Latent Classes and Cumulative Impacts of Adverse Childhood Experiences

Childhood adversity is associated with anxiety and depression in older adults: A cumulative risk and latent class analysis

BACKGROUND

The long-lasting influence of childhood adversity on mental health is well documented; however empirical research examining how this association extends into older adults is limited. This study operationalises adversity using cumulative risk and latent class analysis (LCA) models to assess how adversity exposure and typologies may predict anxiety and depression in older adults.

METHODS

Data came from the Personality and Total Health (PATH) Through Life Project (N = 2551, age 60-66). Participants retrospectively reported their childhood experiences of domestic adversity on a 17-item scale. Mental health was measured using four validated questionnaires of depression and anxiety.

RESULTS

Linear and generalised additive models (GAM) indicated a dose-response relationship, where a greater number of cumulative adversities were associated with poorer scores on all four mental health measures. LCA identified a four-class solution; with high adversity and high parental dysfunction being associated with poorer mental health outcomes while moderate parental dysfunction and low adversity groups scored at healthy levels. Women reported higher overall anxiety than men, but no notable interactions between ACEs and gender were observed. Patterns revealed by LCA were similar to patterns shown by the cumulative risk model.

LIMITATIONS

There is a large time gap from childhood to assessment, making our study susceptible to recall bias. Also, our findings were based on cross-sectional data, limiting causal inferences.

CONCLUSION

Childhood adversity had independent and additive contributions to depression and anxiety in older adulthood, and both cumulative risk and person-centred approaches captured this relationship.

Adverse Childhood Experiences, Women Who Are Sex Trafficked, and Social Service Utilization: Implications for Social Work

The aim of this study was to examine the associations between adverse childhood experiences (ACEs) and the high levels of social service usage by women who are sex trafficked. Fifty (N = 50) women who were sex trafficked were surveyed using purposive and snowball sampling methods. The ACEs score for respondents ranged from 2 to 10 with an average score of 7.4 (SD = 2.3). Emotional and sexual abuse tied at 88 percent as the most frequently cited ACEs among the women in this sample. The prevalence of ACEs was significantly higher in this sample compared with known estimates in similar populations, ranging from 20 percent to 54 percent (p < .001). Considering the well-established link between ACEs and poor health outcomes, these findings point to the need for innovative and targeted social service provisions to women who were formerly sex trafficked that take into consideration the high level of ACEs of the women. Given the sociodemographic diversity of this sample, there is a need for services that are trauma-informed, innovative, and culturally sensitive in a variety of social service settings.

Trajectories of risk and resilience: The role of empathy and perceived social support in the context of early adversity

BACKGROUND

Evidence overwhelmingly suggests that adverse childhood experiences (ACEs) is a risk factor for poor mental health outcomes. However, the specific mechanisms via which ACEs confer an increased risk of psychopathology are less well understood.

OBJECTIVE

The study modelled the effect of empathy and perceived social support (PSS) on mental health outcomes in a mixed clinical and non-clinical population, within the context of exposure to ACEs.

PARTICIPANTS AND SETTING

A total of 575 participants (comprising a treatment-receiving and community-based sample), aged 18 to 65 completed self-report measures assessing early adversity, PSS, empathy, and mental health outcomes.

METHODS

Multiple mediation analyses were used to investigate whether empathy and PSS mediated the relationship between self-reported ACEs and mental health outcomes, and whether affective and cognitive empathy affected differentially the link between emotional neglect and psychological distress.

RESULTS

Results revealed a statistically significant indirect effect of ACEs on adult mental health through affective empathy and PSS. Emotional neglect was the only type of adversity significantly correlated with both dimensions of empathy. The indirect effect of emotional neglect on mental health outcomes via cognitive and affective empathy was also statistically significant.

CONCLUSIONS

Study results highlight the role of affective empathy and PSS as transdiagnostic mechanisms influencing the pathway between early adversity and adult mental health, and the importance of taking these into account when designing interventions aiming to promote well-being among those who have experienced childhood adversity.

Cluster analysis exploring the impact of childhood neglect on cognitive function in patients with bipolar disorder

BACKGROUND

Bipolar disorder (BD) is a severe mental disorder related to neurocognitive deficits. Exposure to childhood trauma is associated with worse cognitive performance. Different compositions of childhood trauma in BD and their impacts on cognition are rarely reported.

METHODS

We used the Brief Assessment of Cognition in Affective Disorders (BAC-A) to assess cognitive performance and the Chinese version of the Short Form of the Childhood Trauma Questionnaire (C-CTQ-SF) to assess childhood trauma experience among 55 euthymic BD patients. Cluster analysis was applied to dissect their childhood trauma experiences, which revealed three distinct clusters: a low trauma group, neglect-focus group, and multiple-trauma-experience group. We compared the cognitive function between the three clusters and used a generalized linear model to evaluate the impact of childhood neglect on cognitive domains.

RESULTS

The neglect-focus cluster showed prominent exposures to physical and emotional neglect (41.8%). BD patients in this cluster performed worse in BAC-A compared with patients in the multiple trauma cluster, especially in working memory and processing speed. The neglect-focus group revealed a significant negative effect on the composite score (ß = -0.904, p = 0.025) and working memory (ß = -1.150, p = 0.002) after adjusting sex, age, education year, BMI and total psychotropic defined daily dose.

CONCLUSIONS

Distinct patterns of childhood trauma experience are seen in BD patients and are related with different cognitive profiles. Early exposure of neglect-focus trauma was associated with the worst cognitive performance in current study. Further studies investigating the intensity of the neglect, as well as individual resilience and coping mechanisms in BD, are warranted.

Patterns of Adverse Childhood Experiences and Problematic Health Outcomes Among US Young Adults: A Latent Class Analysis

INTRODUCTION

Adverse childhood experiences (ACEs) predict problematic health outcomes (eg, substance use, mental health) among young adults; whether specific ACEs are differentially associated with specific substance use and mental health symptoms is understudied.

METHODS

Latent class analysis (LCA) identified classes of ACEs among 2209 US young adults (Mage = 24.69, range: 18-34; 57.4% female; 30.9% sexual minority; 35.8% racial/ethnic minority) in a 2-year study (2018-2020). Multivariable logistic regressions examined ACEs (reported in 2019) in relation to 2020 reports of current (past 30-day) substance use (ie, tobacco use; cannabis use and hazardous use; alcohol use and binge drinking) and mental health (ie, ≥moderate depression and anxiety symptoms), controlling for sociodemographics (ie, age, gender, race, ethnicity, sexual orientation, education).

RESULTS

Overall, 65.4% reported ≥1 ACE (M = 2.09, SD = 2.30); 34.8%, 39.1%, and 71.1% current tobacco, cannabis, and alcohol use; 39.1% and 15.3% hazardous cannabis use and binge drinking; and 24.2% and 34.5% ≥moderate depression and anxiety symptoms, respectively. LCA yielded 4 classes: Low ACEs (referent; 55.6%), Poor family health and divorce (16.3%), Parental abuse (16.0%), and High ACEs (12.1%). High ACEs (vs Low ACEs) was associated with each adverse substance use and mental health outcome except alcohol use. Poor family health and divorce was associated with tobacco use, cannabis use, and both mental health outcomes. Parental abuse was associated with tobacco use, cannabis use, hazardous cannabis use, and both mental health outcomes.

CONCLUSIONS

Health promotion interventions for young adults must assess ACEs, given that certain types of ACEs may be associated with distinct substance use and mental health outcomes.

A Scoping Review on Adverse Childhood Experiences Studies Using Latent Class Analysis: Strengths and Challenges

Adverse childhood experiences (ACEs) studies reveal the profound impacts of experiencing trauma and hardships in childhood. However, the cumulative risk approach of treating ACEs obscures the heterogeneity of ACEs and their consequences, making actionable interventions impossible. latent class analysis (LCA) has increasingly been used to address these concerns by identifying underlying subgroups of people who experience distinctive patterns of co-occurring ACEs. Though LCA has its strengths, the existing research produces few comparable findings because LCA results are dependent on ACEs measures and indicators, which vary widely by study. Therefore, a scoping review of ACEs studies using LCA that focuses on ACEs measures, indicators, and findings is needed to inform the field. Following Arksey and O'Malley's five-stage scoping review methodological framework, we first identified 211 articles from databases of EBSCOhost, PubMed, and Scopus using "adverse childhood experiences" for title search and "latent class analysis" for abstract search. Based on the inclusion criteria of peer-reviewed articles written in English published from 2012 to 2022 and the exclusion criteria of nonempirical studies and the LCA not analyzing ACEs, we finally selected 58 articles in this scoping review. Results showed LCA has been increasingly endorsed in the ACEs research community to examine the associations between ACEs and human health and well-being across culturally diverse populations. LCA overcame the limitations of the traditional methods by revealing specific ACEs clusters that exert potent effects on certain outcomes. However, the arbitrary nature of selecting ACEs indicators, measures, and the limited use of theory impedes the field from moving forward.

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

Introduction

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

Methods

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

Results

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

Conclusions

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

Examining the relationship between adversity and suicidality and self-harm in Irish adolescents from 2020 to 2022

BACKGROUND

Research indicates that there is a strong association between childhood adversity and youth suicide and self-harm. However, there is currently a lack of understanding about the patterns of adversity most frequently experienced by youth across social settings, and whether these typologies differently predict youth engagement in suicide and self-harm. This study examines the dominant patterns of adversity experienced by adolescents across home, peer, and school contexts, and explores the relationship between youth's adversity profiles and their suicide and self-harm outcomes, across a two year period (2020-2022).

METHODS

Secondary analyses were performed on data collected from 10,281 (50 % male) adolescents who participated in the Irish Planet Youth questionnaire in 2020 (n = 5004) or 2022 (n = 5277).

RESULTS

Findings from clustered latent class analyses indicated that there are four dominant profiles of adversity experienced by adolescents. Class 1 (Multiple Adversity) was characterised by a high probability of experiencing adversity across multiple social settings. Class 2 (Parent Adversity) had a strong likelihood of experiencing adversity with parents. Class 3 (Peer Adversity) were likely to experience adversity within the peer/friend domain. Class 4 was characterised by a low probability of experiencing adversity. Findings from logistic regression models with BCH training weights indicated that there were significant differences in self-harm and suicidality across the adversity classes. In comparison to the low adversity group, adolescents in the multiple adversity group were more likely to self-harm and attempt suicide.

LIMITATIONS

These findings are based on cross-sectional data and rely on the use of single-item measurements, which may limit the generalisability of findings.

DISCUSSION

Results indicate that youth who experience adversity across home, peer and school contexts are at the greatest risk of engaging in suicide and self-harm. These findings have important implications for policy and practice, and suggest that youth experiencing adversity across multiple settings should be priority targets for intervention.

Early adverse childhood experiences and preschoolers' attentional regulation: A latent class analysis

BACKGROUND

Adverse childhood experiences (ACEs) profoundly disrupt preschoolers' attentional regulation development. Different patterns of ACEs may be associated with different attentional regulation outcomes.

OBJECTIVE

Drawing from developmental systems theory and attachment theory, this study aimed to identify distinct patterns of early ACEs at age three and examined the associations of these patterns with preschoolers' attentional regulation at age five.

PARTICIPANTS AND SETTING

This study used the two waves of longitudinal data from the Future of Families and Child Wellbeing Study (N = 4457).

METHODS

First, this study applied latent class analysis (LCA) across nine indicators of ACEs at age three. Second, class membership was examined for associations with preschoolers' attentional regulation at age five.

RESULTS

LCA identified four latent classes of ACEs: separation (41.2 %), parental incarceration (33 %), family dysfunction (20.8 %), and child abuse (5 %). Children in the child abuse class exhibited lower levels of attentional regulation than those in the family dysfunction class (0.33 standard deviation difference, p < .01) or separation class (0.48 standard deviation difference, p < .001). Children in the parental incarceration class demonstrated lower levels of attentional regulation than those in the separation class (0.63 standard deviation difference, p < .001).

CONCLUSIONS

Findings provide implications for the need to prevent early child abuse and incorporate trauma-informed intervention programs to support preschoolers' attentional regulation during school-entry age.

Associations between early child adversity and lifetime suicide attempts among gender diverse individuals: A moderated mediation

BACKGROUND

This study examines the effect of adverse childhood experiences (ACEs) on lifetime suicide attempts (LSA) across five gender subgroups (i.e., transgender men, transgender women, transgender non-binary, cisgender men and cisgender women).

OBJECTIVE

To examine (1) the prevalence of LSA across gender identity subgroups; (2) whether the association between ACEs and LSA is moderated by gender identity subgroup; (3) depressive symptoms, alcohol use disorder, social support, and social well-being as mechanisms linking ACEs with LSA; and (4) the moderating role of gender identity on the four putative mediators.

PARTICIPANTS AND SETTINGS

We used nationally representative data from a population-based survey of N = 1368 transgender and cisgender individuals collected between 2016 and 2019.

METHODS

Structural equation modeling was used to explore the indirect effect of depressive symptoms on the relation between ACEs and LSA, and the moderating impact of gender identity.

RESULTS

LSA was significantly more prevalent among transgender respondents (cisgender man = 5 %; cisgender woman = 9 %; transgender man = 42 %; transgender woman = 33 %; transgender non-binary = 37 %; p < 0.001). Individuals with more ACEs had a greater risk of engaging in LSA regardless of gender identity; however, moderation results showed that the impact of each additional ACE on LSA was stronger for individuals with transgender identities: the likelihood of engaging in LSA was statistically similar for transgender men with no ACEs and cisgender men with all 8 ACEs. Indirect effects of ACEs on LSA via depressive symptoms were also observed, and the mediating effect was moderated by gender identity.

CONCLUSIONS

By examining the mechanisms linking childhood adversity to LSA, this study demonstrates that not all ACEs impact gender minority subgroups equally.

Associations Between Configurations of Childhood Adversity and Adult Mental Health Disorder Outcomes

The life course perspective and cumulative inequality theory suggest that childhood adversity, occurring during a sensitive period of the life course, can have long-term consequences for adult mental health and well-being. Yet, the long-term influence of adversity on adult outcomes may depend on both the features of adverse childhood experiences (e.g., the number, type, and co-occurrence of adversities) as well as the outcome assessed. Using latent class analysis applied to several waves of prospective data from the Great Smoky Mountain Study (GSMS; N=1,420) we identify subpopulations that are similar in their adversity experiences before age 18. We then predict adult internalizing and substance use disorder diagnoses by adversity experience. Results reveal five distinct classes of adversity, with unique risks for specific diagnoses in adulthood.

Profiles of childhood adversities in Inuit from Nunavik: description and associations with indicators of socioeconomic characteristics, support, and community involvement

OBJECTIVES

Distress and associated health problems reported by Nunavik Inuit emanate from heterogeneous roots, including adverse childhood experiences. This study aims to (1) identify distinct childhood adversity profiles and (2) examine associations between these profiles and sex, socioeconomic characteristics, social support, and community involvement among Nunavimmiut.

METHODS

In a sample of 1109 adult Nunavimmiut, sex, socioeconomic characteristics, support, community involvement, residential school attendance, and 10 forms of adverse childhood experiences (ACEs) were documented using questionnaires. Latent class analyses and weighted comparisons were performed for three subgroups: 18-49 years; 50 years and above with experience of residential school; and 50 years and above without experience of residential school. The analysis design, the manuscript drafts, and the key findings were discussed and co-interpreted with the collaboration of community representatives, taking into consideration Inuit culture and needs.

RESULTS

A total of 77.6% of Nunavimmiut reported having experienced at least one form of childhood adversity. Three ACE profiles were identified among the 18-49-year-olds: low ACEs (43.0%), household stressors (30.7%), and multiple ACEs (26.3%). Two profiles characterized ACEs experienced among the 50-year-olds and over with and without history of residential schooling: low ACEs (80.1% and 77.2%, respectively) and multiple ACEs (19.9% and 22.8%, respectively). Among the group of 18-49-year-olds, as compared to the low ACE profile, the profile with household stressors included proportionally more women (odds ratio [OR] = 1.5) and was associated with lower involvement in volunteering and community activities (mean score reduced by 0.29 standard deviation [SD]) and lower family cohesion (SD = - 0.11), while the multiple ACE profile was related to a lower rate of employment (OR = 0.62), lower family cohesion (SD = - 0.28), and lower satisfaction with ability to practice traditional activities (SD = - 0.26).

CONCLUSION

Childhood adversities among Nunavimmiut do not occur in isolation and experiencing multiple forms of childhood adversities predicts lower socioeconomic status, support, and community involvement in adulthood. Implications for the planning of health and community services in Nunavik are discussed.

Adverse Childhood Experiences and Depression: The Mediating Role of Resilience and Emotional Regulation

The current study examined the mediating roles of resilience and emotional regulation in the association between childhood trauma and depressive symptoms among individuals who experienced adverse childhood experiences (ACEs). Data from 200 women aged 17 to 77 years who were psychiatric outpatients were collected using self-reported questionnaires assessing child adversity, depressive symptoms, resilience, and emotional regulation. A positive correlation was found between a subscale of the ACE-IQ and depression. Childhood trauma was associated with higher risk of depressive symptoms among participants with lower resilience (an association that was partly explained by resilience level [mediation]). Emotional regulation was not a significant mediator in the childhood trauma-depression association. Our findings indicate that resilience is a key mediator between childhood trauma and depression. Individuals who experienced childhood trauma may benefit from evidence-based interventions focused on strengthening resilience and improving coping strategies. [Journal of Psychosocial Nursing and Mental Health Services, 62(1), 45-54.].

Specific domains of positive childhood experiences (PCEs) associated with improved adult health: A nationally representative study

Background

Positive childhood experiences (PCEs) are supportive relationships and environments associated with improved health when aggregated into composite scores. Adverse childhood experiences (ACEs), a reciprocal measure to PCEs, are associated with worse health in aggregate scores and when disaggregated into measures of specific ACE types (hereafter domains). Understanding the associations between specific PCE domains and health, while accounting for ACEs, may direct investigations and intervention planning to foster PCE exposure.

Methods

We analyzed data from the nationally representative United States longitudinal Panel Study of Income Dynamics. Five PCE domains were examined: (i) peer support and healthy school climate, (ii) neighborhood safety, (iii) neighborhood support, and nurturing relationships with (iv) maternal and (v) paternal figures. Survey weighted logistic regression models tested associations between each PCE domain measure and adult general health rating, controlling for demographic covariates and nine ACE exposures: physical, emotional, or sexual abuse/assault; emotional neglect; witnessing intimate partner violence or household substance use; having a parent with mental illness; any parental separation or divorce; and/or having a deceased or estranged parent. Secondary outcomes included adult functional status and mental and physical health diagnoses. We also tested for statistical interactions between PCE domain and ACE score measures.

Results

The sample included 7105 adults. Higher scores for the "peer support and healthy school climate" and "neighborhood safety" domain measures showed the most protective relationships with the adverse health conditions tested, most notably for mental illness. The relationship between PCE domain measures and health outcomes was attenuated, but not statistically moderated by ACE exposure.

Conclusion

Experiencing childhood peer support, a healthy school climate, and neighborhood safety were especially protective against multiple adult health conditions, including for ACE exposed individuals. Interventions that promote PCEs may yield population health gains.

Sex Trafficked Women, Drug Dealers, and Men Who Buy Sex: A Look at "Race"

Black, Native American, Latinx, Asian, and Pacific Islander women all have histories of sexual violence in the United States. Their historical victimizations have set a precedence for contemporary commercial sex victimization. The purpose of this study was to examine the role of "race" in sex trafficking. Data from 50 women with sex trafficking histories resulted in three candidate themes and five subthemes that include (a) sex trafficked women (White women, Black women vs. White women, and all women with unique subthemes related to drug use and locations); (b) Black male traffickers; and (c) Black and White male customers.

Adversity profiles of children receiving care and support from social services: A latent-class analysis of school-aged children in Wales

BACKGROUND

Children receive care and support from social services due to the risk of harm or impeded development or because of disability. This study aimed to identify typologies of adversity experienced by children receiving care and support from social services and to explore how typologies differ by sociodemographic characteristics.

METHODS

This is a cross-sectional study of 'Children Receiving Care and Support' (N = 12 792) during 2017/2018 in Wales, UK. We sought to (1) examine the prevalence of household adversities experienced by children in receipt of care and support from social services; (2) identify typologies of household adversities; and (3) explore how typologies of household adversities differ by family characteristics (demographics, measures of social disadvantage, perinatal and care factors).

RESULTS

We found evidence for multiple risk factor constellations. The four-class solution suggested four distinct classes of adversities: child disability (50.0%), low adversities (20.3%), family poor health (6.7%) and multiple risks (23.0%). Children in the 'multiple risk' class were significantly more likely to be younger, more deprived and 'looked after' by the local authority compared with those in the 'low adversities' class.

CONCLUSIONS

Given the presence of different constellations of household adversities, policies and interventions that address multiple risk factors simultaneously may be more effective and have longer-lasting benefits.

A Network Analysis of the Relationship Between Mental and Physical Health in Unsheltered Homeless Persons in Los Angeles County

Homelessness is a public health crisis both nationally, in the United States, and internationally. Nevertheless, due to the hidden vulnerabilities of persons who are without shelter, little is known about their experiences during periods of homelessness. The present research adopts a network approach that conceptualizes how the major risk factors of homelessness interact, namely substance abuse problems, poor mental health, disability, and exposure to physical or sexual violence by an intimate partner. Our analysis draws on a large demographic survey of over 5,000 unsheltered homeless persons conducted in 2017 by the Los Angeles Homeless Services Authority. We estimated a network structure for 12 survey items tapping individual risk using the graphical least absolute shrinkage and selection operator algorithm. We then examined network centrality metrics and implemented a community detection algorithm to detect communities in the network. Our results indicated that mental illness and intimate partner violence (IPV) are central measures that connect all other mental and physical health variables together and that post-traumatic stress disorder and IPV are both highly affected by changes in any part of the network and, in turn, affect changes in other parts of the network. A community detection analysis derived four communities characterized by disability, sexual victimization and health, substance use, and mental health issues. Finally, a directed acyclic graph revealed that drug abuse and physical disability were key drivers of the overall system. We conclude with a discussion of the major implications of our findings and suggest how our results might inform programs aimed at homelessness prevention and intervention.

The association between adverse childhood experiences and depression trajectories in the Add Health study

BACKGROUND

Adverse childhood experiences (ACEs) are potentially traumatic experiences that occur before age 18. ACEs are linked to depression in adulthood, but little is known about the association between ACEs and depression trajectories across the lifespan.

OBJECTIVE

To examine the association between specific types of ACEs, cumulative ACE scores, and depression trajectories from adolescence to adulthood.

PARTICIPANTS AND SETTING

Waves 1-4 of the National Longitudinal Study of Adolescent to Adult Health (N = 12,888), spanning ages 12 years to 43 years.

METHODS

We constructed trajectories of depression scores using a modified 9-item Center for Epidemiologic Studies Depression Scale (CES-D-9). We used weighted logistic regression to calculate odds ratios and confidence intervals for each ACE and ACE score and depression trajectories after adjusting for confounders.

RESULTS

We found 75.3 % experienced at least one ACE and 14.7 % experienced 4+ ACEs. We identified three CES-D-9 trajectories: consistently low (Group 1), decreasing (Group 2), and increasing (Group 3) depression scores. All types of abuse, neglect, and community violence were significantly associated with trajectory Groups 2 and 3 vs 1 (p < .05). Foster home placement, poverty, and parental incarceration were associated with Group 2 vs 1. ACE scores showed a dose-response association with Group 3 vs 1 [aORs for 1ACE = 1.43 (0.93-2.20); 2-3ACEs = 1.97 (1.30-3.00); 4+ACEs = 3.08 (1.86-5.09)], and Group 2 vs 1 [aORs for 1ACE = 1.26 (0.87-1.83); 2-3ACEs = 1.93 (1.36-2.74); 4+ACES = 2.70 (1.90-3.84)].

CONCLUSIONS

ACEs can have a lasting impact on depression through adulthood, highlighting the need to mitigate their impact to prevent depression-associated morbidity and mortality.

Patterns of adverse childhood experiences and cardiovascular risk factors in U.S. adults

Adverse Childhood Experiences (ACEs) are associated with poor health yet, we know little about how distinct patterns of ACE types are associated with cardiovascular (cardiovascular (CVD)) risk factors. The current study 1) examined associations of latent ACE classes with modifiable CVD risk factors including high cholesterol, smoking, diabetes, hypertension, high triglycerides, physical inactivity, overweight/obesity, and lifetime depression; and 2) examined the impact of socioeconomic status-related (SES) factors on these relationships. Using a cross-sectional analysis of the National Epidemiologic Survey of Alcohol and Related Conditions-III (n = 36,309) data, four latent classes of ACEs were previously identified: 1) low adversity, 2) primarily household dysfunction, 3) primarily maltreatment, and 4) multiple adversity types. We examined the association of these classes with CVD risk factors in adulthood and subsequently, the same model accounting for SES-related factors. Tobacco smoking, overweight/obesity, and lifetime depression were each associated with higher odds of being in classes 2, 3, and 4 than class 1, respectively. These relationships held after adjusting for SES-related factors. Class 4 was associated with the most CVD risk factors, including high triglycerides and high cholesterol after controlling for SES-related factors. The consistent associations between tobacco smoking, overweight/obesity, and lifetime depression with each adverse ACE profile, even after controlling for SES, suggest behavioural CVD prevention programs should target these CVD risk factors simultaneously.

The Relationship of Risky Online Behaviors and Adverse Childhood Experiences to Online Sexual Victimization Among Korean Female Adolescents

Prior research has demonstrated that online sexual victimization (OSV) is a significant social problem and is associated with adolescents' negative developmental outcomes. However, it remains unclear whether adolescents' risky online behaviors and offline victimization are related to the risk of OSV. The present study examined whether female adolescents' risky online behaviors (mood regulation through the Internet, ingratiating behavior, disclosure of personal information, harassing behavior, talking with someone met online, and sexual behavior) and offline victimization (adverse childhood experiences [ACEs]) would be associated with OSV. This study recruited female adolescents and their mothers within six metropolitan cities and provinces of residential areas of South Korea. A total of 509 female adolescents participated in the survey (aged 13-18 years). The present study employed multivariate regression to examine the relationship of risky online behaviors and offline victimization to the experience of OSV. Female adolescents' risky online behaviors (harassing behavior, talking with someone met online, and sexual behavior) were significantly associated with OSV, and those with high exposure to maltreatment and family dysfunction during childhood were more at risk of OSV than adolescents with low exposure to ACEs. The results suggest that it is important to address the effects of risky online behaviors and exposure to offline victimization on female adolescents' sexual victimization online. Identifying risky online behaviors and offline victimization related to OSV can help researchers and practitioners further understand female adolescents' online victimizations in the context of offline and online dynamics.

Patterns of Adverse Childhood Experiences and Mental Health: Evidence From College Students in Korea

Adverse childhood experiences (ACEs) are concerning exposures that may have detrimental effects on mental health. Much of the prior evidence on ACEs comes from the U.S and western developed countries. In light of the limited knowledge of ACEs in other social contexts and the interconnection among adversities, this study aims to identify distinct patterns of co-occurring ACEs and examines the associations between those adversities and mental health in South Korea. We used data from a national sample of Korean college students recruited via non-probability quota sampling in 2019 (N = 1037). The dependent variables included three measures of mental health assessed by the Brief Symptom Inventory depression symptoms, anxiety symptoms, and somatization symptoms. The independent variable was the patterns of ACEs identified using 14 indicators of childhood adversity. We conducted a Latent Class Analysis with a distal outcome, using the Bolck, Croons, and Hagenaars method. The analysis found four patterns of ACEs: extreme adversity (8%), family violence (20.3%), economic adversity (10.4%), and low adversity (61.3%). The extreme adversity group exhibited multiple exposures, including interpersonal violence in home environments, economic hardship, and bullying victimization by peers. The results suggest that the extreme adversity and family violence groups showed significantly worse mental health symptoms than the economic adversity and low adversity groups. Also, the extreme adversity group reported significantly higher levels of depression symptoms and somatization symptoms than the family violence group. This study expands the current understanding of ACEs and their harmful effects on mental health in young adulthood specific to Korea while comparing them with other social contexts. Researchers and practitioners should recognize the co-occurrence of child adversities, rather than overestimating sole adversity, to develop effective strategies for promoting mental health.

Patterns and trajectories of children's maltreatment experiences in Taiwan: Latent transition analysis of a nationally representative longitudinal study

BACKGROUND

Little is known about the patterns of child maltreatment change over time and vary according to gender and child protective services (CPS) experience in Taiwan.

OBJECTIVE

To examine the latent status and the trajectories of child maltreatment and to identify effects that gender and CPS have on these statuses and trajectories in Taiwan.

PARTICIPANTS AND SETTING

A national proportionately stratified sample of 6233 4th-grade students were recruited from 314 elementary schools in Taiwan, and followed up at 6th and 8th graders. A total of 1908 students completed valid data at all three time points was analyzed.

METHODS

Latent class analysis and latent transition analysis were used to identify the number of latent variables and the patterns of child maltreatment. Multiple-group model was used to test with gender difference.

RESULTS

Four latent maltreatment statuses were identified: high all maltreatment, high psychological maltreatment, high neglect, and no/low maltreatment. A reduction in maltreatment severity occurred over time was found. The percentage of students in the "high all maltreatment" and "high neglect" groups decreased whereas those in the "high psychological maltreatment" and "no/low maltreatment" groups increased. Differences in the transition probabilities of latent maltreatment status by gender was revealed. The percentage of CPS recipients in the "high all maltreatment" decreased over time.

CONCLUSIONS

This study highlighted the dynamic nature of child maltreatment and described the timing, continuity, and change that characterizes children's exposure to maltreatment in Taiwan. Policies and interventions geared toward early detection, mitigation, and prevention of child maltreatment are needed.

Adverse Childhood Experiences and Intimate Partner Violence Among Youth in Cambodia: A Latent Class Analysis

Adverse childhood experiences (ACEs) are a global public health problem, including in low- and middle-income country settings, and are associated with increased risk of intimate partner violence (IPV) during young adulthood. However, current measurement of ACEs may underestimate sequelae of different combinations, or classes, of ACEs and mask class-specific associations with adult exposure to IPV. We used data among ever-partnered young women and men aged 18-24 years from the Cambodia Violence Against Children Survey (N_w = 369; N_m = 298). Participants retrospectively reported on seven ACEs and lifetime physical and/or sexual IPV victimization and perpetration. Latent classes comprised of ACEs were used as predictors of physical and/or sexual IPV perpetration and victimization, controlling for household wealth. Identified latent classes for women were "Low ACEs" (60%), "Community Violence and Physical Abuse" (23%), and "Physical, Sexual and Emotional Abuse" (17%). Latent classes for men were "Low ACEs" (48%) and "Household and Community Violence" (52%). Among women, those in the Physical, Sexual and Emotional Abuse class were more likely to experience and perpetrate physical and/or sexual IPV in their romantic relationships compared to the reference group (Low ACEs). Women in the Community Violence and Physical Abuse class were more likely to perpetrate physical and/or sexual IPV, but not experience IPV, compared to women in the Low ACEs class. Among men, those in the Household and Community Violence class were more likely to perpetrate physical and/or sexual IPV against a partner, compared to men in the Low ACEs class. Overall, patterns of ACEs were differently associated with IPV outcomes among young women and men in Cambodia. National violence prevention efforts might consider how different combinations of childhood experiences shape risk of young adulthood IPV and tailor interventions accordingly to work with youth disproportionately affected by varied combinations of ACEs.

Childhood Adversity, Emotional Well-Being, Loneliness, and Optimism: a National Study

Optimism and loneliness, which reflect the expected inverse associations with excess morbidity and mortality, are theoretically and empirically associated with early adversities and offer potential avenues for clinical support. The current study first estimates latent classes of adverse childhood experiences and, second, assesses the role of these experiences on later reports of optimism and loneliness in late adolescence and emerging adulthood, and the role of emotional regulation and common mental disorders. Surveys were conducted in a longitudinal household sample of adolescents recruited in 2013 (average age of 20 at wave 6 follow-ups). The analytic sample included 1177 female and male respondents representative of their age group in the USA at baseline. Latent classes were estimated based on 10 indicators of childhood adversity. Respondents were assigned to classes using posterior probabilities of latent class membership, and class membership was used to predict psychological outcomes in multivariable models. Three latent classes of childhood adversity were identified in the current sample, representing low childhood adversity (81.5%), higher probability of family dysfunction with lower levels of interpersonal abuse (13.4%), and high adversity including higher probabilities of parental discord and violence as well as child abuse (5.1%). Both classes of respondents who faced greater childhood adversity were more likely to report greater loneliness and lower optimism in emerging adulthood. Results were attenuated by measures of emotional well-being. Addressing adolescent loneliness and supporting optimistic outlooks in emerging adulthood are two pathways with potential benefits to reduce mental and physical morbidities.

Adverse childhood experiences and child behavioral health trajectory from early childhood to adolescence: A latent class analysis

BACKGROUND

Adverse childhood experiences (ACEs) profoundly influence child development. Different patterns of ACEs among boys and girls may be associated with different developmental trajectories.

OBJECTIVE

This study aimed to identify patterns of ACEs at age three and tested the associations of these patterns with child behavioral health problems from age three to age fifteen.

PARTICIPANTS AND SETTING

This study used data (N = 4898) from the Fragile Families Child Wellbeing Study.

METHODS

First, this study conducted latent class analysis (LCA) across ten indicators of ACEs at age 3. LCA was conducted separately for boys and girls. Second, class membership was tested for associations with child internalizing symptoms and externalizing behaviors (ages three, five, nine, and fifteen years).

RESULTS

LCA identified five classes of ACEs for girls: low ACEs, parental separation, financial difficulty, chaotic home, and child maltreatment. LCA for boys, however, identified a six-class solution, in which there was a physical abuse-only class, while also a sixth high ACEs class that included both physical and emotional abuse. Classes with the most ACEs often had the highest symptomology (internalizing symptoms ranging from 0.24 to 0.56; externalizing ranging from 0.36 to 1.00; ps < .05). However, differences in behavioral health were detected depending on the patterns of ACES. At ages nine and fifteen, the financial difficulty group also had high symptomatology (internalizing symptoms ranging from 0.23 to 0.43; externalizing from 0.23 to 0.46; ps < .05).

CONCLUSIONS

Findings provide implications including the need to examine ACEs heterogeneity and address financial difficulty as a substantial ACE.

Clusters of Adversity Types Among U.S. Youth: Associations With Mental Health

INTRODUCTION

Childhood adversities are risk factors for subsequent mental health problems. Research commonly focuses on adverse childhood experiences, despite evidence that other exposures, such as neighborhood violence or peer victimization, co-occur with adverse childhood experiences and are associated with similar mental health outcomes. This study explored the clustering of these exposures and examined the associations with mental health.

METHODS

Data were a nationally representative sample of U.S. children aged 10-17 years (N=1,959), collected in 2013-2014. Latent class analysis was conducted on 22 types of childhood adversity. Regression models examined associations with mental health and substance use. These secondary analyses were conducted in 2021.

RESULTS

A total of 5 classes were identified: Low all (59% of the sample), Abuse (29%), High multiple adversities (5%), Peer adversity (4%), and Neighborhood violence (4%). All classes had poorer mental health and a higher prevalence of substance use than Low all, with particularly harmful levels in High multiple adversities. Neighborhood violence was not significantly different from High multiple adversities on mental health symptoms and showed a greater proportion of past-year substance use than all other classes except High multiple adversities. Peer adversity and Abuse classes did not differ significantly in any outcomes.

CONCLUSIONS

Findings highlight the particularly deleterious impact of neighborhood violence and highly co-occurring adversity types on mental health and substance use. It is important to extend our conceptualization of adverse childhood experiences to include peer adversity and neighborhood violence and shift from a siloed approach to examining all these exposures.

Adverse childhood experiences and premature mortality through mid-adulthood: A five-decade prospective study

Background

Adverse childhood experiences (ACEs) can have lasting effects on adult health and survival. In this study, we aimed to examine how the cumulative number and clustering patterns of ACEs were related to premature mortality.

Methods

Participants (N=46 129; 45% White, 48% Black; 49·5% females) were offspring (born in 1959-1966) of participants enrolled in the Collaborative Perinatal Project (CPP). We conducted latent class analysis to examine the clustering patterns of ACEs assessed between children's birth and age seven. We also calculated the cumulative ACE scores of 13 individual ACEs. Cox regression models were used to examine the associations of ACE clusters and scores with risk of premature mortality from adolescence to mid-adulthood.

Findings

At the start of the follow-up for mortality in 1979, participants were 12-20 years old (Mean=15·99 years), and within the 38-year follow-up through 2016, 3 344 deaths were observed among the 46 129 CPP offspring. Five latent classes of ACEs were identified. Compared to children with Low Adversity (48% of the sample), children in Family Instability (9%, HR=1·28, 95%CI 1·07-1·53), Poverty & Crowded Housing (21%, HR=1·41, 95%CI 1·24-1·62), and Poverty & Parental Separation (19%, HR=1·50, 95%CI 1·33-1·68) classes had higher hazards of premature mortality. In addition, children with 2 (HR=1·27, 95%CI 1·14-1·41), 3 (HR=1·29, 95%CI 1·15-1·45), and 4+ (HR=1·45, 95%CI 1·30-1·61) ACEs had higher hazards of mortality than those with no ACE. The clusters of Poverty & Crowded Housing (HR=1·28, 95%CI 1·10-1·49) and Poverty & Parental Separation (HR=1·23, 95%CI 1·02-1·48) remained associated with higher risk of premature mortality, beyond the cumulative risk of higher number of ACEs (HR=1·05, 95%CI 1·01-1·08).

Interpretation

About half of the CPP cohort experienced early life adversities that clustered into four distinct patterns, which were associated with different risk of premature mortality. It is important to deepen our understanding of how specific clusters of childhood adversities affect health and premature mortality to better inform approaches to prevention and interventions.

Patterns of adverse childhood experiences and associations with prenatal substance use and poor infant outcomes in a multi-country cohort of mothers: a latent class analysis

BACKGROUND

This paper enumerates and characterizes latent classes of adverse childhood experiences and investigates how they relate to prenatal substance use (i.e., smoking, alcohol, and other drugs) and poor infant outcomes (i.e., infant prematurity and low birthweight) across eight low- and middle-income countries (LMICs).

METHODS

A total of 1189 mother-infant dyads from the Evidence for Better Lives Study cohort were recruited. Latent class analysis using the Bolck, Croon, and Hagenaars (BCH) 3-step method with auxiliary multilevel logistic regressions was performed.

RESULTS

Three high-risk classes and one low-risk class emerged: (1) highly maltreated (7%, n = 89), (2) emotionally and physically abused with intra-familial violence exposure (13%, n = 152), (3), emotionally abused (40%, n = 474), and (4) low household dysfunction and abuse (40%, n = 474). Pairwise comparisons between classes indicate higher probabilities of prenatal drug use in the highly maltreated and emotionally abused classes compared with the low household dysfunction and abuse class. Additionally, the emotionally and physically abused with intra-familial violence exposure class had higher probability of low birthweight than the three remaining classes.

CONCLUSION

Our results highlight the multifaceted nature of ACEs and underline the potential importance of exposure to childhood adversities on behaviors and outcomes in the perinatal period. This can inform the design of antenatal support to better address these challenges.

Stressful Events and Adolescent Psychopathology: A Person-Centred Approach to Expanding Adverse Childhood Experience Categories

Stress from cumulative adverse childhood experiences (ACEs) can pose a serious risk of experiencing anxiety, depression, and other mood disorders in adolescence. However, there is a paucity of research identifying specific profiles or combinations of exposure to other forms of stressful life events and their impact on adolescent psychopathology. This study attempted a conceptual expansion of the ACE checklist by examining these stressful events. The study used cross-sectional data from a modified version of the CASE Study survey where 864 adolescents (56% female, n = 480), aged from 11 - 18 years were recruited from four post-primary schools in the North-West region of NI. Latent class analysis of the 20-item stressful events checklist revealed 3 distinct risk classes: a low-risk class (53.5%), at-risk class (42.7%), and an immediate-risk class (3.8%). Results showed those at most risk of adolescent psychopathology had the highest probability of encountering interpersonal relationship issues, experiencing family dysfunction, and having close friends experiencing psychological difficulties. Findings indicate that the original ten ACE categories may be too narrow in focus and do not capture the wide range of childhood adversity. Expanding the ACE checklist to include other stressful events is discussed as these may also be antecedents to psychopathologic responses.

Adverse childhood experiences and comorbidity in a cohort of people who have injected drugs

BACKGROUND

Childhood adversity is associated with the onset of harmful adult substance use and related health problems, but most research on adversity has been conducted in general population samples. This study describes the prevalence of adverse childhood experiences in a cohort of people who have injected drugs and examines the association of these adverse experiences with medical comorbidities in adulthood.

METHODS

Six hundred fifty three adults were recruited from a 30-year cohort study on the health of people who have injected drugs living in and around Baltimore, Maryland (Median age = 47.5, Interquartile Range = 42.3-52.3 years; 67.3% male, 81.1% Black). Adverse childhood experiences were assessed retrospectively in 2018 via self-report interview. Lifetime medical comorbidities were ascertained via self-report of a provider diagnosis. Multinomial logistic regression with generalized estimating equations was used to examine the association between adversity and comorbid conditions, controlling for potential confounders.

RESULTS

Two hundred twelve participants (32.9%) reported 0-1 adverse childhood experiences, 215 (33.3%) reported 2-4, 145 (22.5%) reported 5-9, and 72 (11.1%) reported ≥10. Neighborhood violence was the most commonly reported adversity (48.5%). Individuals with ≥10 adverse childhood experiences had higher odds for reporting ≥3 comorbidities (Adjusted Odds Ratio = 2.9, 95% CI = 1.2 - 6.8, p = .01).

CONCLUSIONS

Among people who have injected drugs, adverse childhood experiences were common and associated with increased occurrence of self-reported medical comorbidities. Findings highlight the persistent importance of adversity for physical health even in a population where all members have used drugs and there is a high burden of comorbidity.

Expanding adverse child experiences to inequality and racial discrimination

There is a well-established correlation between health and adverse childhood experiences (ACEs). Arguments have been made to expand ACE scales to include indicators of racism and structural inequalities. In this paper, we use nationally representative data to examine the relationships between latent groups of an expanded adversity scale and a broad range of child health outcomes. Data were obtained from a merger of the 2017 and 2018 National Survey of Children's Health (NSCH) and analyzed in 2021 (n = 52,129). Adversities were defined as violent victimization, violence exposure, a range of parental problems, racial discrimination, food insecurity, and unkempt housing. Latent class analysis (LCA) was used to uncover emergent groups of adversities, and logistic regression was used to assess group relationship to global and diagnosed measures of health. Four groups emerged: high all (3.6%), material and food hardship (11.9%), parental problems (10.3%), and low all (74.2%). Results showed the high all groups at greater odds of almost all outcomes. Compared to low all group, high all had particularly higher odds of any special (OR = 2.29) or complex (OR = 2.53) healthcare need, frequent severe headaches (OR = 2.07), and depression (OR = 3.4) or anxiety (OR = 2.11). Our analysis noted separation of experiences based on additional items related to structural inequalities: food insecurity, poverty, and unkempt housing. However, augmenting existing ACE scales with these indicators may be unnecessary as children most at-risk for poor health were a very small group (1 in 28) that experienced multiple forms of violence and parental problems.

Personality as a Possible Intervention Target to Prevent Traumatic Events in Adolescence

Traumatic events (severe injury, violence, threatened death) are commonly experienced by children. Such events are associated with a dose-response increasing risk of subsequent substance use, mental illness, chronic disease, and premature mortality. Preventing the accumulation of traumatic events is thus an urgent public health priority. Substance use risk personality profiles (impulsivity, sensation seeking, hopelessness, and anxiety sensitivity) may be an important target for preventing trauma exposure, given associations between these personality traits and risky behaviour, substance misuse, and injuries across adolescence. The current study aimed to investigate associations between personality at age 13 and the number of traumatic events experienced by age 18. It also examined associations between traumas before age 13 and personality at age 13. Participants were the control group of a cluster-randomised controlled trial examining prevention of adolescent alcohol misuse. Baseline data were collected at ages 12–13 (2012). Participants were followed-up at ages 18–19 (2017–2018). Personality profiles of hopelessness, anxiety sensitivity, impulsivity, and sensation seeking were measured at baseline using the Substance Use Risk Profile Scale. Traumatic events and age of exposure were measured at age 18–19 using the Life Events Checklist for DSM-5. Mixed-effect regression was conducted on 287 participants in Stata 17, controlling for sex. High scores on hopelessness, impulsivity, and sensation seeking at age 13 were associated with a greater number of traumatic events by age 18. Impulsivity and sensation seeking predicted the number of new traumatic events from age 13 to 18. Prior trauma exposure was associated with high hopelessness at age 13. Adolescents exhibiting high impulsivity or sensation seeking may be at greater risk of experiencing traumatic events. Additionally, early trauma exposure may contribute to the development of a hopelessness personality trait.

Adverse experiences and mental health problems in perpetrators of intimate partner violence in Northern Ireland: A latent class analysis

BACKGROUND

Trauma and adverse experiences among perpetrators of intimate partner violence (IPV) have been associated with more serious patterns of offending.

OBJECTIVE

To examine 1) how traumatic and adverse experiences cluster together and co-occur among IPV perpetrators, and 2) whether different patterns of trauma exposure are associated with specific mental health problems.

PARTICIPANTS AND SETTING

The sample consisted of 405 convicted IPV perpetrators from Northern Ireland.

METHODS

Data was collected between 2018 and 2019. Latent class analysis identified typologies of exposure to traumatic and adverse experiences. A series of binary logistic regression analyses explored associations between the identified classes and five categories of probable mental health problems.

RESULTS

Three adversity classes were identified: a baseline class (59.2%), characterised by relatively low levels of exposure to most types of adversity; a 'childhood adversity' class (32.9%), with high levels of childhood adversity; and a 'community violence and disadvantage' class (7.9%), which had high probabilities of endorsing adversities related to economic hardship and community violence. Regression analyses showed that the childhood adversity class was significantly associated with increased likelihood of all categories of mental health problems, except for neurodevelopmental disorders (ORs = 1.77-3.25). The community violence and disadvantage class was significantly associated with probable mood and anxiety disorder (ORs 3.92 and 8.42, respectively).

CONCLUSIONS

Different patterns of exposure to adversities were associated with distinct mental health problems in the present sample. Early intervention to prevent poly-victimisation, the clustering of adversities in childhood and the resulting accumulation of risk may be a useful component of preventive responses for IPV in Northern Ireland.

Latent Class Patterns of Adverse Childhood Experiences and Their Relationship to Veteran Status and Sex in the National Epidemiologic Survey of Alcohol and Related Conditions Wave III

INTRODUCTION

Adverse childhood experiences (ACEs) are associated with poor psychosocial and health outcomes in adulthood. Veterans and females experience ACEs disproportionately. A greater understanding of this disparity may be achieved by examining the relationship between distinct ACE patterns and these demographic characteristics. Therefore, this study examined distinct ACE patterns and their association with Veteran status, sex, and other demographics in a nationally representative sample of U.S. adults to inform interventions tailored to ACE patterns experienced by specific groups.

MATERIALS AND METHODS

Latent class analysis (LCA) was conducted with data from the National Epidemiologic Survey of Alcohol and Related Conditions-III, a nationally representative structured diagnostic interview conducted from 2012-2013. The target population was the noninstitutionalized adult population living in the USA. The analytic sample was 36,190 (mean age 46.5 years; 48.1% male). Of these participants, 3,111 were Veterans. Data were analyzed between September 2020 and January 2021.

RESULTS

Latent class analysis revealed a four-class solution: (1) "Low adversity" (75.3%); (2) "Primarily household dysfunction" (9.0%); (3) "Primarily maltreatment" (10.7%); and (4) "Multiple adversity types" (5.1%). Compared to "Low adversity," members in the other classes were more likely to be Veterans (odds ratio (OR)C2vC1 = 1.33, ORC3vC1 = 1.55, ORC4vC1 = 1.98) and female (ORC2vC1 = 1.58, ORC3vC1 = 1.22, ORC4vC1 = 1.65). While lower education and income were also related to higher adversity class membership, Veteran status and sex were the strongest predictors, even when controlling for education and income.

CONCLUSIONS

Distinct and meaningful patterns of ACEs identified in this study highlight the need for routine ACE screenings in Veterans and females. As in the current study, operationalizing and clustering ACEs can inform screening measures and trauma-informed interventions in line with personalized medicine. Future work can test if classes are differentially associated with health outcomes.

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.

Clusters of adverse childhood experiences and unmet need for care coordination

BACKGROUND

The lack of consensus on how to measure ACEs limits our estimation of their impact on health outcomes and understanding of which ACE clusters drive unmet care coordination (CC) needs.

OBJECTIVES

1) Identify latent classes of ACEs among a representative group of U.S. children; 2) Examine the association between these classes and unmet needs for CC.

PARTICIPANT AND SETTING

Using the 2016-2017 National Survey of Children's Health, we sampled children ages 0-17 the who had seen >1 healthcare provider within 12 months (n = 38,758).

METHODS

We conducted latent class analyses and weighted logistic regression analyses to examine associations between latent classes and unmet need for CC.

RESULTS

We identified seven distinct classes: household poverty and parental divorce, household poverty and parental death, household poverty only, household substance abuse and witnessing violence, multiple ACEs, household poverty and child discrimination, and household poverty and household mental illness. Children in the following classes had the greatest odds of unmet need for CC: household poverty only (AOR 2.0; 95% CI, 1.42-2.84), household poverty and household mental illness (AOR 1.67; 95% CI, 1.15-2.44), multiple ACEs (AOR 2.31; 95% CI, 1.53-3.50), and household poverty and child discrimination (AOR 3.55; 95% CI, 1.71-7.37).

CONCLUSIONS

Children who experienced specific combinations of ACEs, have an increased risk of unmet need for CC, with those experiencing both poverty and discrimination having the highest odds of unmet need for CC. Discrimination widens the gap of unmet CC need for poor children.

Patterns of adverse childhood experiences and mental health outcomes among American Indians with type 2 diabetes

BACKGROUND

Extensive research demonstrates that Adverse Childhood Experiences (ACEs) are highly interconnected and have numerous health consequences well into adulthood. Yet, there is a dearth of focused research that examines ACEs and health inequities for American Indians (AIs).

OBJECTIVE

To assesses the prevalence of ten types of childhood adversities, explore constellations of exposures, and examine whether there are differential risks of mental health outcomes according to sub-group classification.

PARTICIPANTS AND SETTING

Adult AIs with type 2 diabetes from five reservation-based tribal communities in the Great Lakes region of the U.S.

METHODS

Prevalence was estimated using a modified version of the World Health Organization's ACE-International Questionnaire. To examine heterogeneity in ACEs exposures, latent class analysis was used. Risk of mental health outcomes was calculated by class.

RESULTS

The four most common ACEs reported were residing with someone who abused substances, witnessing household violence, incarceration of a household member, and sexual abuse. Three latent classes were identified: low risk (56.7%), family maladjustment with high probabilities of household violence, incarceration, and substance abuse (27.1%), and complex trauma (16.3%) with moderate to high probabilities of exposure to all ACEs. The most consistent differences in mental health outcomes were between the low risk and complex trauma classes.

CONCLUSIONS

Identification of a high number of participants in the low-risk class helps structure a more wholistic image of AI families, as negative stereotypes of AIs are abundant. For the minority of individuals in the complex trauma class, risk for chronic mental health challenges and co-morbidities appears to be high.

Adverse childhood experiences (ACEs), excessive alcohol use and intimate partner violence (IPV) perpetration among Black men: A latent class analysis

BACKGROUND

Adverse childhood experiences (ACEs) have been linked to subsequent intimate partner violence (IPV) perpetration and alcohol use. Although higher rates of ACEs are found in racial/ethnic minority populations, there is a paucity of research examining ACEs patterns and risk for IPV perpetration and excessive alcohol use among Black men.

OBJECTIVE

To identify homogeneous subgroups based on ACEs among Black men using latent class analysis and assessing risk for later IPV perpetration and excessive alcohol consumption in adulthood.

METHODS

Using a sample of Black men (n = 2306) from Wave 2 of the National Epidemiologic Survey of Alcohol and Related Conditions (NESARC), we conducted latent class analysis (LCA) to examine their ACEs patterns based on 10 domains. ACE classes were used in logistic regression models to predict IPV perpetration and unhealthy alcohol use.

RESULTS

LCA revealed three classes: (1) High Household Dysfunction & Physical Neglect; (2) Physical/Emotional Abuse; and (3) Low ACEs. Men in the High Household Dysfunction & Physical Abuse (OR = 3.95, p < 0.001), and Physical/Emotional Abuse (OR = 2.37, p < 0.001) classes had increased risk for IPV perpetration (ref: Low ACEs class) controlling for sociodemographic factors. No significant association was found between class membership and unhealthy alcohol use.

CONCLUSIONS

Our findings highlight the need for interventions aimed at addressing ACEs among Black boys as they increase risk for negative outcomes in adulthood. Future research should explore heterogeneity in ACEs among youth and risk of IPV and explore possible causal mechanisms in the development of IPV among adults who have experienced ACEs.

Positive Functioning Moderates the Association between Classes of Adverse Childhood Experiences and Adolescent Depressive Symptoms

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.

Childhood adversities and mental health outcomes: Does the perception or age of the event matter?

The current study extends knowledge regarding the individual contribution of different adverse experiences to mental health symptoms in late adolescence by including the perception of how upsetting each experience was to the adolescent and the age at the first occurrence. We also sought to move beyond sum scores of adverse experiences by using a person-centered approach to classifying individuals with similar co-occurrence of adversities. The data came from a longitudinal study of maltreatment on adolescent development (N = 454). Self-reported childhood adversities were assessed at Wave 4 (average of 7 years postbaseline) and examined with respect to current mental health symptoms (depression, PTSD, anxiety, and externalizing). Although the adversity sum score was a potent predictor of all mental health outcomes, the results indicated that the use of a sum score obscures information about the importance of individual adversities. Additionally, the influence of age of occurrence varied based on the adversity and outcome, while the perception of the event did not add much unique variance. Finally, the latent class analyses provided unique information about the patterns of co-occurring adversity in this sample, and that membership in either of the multiple-adversity classes was associated with more mental health symptoms.

Dual trajectories of parenting self-efficacy and depressive symptoms in new, postpartum mothers and socioemotional adjustment in early childhood: A growth mixture model

Postpartum depression and low parental self-efficacy (PSE) are risk factors for poor child behavior. Little is known, however, about the course of dual trajectories of cooccurring depressive symptoms and PSE or its impact on children's socioemotional development. This study sought to identify trajectories of postpartum PSE and depressive symptoms in new, first-time mothers using growth mixture modeling. Results demonstrated a class of women with "low risk" (88.8%) who manifested low levels of depression and high levels of PSE during the postpartum period; a second group of women, labeled "early risk" (6.3%) with high levels of depression that decreased over time but lower levels of PSE that remained fairly stable; and a final trajectory group deemed the "late-risk" class (4.9%) with initially low levels of depression and high levels of PSE that significantly increased and decreased, respectively, over the period. Early childhood trauma, parenting stress, and poor parenting practices were associated membership in a high-risk class. Mothers in the high-risk groups reported children with more aggressive and defiant behavior at age 3. We conclude by discussing the implications of our findings for developing effective and sensitive interventions.

How Early Stressful Life Experiences Combine With Adolescents' Conjoint Health Risk Trajectories to Influence Cardiometabolic Disease Risk in Young Adulthood

Research has primarily focused on additive (unique) associations between early stressful life experiences (specifically, socioeconomic adversity and maltreatment) and young adults' cardiometabolic disease risk without considering multiplicative (synergistic) influences. Furthermore, research has not fully considered the varying patterns of health risk trajectories (e.g., substance use, obesogenic-related behaviors, depressive symptoms) across adolescence and the transition to young adulthood that may link earlier stressful experiences and later cardiometabolic disease risk. This study examined heterogeneity in conjoint health risk trajectories from adolescence to the transition to young adulthood and their additive and multiplicative (synergistic) influences with early stressful life experiences on cardiometabolic disease risk in young adulthood using data from the National Longitudinal Study of Adolescent to Adult Health (n = 9,421; 55.6% female) over a period of 13 years. Four distinct conjoint health risk trajectories were identified considering trajectories of substance use behaviors, obesogenic-related behaviors, and depressive symptoms: (a) overall high-risk, (b) behavioral risks, (c) psycho-obesogenic risks, and (d) overall low-risk. Socioeconomic adversity and maltreatment were additively and multiplicatively associated with cardiometabolic disease risk in young adulthood. Individuals with overall high-risk conjoint trajectories averaged higher cardiometabolic disease risk in young adulthood when they were exposed to early socioeconomic adversity. Implications for personalized interventions for individuals who have experienced multiple forms of health risks are discussed.

Association between sexual abuse victimization during the life course and suicidal behaviors in male and female college students in China: Timing, duration, types and patterns

BACKGROUND

A certain link between sexual abuse (SA) victimization and suicidal behaviors has been confirmed, but it remains unclear whether this association varies with regard to SA characteristics and gender.

METHODS

Participants were 4034 college students drawn from a cross-sectional study conducted in Hefei, China. Gender-stratified latent class analysis (LCA) and logistic regression models were used to examine the relationships between timing, duration, types and patterns of SA victimization and suicidal behaviors.

RESULTS

For the males, SA in the elementary school or earlier period was associated with suicidal ideation (OR: 3.29, 95%CI: 2.20-5.38), plans (OR: 3.44, 95% CI: 1.54-7.77) and preparations (OR:3.05, 95% CI: 1.19-7.74). All types of SA were significantly associated with the four types of suicidal behaviors. Dose-response relationship and cumulative effect were found between duration, types of SA victimization and suicidal behaviors. Three latent classes of SA victimization were identified for males and females, respectively. For males, the "moderate SA" class and "persistent SA" class were associated with the four types of suicidal behaviors. For the females, SA during the university period was associated with suicidal ideation (OR: 2.47, 95% CI: 1.24-4.93). Only suicidal ideation was associated with the "moderate SA" class.

LIMITATIONS

The cross-sectional survey design did not allow to conclude any causality.

CONCLUSIONS

The relationship between SA victimization and suicidal behaviors varies in terms of SA victimization characteristics and the relationships were stronger in males than in females.

Expanding our Understanding of Intergenerational Exposure to Adversity

The present study examined the intergenerational continuity of adverse childhood experiences (ACEs) for parents and their adolescent offspring. Data were from a longitudinal study of the effects of maltreatment on adolescent development. Only biological parents (n=185) and one adolescent per parent (n=164) were included in the analytic sample. Self-reported retrospective data on childhood adversities was obtained at the 3^rd wave for parents and the 4^th wave for adolescents (M _age=18.16). For siblings in the study, one was randomly chosen to be included. Latent class analysis was used to examine 1-4 class solutions for parents and adolescents separately and crosstabs were used to show the concordance between assignment to similar classes for the parent and child. Results indicated 2 class solutions for both the parent and child: a high ACEs class characterized by witnessing intimate partner violence and all maltreatment types and a low ACES class characterized by no adversities. Concordance was highest for both parent and child being assigned to the low ACEs class (52% of the dyads). There were 9% of the dyads who were concordant for being assigned to the high ACEs class, indicating less continuity of adversity than expected. Overall the findings show some intergenerational continuity of adversity, but further work should be done to characterize the different patterns of concordance/discordance between parent and child ACEs.

Combinations of adverse childhood events and risk of postpartum depression among mothers enrolled in a home visiting program

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.

Adverse childhood experiences (ACEs) on mental disorders in young adulthood: Latent classes and community violence exposure

Adverse childhood experiences (ACEs) have significant impacts on mental health outcomes. There is a growing interest in expanding the scope of ACEs beyond household environments. To date, few studies examine multidimensional ACEs with community violence. This study aims to (1) identify underlying ACE classes including exposure to community violence, and (2) investigate the associations of ACE classes with mental disorders in adulthood: depression, anxiety, and Post-Traumatic Stress Disorder (PTSD). We employed Latent Class Analysis (LCA) and logistic regression analyses using the data from the National Longitudinal Study of Adolescent and Adult Health (Add Health). The LCA identified four heterogeneous ACE classes: (1) child maltreatment (17.47%), (2) household dysfunction (14.39%), (3) community violence (5.36%), and (4) low adversity (62.79%). Three logistic analyses showed that the "child maltreatment" class was more likely to report a depression (OR = 1.56, CI = 1.26-1.92), anxiety (OR = 1.31, CI = 1.06-1.62), and PTSD (OR = 1.97, CI = 1.35-2.87) in adulthood compared to the "low adversity" class. Also, the "community violence" class was more likely to have PTSD (OR = 2.15, CI = 1.14-4.06) in adulthood, compared to the "low adversity" class. However, the "household dysfunction" class was not significantly different in all three mental disorders from the "low adversity" class. Findings supported the differences in mental disorders in young adulthood by types of exposures to ACEs. The study highlights the importance of considering types of ACEs exposure for promoting mental health of young adults.

Patterns of exposure to adverse childhood experiences and their associations with mental health: a survey of 1346 university students in East Asia

INTRODUCTION

Adverse childhood experiences (ACEs) constitute a significant global mental health burden. Prior studies typically investigated the impact of ACEs on mental health using a cumulative risk approach; most ACEs studies were also conducted in Western settings.

PURPOSE

This study aimed to examine ACEs using a pattern-based approach and assess their associations with mental health outcomes by early adulthood in East Asia.

METHODS

The present study included measures of exposure to 13 categories of ACEs, depression, anxiety, maladjustment, and posttraumatic stress in a sample of 1346 university students from Hong Kong, China, Taiwan, and Japan.

RESULTS

Latent class analysis indicated three distinct patterns of ACE exposure: Class 1: Low ACEs (76.0%); Class 2: Household Violence (20.6%); and Class 3: Household Dysfunction (3.4%). Those representing Class 3 had significantly more ACEs compared with those in Classes 1 or 2. Controlling for age and sex, those in Class 2 reported significantly higher depression and maladjustment symptoms compared with those in Class 1; both Classes 2 and 3 had significantly higher anxiety symptoms and odds for meeting diagnostic criteria for posttraumatic stress disorders compared with those in Class 1.

CONCLUSIONS

Study findings suggest that young adults' mental health, at least under certain contexts, is more closely linked with the nature and pattern of ACE co-occurrence, rather than the number of ACEs.

The patterns of adverse childhood experiences among Chinese children: Four-year longitudinal associations with psychopathological symptoms

The objective of this longitudinal study was to identify the contribution of individual, cumulative and patterns of adverse childhood experiences (ACEs) exposure in the prediction of psychopathological outcomes during adolescence in the context of Chinese culture. Children from 3 large elementary schools of Bengbu, Anhui Province, China were enrolled in the 3 waves survey from 2013 (mean age = 8.15 years, SD = 0.88) to 2017 (mean age = 11.92 years, SD = 0.88). Latent class analysis (LCA) was used to identify homogeneous, mutually exclusive "classes" of 10 most common ACEs. Logistic regression was used to examine the association between individual, cumulative and patterns of ACEs and depressive and externalizing symptoms at Wave 3. Of the 1766 respondents included in the sample, 75% had at least 1 and 21.5% reported 4 or more ACEs. We found the dose-response relationship between cumulative ACEs and psychopathological outcomes. Results from LCA revealed three high-risk profiles and one low-risk profile, which were labeled: high ACEs (5.7%), highly abusive and adverse events (20.1%), highly abusive and neglected (21.3%), and low ACEs (52.9%). Compared to low ACEs class, each high-risk profile was differentially associated with psychopathological outcomes over 4-year period. Children exposed to high ACEs were at higher risk for future depressive and externalizing symptoms than other classes. This study provides evidence for the predictive impact of ACEs on adolescent psychopathological symptoms in Chinese culture. Clinicians should routinely assess for ACEs to identify children exposed to the most problematic ACE patterns and provide preventive intervention immediately, rather than provide treatment later in life.