exposure to stress or adversity. This meta-analysis evaluated the association between cognitive reappraisal and personal resilience. A systematic and exhaustive search identified 64 independent samples from 55 studies (N = 29,824) that examined the correlation between cognitive reappraisal and personal resilience. A random-effects model revealed a positive summary effect (r = 0.47, p < .001), indicating that higher cognitive reappraisal was associated with higher personal resilience. Six potential meta-moderators were tested: culture, age, name of the cognitive reappraisal measure, name of the personal resilience measure, study design, and publication period. After two extreme effect size outliers were omitted, tests of publication bias did not reveal any publication bias in this line of research. This quantitative synthesis offers compelling evidence showing that cognitive reappraisal skills operate as a protective strategy against stress and adversity and, therefore, enhance personal resilience. The protective benefits of cognitive reappraisal in relation to personal resilience are relatively robust, as the correlations were statistically significant for all subgroups in the meta-moderation analyses.

Adverse Childhood Events, Mood and Anxiety Disorders, and Substance Dependence: Gene x Environment Effects and Moderated Mediation

Background

Adverse childhood events (ACEs) contribute to the development of mood and anxiety disorders and substance dependence. However, the extent to which these effects are direct or indirect and whether genetic risk moderates them is unclear.

Methods

We examined associations among ACEs, mood/anxiety disorders, and substance dependence in 12,668 individuals (44.9% female, 42.5% African American/Black, 42.1% European American/White). We generated latent variables for each phenotype and modeled direct and indirect effects of ACEs on substance dependence, mediated by mood/anxiety disorders (forward or "self-medication" model) and of ACEs on mood/anxiety disorders, mediated by substance dependence (reverse or "substance-induced" model). In a sub-sample, we also generated polygenic scores for substance dependence and mood/anxiety disorder factors, which we tested as moderators in the mediation models.

Results

Although there were significant indirect effects in both directions, mediation by mood/anxiety disorders (forward model) was greater than by substance dependence (reverse model). Greater genetic risk for substance dependence was associated with a weaker direct effect of ACEs on substance dependence in both the African- and European-ancestry groups (i.e., gene-environment interaction) and a weaker indirect effect in European-ancestry individuals (i.e., moderated mediation).

Conclusion

We found greater evidence that substance dependence results from self-medication of mood/anxiety disorders than that mood/anxiety disorders are substance induced. Among individuals at higher genetic risk for substance dependence who are more likely to develop a dependence diagnosis, ACEs exert less of an effect in promoting that outcome. Following exposure to ACEs, multiple pathways lead to mood/anxiety disorders and substance dependence. Specification of these pathways could inform individually targeted prevention and treatment approaches.

Adverse Childhood Events, Mood and Anxiety Disorders, and Substance Dependence: Gene X Environment Effects and Moderated Mediation

Background

Adverse childhood events (ACEs) contribute to the development of mood and anxiety disorders and substance dependence. However, the extent to which these effects are direct or indirect and whether genetic risk moderates them is unclear.

Methods

We examined associations among ACEs, mood/anxiety disorders, and substance dependence in 12,668 individuals (44.9% female, 42.5% African American/Black, 42.1% European American/White). We generated latent variables for each phenotype and modeled direct and indirect effects of ACEs on substance dependence, mediated by mood/anxiety disorders (forward or "self-medication" model) and of ACEs on mood/anxiety disorders, mediated by substance dependence (reverse or "substance-induced" model). In a sub-sample, we also generated polygenic scores for substance dependence and mood/anxiety disorder factors, which we tested as moderators in the mediation models.

Results

Although there were significant indirect effects in both directions, mediation by mood/anxiety disorders (forward model) was greater than by substance dependence (reverse model). Greater genetic risk for substance dependence was associated with a weaker direct effect of ACEs on substance dependence in both the African- and European-ancestry groups (i.e., gene-environment interaction) and a weaker indirect effect in European-ancestry individuals (i.e., moderated mediation).

Conclusion

We found greater evidence that substance dependence results from self-medication of mood/anxiety disorders than that mood/anxiety disorders are substance induced. Among individuals at higher genetic risk for substance dependence who are more likely to develop a dependence diagnosis, ACEs exert less of an effect in promoting that outcome. Following exposure to ACEs, multiple pathways lead to mood/anxiety disorders and substance dependence. Specification of these pathways could inform individually targeted prevention and treatment approaches.

Adverse Childhood Experiences and Poor Sleep Quality in Older Adults: The Influence of Emotion Regulation

BACKGROUND

Adverse childhood experiences (ACEs) are associated with sleep impairment across the life span, but little is known about modifiable factors that may ameliorate this relationship, such as adaptive emotion regulation (ER) skills.

METHODS

Data were obtained from an online questionnaire completed by a community sample of older adults (N = 278). The questionnaire included the Pittsburgh Sleep Quality Index, an Adverse Childhood Experiences questionnaire, the Cognitive Emotion Regulation Questionnaire (CERQ), and measures of health conditions, and other sample demographics. Moderation analyses were used to examine the interaction between ACEs and 5 adaptive ER skills of CERQ on sleep quality in older adults, while accounting for the effects of age, sex, income, body mass index, and health.

RESULTS

ACEs were significantly associated with worse sleep quality in older adults, and this effect was moderated by positive reappraisal and refocusing on planning (all ps < .05). For individuals reporting greater use of these ER skills, ACEs had no effect on sleep quality, whereas for individuals reporting less frequent use of these ER skills, ACEs were associated with substantially worse sleep quality. This relationship remained significant after accounting for age, sex, income, body mass index, and health conditions in the model.

CONCLUSIONS

The effects of ACEs on sleep quality persist into older age; however, greater use of ER skills that focus on positively reframing negative events and identifying strategies for coping protect against sleep impairment in individuals with higher ACEs.

Relationships Among Adverse and Benevolent Childhood Experiences, Emotion Dysregulation, and Psychopathology Symptoms

This cross-sectional study sought to examine adverse childhood experiences (ACEs), benevolent childhood experiences (BCEs), and emotion dysregulation as they relate to psychopathology symptoms (posttraumatic stress disorder [PTSD], anxiety, depression) in university students in emerging adulthood. Students at a United States university (N = 1,498) completed an online survey during the fall 2021 and spring 2022 semesters. Measures include the Adverse Childhood Experiences Questionnaire, Benevolent Childhood Experiences Scale, Difficulties in Emotion Regulation Scale-Short Form, PTSD Checklist for the Diagnostic and Statistical Manual of Mental Disorders 5th edition, Patient Health Questionnaire 8, and Generalized Anxiety Disorder 7 Scale. ACEs significantly related to greater symptoms and positive screens for PTSD, depression, and anxiety. BCEs significantly related to fewer symptoms and positive screens for PTSD, depression, and anxiety. Emotion dysregulation was a significant mediator of relationships between ACEs and all symptom types (direct and indirect effects were both significant, supporting partial mediation). Emotion dysregulation was a significant partial mediator of relationships between BCEs and all symptom types (direct and indirect effects were both significant, supporting partial mediation). Results showed significant small moderation effects of BCEs on the relationships of ACEs-emotion dysregulation, ACEs-depression symptoms, ACEs-anxiety symptoms, and emotion dysregulation-PTSD symptoms. Implications for colleges and universities are discussed.

Association of adverse childhood experiences and depression among medical students: the role of family functioning and insomnia

Background

Few studies have explored the mechanisms linking adverse childhood experiences (ACEs) to depression in medical students. This study aimed to investigate the relationship between ACEs and depression through the serial mediation effect of family functioning and insomnia.

Methods

A cross-sectional survey was conducted with 368 medical students from university in Chengdu in 2021. The participants were asked to complete four self-report questionnaires, including ACEs scale, the family APGAR index, the ISI and PHQ-9. Singe and serial mediation analyses were conducted using structural equation modeling by Mplus 8.3.

Results

ACEs had a significant direct effect on depression (β = 0.438, p < 0.001) and through three significantly indirect pathways: (1) through family functioning (β = 0.026, 95% CI: 0.007-0.060), accounting for 5.9% of the total effect; (2) through insomnia (β = 0.103, 95% CI: 0.011-0.187), accounting for 23.5% of the total effect; and (3) through the serial mediators involving in family functioning and insomnia (β = 0.038, 95% CI: 0.015-0.078), accounting for 8.7% of the total effect. The total indirect effect was 38.1%.

Limitations

This cross-sectional study prevented us from establishing causality.

Conclusion

This study highlights the role of family functioning and insomnia as serial mediators of the relationship between ACEs and depression. Findings help to elucidate the mechanism that underlines the pathway between ACEs and depression in medical students. These findings may indicate developing measures to strengthen family functioning and improve insomnia aiming to reduce depression in medical students with ACEs.

"Psychologically and emotionally, it affects me 'til this day": exploration of childhood sexual abuse perspectives among older adults living with HIV in South Carolina

OBJECTIVES

The influence of childhood sexual abuse (CSA) may be seen immediately or across the life course. CSA is also associated with increased HIV-risk behavior, and greater likelihood of an HIV/STI diagnosis. The aim of this study was to explore the perspectives of CSA among older adults living with HIV.

METHODS

Twenty-four adults living with HIV aged 50 to 67 years (mean age = 58.5 years), with a history of CSA, receiving care from an HIV clinic in South Carolina, participated in the study. In-depth semi-structured interviews were conducted, audio recorded and analyzed using a thematic analytic approach. The iterative analytic process included a three-step approach: discussion of initial thoughts and key concepts, identification and reconciliation of codes, and naming of emergent themes.

RESULTS

Four themes emerged: Psychological issues due to CSA, relationship challenges due to CSA, self-blame, and reliving childhood trauma (subtheme: lack of influence of CSA today). Some participants reported feeling the influence of CSA several years after the event while others noted that that there was a lack of influence of CSA at present.

CONCLUSIONS

Trauma-informed intervention programs are needed for older adults living with HIV who still experience the influence of their CSA experience. Future research should delve into the design and feasibility of implementing these programs.

Current state of the evidence on community treatments for people with complex emotional needs: a scoping review

BACKGROUND

Improving the quality of care in community settings for people with 'Complex Emotional Needs' (CEN-our preferred working term for services for people with a "personality disorder" diagnosis or comparable needs) is recognised internationally as a priority. Plans to improve care should be rooted as far as possible in evidence. We aimed to take stock of the current state of such evidence, and identify significant gaps through a scoping review of published investigations of outcomes of community-based psychosocial interventions designed for CEN.

METHODS

We conducted a scoping review with systematic searches. We searched six bibliographic databases, including forward and backward citation searching, and reference searching of relevant systematic reviews. We included studies using quantitative methods to test for effects on any clinical, social, and functioning outcomes from community-based interventions for people with CEN. The final search was conducted in November 2020.

RESULTS

We included 226 papers in all (210 studies). Little relevant literature was published before 2000. Since then, publications per year and sample sizes have gradually increased, but most studies are relatively small, including many pilot or uncontrolled studies. Most studies focus on symptom and self-harm outcomes of various forms of specialist psychotherapy: most result in outcomes better than from inactive controls and similar to other specialist psychotherapies. We found large evidence gaps. Adaptation and testing of therapies for significant groups (e.g. people with comorbid psychosis, bipolar disorder, post-traumatic stress disorder, or substance misuse; older and younger groups; parents) have for the most part only reached a feasibility testing stage. We found little evidence regarding interventions to improve social aspects of people's lives, peer support, or ways of designing effective services.

CONCLUSIONS

Compared with other longer term mental health problems that significantly impair functioning, the evidence base on how to provide high quality care for people with CEN is very limited. There is good evidence that people with CEN can be helped when specialist therapies are available and when they are able to engage with them. However, a much more methodologically robust and substantial literature addressing a much wider range of research questions is urgently needed to optimise treatment and support across this group.

The Influence of Parents on Emotion Regulation in Middle Childhood: A Systematic Review

Emotion regulation (ER) has been identified as a transdiagnostic risk factor for psychopathology, making it an ideal target for prevention and treatment. This study explores how parents can nurture the development of child ER. In April 2022, a systematic review was executed focusing on malleable factors in the parental emotion-socialization process during middle childhood. Papers in PubMed, Web of Science and Medline were screened on content-related and methodological criteria. Their methodological quality was assessed. Knowledge was assembled using a summarizing framework encompassing four factors involved in emotion socialization. Fifty papers shed light on modifiable factors at the level of parental meta-emotion philosophy, emotion-related socialization behaviors, the ER skills of parents and the emotional climate of the family. Adaptive socialization appears to be context- and child-specific, thereby taxing parents’ ER skills and their ability to put them into practice flexibly. The four changeable factors in the emotion-socialization process are highly intertwined, resulting in four possible entries for parent-directed interventions. Importantly, time should be devoted to the ER capacities of parents and their ability to attune to the situation and their child. Regarding the latter, replication studies are necessary. Recommendations for clinical interventions are provided.

The role of maternal child maltreatment history and unsupportive emotion socialization in the intergenerational transmission of emotion regulation difficulties

BACKGROUND

Maternal mental health problems and poor parenting are thought to account for the intergenerational transmission of poor outcomes to offspring of mothers who have experienced child maltreatment.

OBJECTIVE

Given that emotion regulation (ER) difficulties have been linked to adult psychopathology and maladaptive parenting, the goal of the present study was to examine the mechanisms through which a maternal history of child maltreatment, and subsequent difficulties with ER, might contribute to unsupportive emotion socialization and the intergenerational transmission of ER difficulties.

PARTICIPANTS AND SETTING

Mothers and their young adult children (aged 18-25) were recruited from across Canada to participate in an online study (N = 185 dyads).

METHODS

Mothers responded to questionnaires assessing their child maltreatment histories and ER difficulties. Young adults retrospectively reported on their mothers' emotion socialization behaviours in adolescence as well as their own difficulties with ER.

RESULTS

A moderated mediation analysis revealed that mothers who endorsed more types of child maltreatment were described as using more unsupportive contingencies, but only in the context of high levels of maternal ER difficulties. The indirect effect of maternal child maltreatment on young adults' ER difficulties was only significant for mothers with high levels of ER difficulties. More specifically, maternal difficulties with impulse control and emotional clarity contributed to more unsupportive contingencies.

CONCLUSIONS

Mothers who have experienced multiple forms of child maltreatment may be more likely to struggle with ER and engage in unsupportive emotion socialization behaviours, which may increase the risk of emotional difficulties in their children. Survivors of child maltreatment should have access to interventions that promote ER skills to improve their own well-being and to prevent the transmission of ER difficulties to future generations.

Affective Practices of Diabetes Self-Management Among Older Adults: Cumulative Effects of Childhood Adversity

BACKGROUND AND OBJECTIVES

A strong correlation exists between Type 2 diabetes mellitus and adverse childhood experiences. How adverse childhood experiences inform later-life diabetes management is less understood. This article examines diabetes management from the perspective of affective practice to explore the lingering impact of trauma biographies in diabetes management.

RESEARCH DESIGN AND METHODS

This secondary narrative analysis of 15 in-depth interviews with community-dwelling older adults with diabetes (subsample of the Subjective Experiences of Diabetes Study) focuses on the ways their reported childhood adversity affects perceptions of and responses to diabetes self-management.

RESULTS

The experiences of adversity in childhood accumulate, throughout the life course, in the affective practices informing diabetes self-management, from blood glucose testing, to food consumption, to the emotions invested in body size. We identify 3 thematic areas that emerged across participants: (a) undermining self-worth, (b) (over)eating and food as comfort, and (c) weight and body size.

DISCUSSION AND IMPLICATIONS

Our findings highlight affective practices as a mechanism through which adverse events accumulate and shape well-being over the life course. This analysis also suggests the potential for (de)accumulation of affective practices to improve diabetes management. The findings support recent calls for trauma-informed clinical care.

The My Strengths Training for Life™ program: Rationale, logic model, and description of a strengths-based intervention for young people experiencing homelessness

Traditionally, UK housing services have focused on providing temporary accommodation, identifying risk factors, and preventing negative outcomes to young people experiencing homelessness. However, deficit approaches may lead young people to becoming dependent on services and face greater marginalization and stigmatization. Meeting long-standing calls to focus more on young people's positive attributes and abilities, the My Strengths Training for Life™ (MST4Life™) program was developed as a community partnership with a large housing service. This paper describes the rationale, logic model, and content of the MST4Life™ program using the TIDieR (Template for Intervention Description and Replication) checklist. MST4Life™ is a strengths-based and experiential psychoeducation intervention for young people aged 16-24 years who are homeless or at risk. Grounded in positive youth development and basic psychological needs theory, its aim is to provide meaningful opportunities for participants to recognize, use, and further develop their mental skills and strengths. In turn, enhancing intentional self-regulation is expected to improve physical, mental, and social health and wellbeing, and support positive transitions to independent living. The potential long-term impacts include a reduction in the number of young people returning as homeless, lower rates of mental illness and mortality, and a cost saving to the public purse.

Emotion Regulation as a Pathway Connecting Early Life Adversity and Inflammation in Adulthood: a Conceptual Framework

Chronic inflammation is implicated in a variety of diseases (e.g., cardiovascular disease and cancer). Much evidence suggests that early life adversity (ELA), such as maltreatment or neglect, can increase risk for inflammation in adulthood. ELA may program proinflammatory activity via its effects on brain areas involved in emotion regulation. Of multiple emotion regulation strategies, some are considered maladaptive (e.g., expressive suppression), while others are generally adaptive (e.g., cognitive reappraisal). We propose a conceptual framework for how emotion regulation tendencies may affect vulnerability or resilience to inflammation in adults who experienced adversity in childhood and/or adolescence. In support of this framework, we summarize evidence for the relationships between emotion dysregulation and higher inflammation (i.e., vulnerability), as well as between cognitive reappraisal and lower inflammation (i.e., resilience), in healthy adults with a history of ELA. Plausible neurobiological, physiological, psychosocial, and ELA-specific factors, as well as interventions, contributing to these associations are discussed. Strengths and limitations of the extant research, in addition to ideas for future directions, are presented.

Deconstructing pathways to resilience: A systematic review of associations between psychosocial mechanisms and transdiagnostic adult mental health outcomes in the context of adverse childhood experiences

Adverse childhood experiences (ACEs) are identified with increased risk of adult mental health difficulties and negative impacts on well-being. However, there is a need to go beyond simple associations and identify candidate mechanisms underpinning the ACEs-mental health relationship. Further methodological heterogeneity points to issues around the operationalization of ACEs and the importance of modelling data using robust research designs. The aim of the current review was to synthesize studies that utilized formal mediation and/or moderation analyses to explore psychological and social variables on the pathway between clearly defined ACEs (as measured by the ACE questionnaire and Childhood Trauma Questionnaire [CTQ]) and common mental health outcomes (depressive, anxiety and post-traumatic stress disorder [PTSD] symptoms) across community samples aged over 18. A total of 31 papers were retrieved for critical appraisal. The majority of the studies explored factors mediating/moderating the link between child adversity and depression and less on anxiety and trauma. Most mechanisms were tested in only single studies, limiting the consistency of evidence. Evidence indicated that the mechanisms underlying associations between ACEs and adult mental health are likely to reflect multiple intervening variables. Further, there are substantial methodological limitations in the extant literature including the proliferation of causal inferences from cross-sectional designs and both measurement and conceptual issues in operationalizing adversity. Consistent transdiagnostic mechanisms relevant to common mental health problems were identified, including perceived social support, emotion regulation and negative cognitive appraisals/beliefs. Further research using longitudinal design is required to delineate the potential contribution of the identified mechanisms.

Promoting brain health through physical activity among adults exposed to early life adversity: Potential mechanisms and theoretical framework

Adverse childhood experiences such as abuse, neglect, and poverty, profoundly alter neurobehavioral development in a manner that negatively impacts health across the lifespan. Adults who have been exposed to such adversities exhibit premature and more severe age-related declines in brain health. Unfortunately, it remains unclear whether the negative effects of early life adversity (ELA) on brain health can be remediated through intervention in adulthood. Physical activity may represent a low-cost behavioral approach to address the long-term consequences of ELA on brain health. However, there has been limited research examining the impact of physical activity on brain health among adults with a history of ELA. Accordingly, the purpose of this review is to (1) review the influence of ELA on brain health in adulthood and (2) highlight evidence for the role of neurotrophic factors, hypothalamic-adrenal-pituitary axis regulation, inflammatory processes, and epigenetic modifications in mediating the effects of both ELA and physical activity on brain health outcomes in adulthood. We then propose a theoretical framework to guide future research in this area.

Mindfulness as a mediator and moderator in the relationship between adverse childhood experiences and depression

Adverse childhood experiences (ACEs) have been associated with a variety of negative physical and psychological health outcomes. The mechanisms by which this occurs and potential protective factors present in this relationship are understudied. Mindfulness is a cognitive resource that may protect individuals against symptoms of psychological distress. It has five core facets and encourages a nonjudgmental acceptance of the present moment. The purpose of this study was to explore the role of mindfulness in the relationship between ACEs and depression, both as a mediator and as a moderator, or protective factor. We hypothesized that the aware, describe, and non-judgement facets of mindfulness would be key factors in both sets of analyses. Participants at a university (N = 279) were given the Five Factor Mindfulness Questionnaire (FFMQ), the Adverse Childhood Experiences Scale (ACES), and the Patient Health Questionnaire (PHQ-8) to measure depression. Results indicated that the describe CI [.02, .11], aware CI [.05, .17], and non-judgement CI [.06, .18] facets of mindfulness significantly mediated the relationship between ACEs and depression. Additionally, the aware facet of mindfulness was also a significant moderator in this relationship, [t (interaction) = -3.22, p < 0.01], such that individuals with a high level of awareness had no increase in depression even as the number of ACEs increased. Negative cognitions associated with ACEs may harm one's ability to effectively describe their feelings and to be fully aware of the present moment, which may contribute to symptoms of depression. Implications for mindfulness-based interventions (MBIs) are discussed.

Adverse Childhood Experiences and Mindfulness in Chinese College Students During the COVID-19 Pandemic

Mindfulness has been found to have many positive effects on life outcomes, including mental health and educational achievement. However, less is known about the antecedents of mindfulness, particularly in Chinese college students. This study examines the effect of adverse childhood experiences (ACEs) on mindfulness among Chinese college students in September 2020, during the COVID-19 pandemic. We hypothesized that ACEs negatively affected students' mindfulness. The data were collected from 1,871 college students from 12 colleges across China. The results aligned with our hypothesis that ACEs was negatively associated with mindfulness. In particular, emotional abuse and neglect in childhood appear to have the most negative effects on mindfulness compared to other dimensions of ACEs such as physical abuse and household challenges.

Early Adverse Stress and Depressive and Bipolar Disorders: A Systematic Review and Meta-Analysis of Treatment Interventions

Introduction: A significant proportion of adults with depressive or bipolar disorders exposed to early adverse stressors do not adequately respond to standard treatments. This review aimed at synthesizing the evidence on the effectiveness of treatment interventions for depressive or bipolar disorders in adult individuals (aged 18 years or more) exposed to adverse stress early in life. Methods: Systematic review and meta-analysis including experimental and quasi-experimental published studies indexed in CINAHL, EMBASE, PubMed, and Web of Science databases and/or in reference lists. Data management and critical appraisal (with the Study Quality Assessment Tools) was conducted independently by multiple researchers. A quality-effects model for meta-analysis was used for data synthesis and publication bias was assessed using the Doi plot and LFK index. The main outcome was short-term reductions in depressive symptoms. Results: Eight randomized controlled trials, three controlled before-and-after (pre-post) studies, and three uncontrolled before-and-after studies were included. Studies lacked bipolar disorder patients. Unclear randomization procedures and reporting of blinded outcome assessor, and limited use of intention-to-treat analysis, were relevant potential sources of bias. Meta-analyses indicated that psychological, pharmacological, and combined interventions were effective in reducing depressive symptoms in the short- (Cohen's d = -0.55, 95% CI -0.75 to -0.36, I ² = 0%) and mid-term (Cohen's d = -0.66, 95% CI -1.07 to -0.25, I ² = 65.0%). However, a high risk of publication bias was detected for these outcomes. A small number of studies, with mixed results, reported interventions with long-term improvements in depressive symptomatology, and short- and mid-term response to treatment and remission. Conclusion: Despite the well-documented long-lasting, negative, and costly impact of early adverse stressors on adult psychopathology, evidence on treatment alternatives remains scant. Trauma-focused treatment interventions-whether psychological interventions alone or in combination with pharmacotherapy-may have the potential to reduce the severity of depressive symptom in adults who were exposed to early adverse stress. Findings must be interpreted with considerable caution, as important study and outcome-level limitations were observed and gray literature was not considered in this systematic review and meta-analysis.

Reducing consequences of child maltreatment during adulthood by public health actions: a Delphi study

BACKGROUND

Child maltreatment (CM) is associated with long-lasting poor health outcomes, as well as increased levels of disability and health-services consumption across the life-span. However, less is known about how CM consequences can be reduced during adulthood. We investigated professional opinions on how to mitigate long-term consequences of CM in a public health (PH) perspective.

METHODS

Using the Delphi method in three rounds, we inquired 91 professionals, mostly European researchers and clinicians about potential PH actions to mitigate CM consequences during adulthood.

RESULTS

Most experts agreed that PH actions are needed. Increasing community awareness and training emotional regulation in affected adults were prioritized strategies. Enlarging curricular knowledge about CM for professionals and developing evidence-based interventions were considered preferred methods. Reducing the barriers for access to interventions for adults, such as those provided by trauma-informed services were also suggested. Participants highlighted the possibility to reduce CM consequences across generations as a significant benefit.

CONCLUSIONS

PH programmes to reduce the burden of CM can be enhanced by specific actions to facilitate the recognition of difficulties in affected adults and to expand the availability of helpful resources. The application of these programmes could be assisted by the use of modern information-technology.

Dating Violence in Adolescence: Implications for Girls' Sexual Health

Adolescents in the United States are too often involved in relationships characterized by coercion and violence. An emerging body of research suggests that dating violence is linked with other health risks in adolescent relationships, particularly sexual risk behavior. The confluence of risks conferred by dating violence and sexual risk behavior are particularly acute for adolescent girls. Adolescent gynecology providers need to understand the nature of dating violence in adolescence and the ways in which dating violence and sexual risk behavior are mutually influential. This article reviews the literature on the links between dating violence and sexual risk in adolescent girls' relationships. The prevalence, risk factors, and consequences of dating violence in adolescence are discussed, followed by a review of the research linking dating violence and sexual risk, with a focus on common mechanisms underlying these relationship risk behaviors. The review concludes with implications for screening, prevention, intervention, and future directions for research.

Emotion regulation strategies modulate the effect of adverse childhood experiences on perceived chronic stress with implications for cognitive flexibility

Exposure to early life adversity is associated with chronic stress and a range of stress-related health problems in adulthood. Since chronic stress debilitates activity in the prefrontal cortex (pFC), maladaptive regulatory strategies in response to stress have been proposed as one explanation for the impact of early life adversity on health outcomes in adulthood. We conducted a study to examine the impact of adverse childhood experiences (ACEs) on cognitive flexibility, a key executive function implicated in activity in the pFC, in a sample of adults (N = 486). Additionally, we investigated whether perceptions of chronic stress in adulthood would mediate the influence of ACEs on cognitive flexibility. However, stress is a subjective experience, and emotion regulation strategies can attenuate the stress response. So, we also examined if individual differences in emotion regulation strategies would modulate the relationship between ACEs and chronic stress. Our results demonstrate that early life adversity, as characterized by ACEs, is associated with decreased cognitive flexibility in adulthood. Additionally, number of ACEs was positively correlated with perceived stress, which in turn was negatively correlated with cognitive flexibility. But, individual differences in the habitual use of emotion regulation strategies moderated the influence of ACEs on chronic stress. Specifically, habitual use of cognitive reappraisal attenuated the stress levels whereas habitual use of expressive suppression exacerbated stress levels. Overall, our study highlights the importance of examining emotion regulation in individuals who have experienced early life adversity.

Safe schools for teens: preventing sexual abuse of urban poor teens, proof-of-concept study - Improving teachers' and students' knowledge, skills and attitudes

Child sexual abuse (CSA) is a difficult form of abuse to detect, with the peak age of reports from 13 to 15 years old. The recent revision of the Philippine school curriculum provided an opportunity to incorporate an educational intervention for prevention of CSA. This study aimed to improve the teachers' and students' knowledge, skills and attitudes on disclosure, identification, and reporting of CSA. This research is a two-phase proof-of-concept cross-sectional study of 237 teachers and 1,458 Grade 7 students from 2 public high schools in metro Manila over a two-year period. Phase 1 involved in-service training curriculum for all teachers on the recognizing, recording, reporting, and referral (4R's) of child abuse and establishment of a referral and support system. Outcome measures included pre- and post-tests and number of CSA reports. Phase 2 involved implementation of eight student modules through the Health and Values Education subjects of the curriculum. Outcome measures were pre- and post-intervention measurement of abuse and module content. Training of teachers resulted in an increase in confidence for identifying CSA from 25% to 57%, and a decrease in apprehension of reporting CSA from 40% to 33%. The Safe Schools for Teens intervention significantly improved self-reported knowledge on abuse, dating violence, and how to help friends as well as on adolescent's impulse control and emotional clarity. There was a significant decline from pre- to post-intervention in self-reported experiences of dating violence which includes physical, sexual and emotional violence, t(793) = 3.363, p = 001 as well as a significant decline in self-reported experiences of emotional abuse from a dating partner, t(837) = 2.693, p = 0.008. The Safe Schools for Teens intervention increases awareness and reporting of child sexual abuse. The intervention also reduces dating violence highlighting that the mindfulness focused approach in connection with systems strengthening is useful for addressing adolescent violence.

Adverse childhood experiences among early care and education teachers: Prevalence and associations with observed quality of classroom social and emotional climate

This study examines the prevalence of self-reported adverse childhood experiences (ACEs) among a sample of 349 early care and education teachers. Seventy-three percent of the sample reported experiencing at least one ACE and 22% reported experiencing 4 or more ACEs. Live observational assessments of the quality of the social and emotional climate in teacher's classrooms were conducted for a subsample of 58 teachers. Within this subsample, reporting a higher number of ACEs was associated with facilitating a lower quality social and emotional classroom climate. Individual ACEs were also examined. Teachers who reported experiencing incarceration of a family member, physical abuse, or emotional abuse were observed to facilitate a lower quality social and emotional classroom climate. This study provides preliminary insight into the prevalence of ACEs among members of the early care and education workforce. Further, it extends previous work examining the multi-generational impacts of ACEs within families by showing that ACEs may influence the care that is provided to children in childcare settings.

The relationship between childhood emotional abuse and chronic pain among people who inject drugs in Vancouver, Canada

BACKGROUND

People who inject drugs (PWID) often contend with chronic pain as a result of illness and trauma, and such pain is known to have significant impacts on mental health, quality of life, and substance use behaviours. Although PWID are also known to have high rates of childhood trauma, little is known about how childhood emotional abuse may be associated with chronic pain in this population.

OBJECTIVE

We undertook this study to explore emotional abuse and chronic pain among PWID.

PARTICIPANTS AND SETTING

This study comprised a total of 1459 participants in Vancouver, Canada between June 2014 and November 2016.

METHODS

We employed multivariable generalized estimating equations with data derived from two prospective cohort studies of community-recruited PWID to examine the relationship between childhood emotional abuse and chronic pain in the past six months.

RESULTS

Among eligible participants, 591 (40.5%) reported childhood emotional abuse, and 760 (52.1%) reported chronic pain in the previous six months. In a multivariable analysis, experiencing childhood emotional abuse remained independently associated with chronic pain (adjusted odds ratio: 1.25; 95% confidence interval: 1.01-1.53) after adjustment for a range of socio-demographic and drug use confounders.

CONCLUSIONS

Our findings suggest that childhood emotional abuse may have lasting relationships with chronic pain among PWID, potentially through established physiological and psychological mechanisms. Current chronic pain treatment may benefit from the evaluation of life course vulnerabilities that may be amenable to earlier interventions. Further, increased availability of effective trauma-informed chronic pain treatment is needed among this vulnerable population.

Adverse childhood experiences and the onset of chronic disease in young adulthood

This study examined the association of adverse childhood experiences (ACEs) with early-onset chronic conditions. We analyzed data from the 2011-2012 Behavioral Risk Factor Surveillance System (BRFSS), which included 86,968 respondents representing a nine-state adult population of 32 million. ACE questions included physical, emotional, and sexual abuse; substance use, mental illness or incarceration of a household member; domestic violence, and parental separation. Outcomes included chronic conditions (cardiovascular disease, chronic obstructive pulmonary disease, cancer, depression, diabetes, and prediabetes); overall health status; and days of poor mental or physical health in the past month. We estimated Poisson regression models of the likelihood of chronic conditions and poor health status comparing adults reporting ≥4 ACEs to respondents with no ACEs within three age strata: 18-34, 35-54 and ≥55 years. The prevalence of ≥4 ACEs was highest among youngest respondents (19%). There was a dose-response gradient between ACE scores and outcomes except for cancer in older adults. Among younger respondents, those reporting ≥4 ACEs had two to four times the risk for each chronic condition and poor health status compared to respondents reporting no ACEs. With few exceptions (depression, poor mental and physical health in the past month), incidence rate ratios were highest in young adults and successively decreased among older adults. This study is among the first to analyze patterns of association between ACEs and adult health disaggregated by age. Young adults with high ACE scores are at increased risk of early-onset chronic disease. Trauma-informed care and ACEs prevention are crucial public health priorities.

The evidence base for routine enquiry into adverse childhood experiences: A scoping review

BACKGROUND

Exposure to adverse childhood experiences (ACEs; e.g., maltreatment, household dysfunction) is associated with a multiplicity of negative outcomes throughout the life course. Consequently, increasing interest is being paid to the application of routine enquiry for ACEs to enable identification and direct interventions to mitigate their harms.

OBJECTIVE

To explore the evidence base for retrospective routine enquiry in adults for ACEs, including feasibility and acceptability amongst practitioners, service user acceptability and outcomes from implementation.

METHODS

A scoping review of the literature was conducted, drawing upon three databases (CINAHL, MEDLINE, PsycINFO) and manual searching and citation tracking. Searches included studies published from 1997 until end of April 2018 examining enquiry into ACEs, or the feasibility/acceptability of such enquiry across any setting. All included studies presented empirical findings, with studies focusing on screening for current adversities excluded.

RESULTS

Searches retrieved 380 articles, of which 15 met the eligibility criteria. A narrative approach to synthesize the data was utilized. Four studies examined practitioner feasibility and/or acceptability of enquiry, three reported service user acceptability and six studies implemented routine ACE enquiry (not mutually exclusive categories). Further, eight studies explored current practice and practitioner attitudes towards ACE enquiry.

CONCLUSIONS

Limited literature was found providing evidence for outcomes from enquiry. No studies examined impacts on service user health or service utilization. Few studies explored feasibility or acceptability to inform the application of routine ACE enquiry. The implementation of routine ACE enquiry therefore needs careful consideration. Focus should remain on evaluating developing models of ACE enquiry to advance understanding of its impact.

Adverse Childhood Experiences in Infancy and Toddlerhood Predict Obesity and Health Outcomes in Middle Childhood

BACKGROUND

The Adverse Childhood Experiences (ACEs) study articulated the negative effects of childhood trauma on adult weight and health. The purpose of the current study is to examine the associations between ACEs in infancy and toddlerhood and obesity and related health indicators in middle childhood.

METHODS

We used data collected from a sample of low-income families enrolled in the national evaluation of Early Head Start (EHS). Data come from 1335 demographically diverse families collected at or near children's ages 1, 2, 3, and 11. An EHS-ACE index was created based on interview and observation items from data collected at ages 1, 2, and 3, which were averaged to represent exposure across infancy and toddlerhood. At age 11, children's height and weight were measured and parents were asked about their child's health.

RESULTS

Children were exposed at rates of 30%, 28%, 15%, and 8% to one, two, three, and four or more EHS-ACEs, respectively. Logistic regressions revealed significant associations between EHS-ACEs in infancy/toddlerhood and obesity, respiratory problems, taking regular nonattention-related prescriptions, and the parent's global rating of children's health at age 11. Across all outcomes examined, children with four or more ACEs had the poorest health. Compared with children with no ACE exposure, the odds of each of the examined health outcomes were over twice as high for children who experienced four or more ACEs.

CONCLUSIONS

Findings highlight that ACEs experienced very early in development are associated with children whose health is at risk later in childhood.

Childhood maltreatment and perceived stress in young adults: The role of emotion regulation strategies, self-efficacy, and resilience

Childhood maltreatment has many deleterious outcomes; however, trait resilience as well as emotion regulation strategies, including suppression and reappraisal, may mediate between childhood maltreatment and later perceived stress. For this study, 267 college students (183 females and 84 males; M age = 19.77, SD = 2.29) completed self-report measures of parental psychological and physical maltreatment, parental emotion neglect, habitual use of suppression and reappraisal strategies, emotion regulation self-efficacy, trait resilience, and recent perceived stress. Analyses were conducted to investigate gender-specific associations. In females, both suppression and reappraisal mediated the relationship between maternal/paternal emotional neglect and perceived stress, and suppression also mediated the relationship between maternal psychological maltreatment and perceived stress. Trait resilience mediated the relationships of all three types of maternal maltreatment, paternal psychological maltreatment, and paternal emotional neglect with perceived stress in females. There were no significant mediation effects in males. Thus, interventions aiming at reducing perceived stress associated with maternal or paternal emotional neglect or maternal psychological maltreatment in women may benefit from targeting both suppression and reappraisal. Such interventions may also be enhanced by efforts to strengthen trait resilience.