Evidence for the Association Between Adverse Childhood Family Environment, Child Abuse, and Caregiver Warmth and Cardiovascular Health Across the Lifespan: The Coronary Artery Risk Development in Young Adults (CARDIA) Study

BACKGROUND

This study aimed to quantify the association between childhood family environment and longitudinal cardiovascular health (CVH) in adult CARDIA (Coronary Artery Risk Development in Young Adults) Study participants. We further investigated whether the association differs by adult income.

METHODS

We applied the CVH framework from the American Heart Association including metrics for smoking, cholesterol, blood pressure, glucose, body mass index, physical activity, and diet. CVH scores (range, 0-14) were calculated at years 0, 7, and 20 of the study. Risky Family environment (range, 7-28) was assessed at year 15 retrospectively, for childhood experiences of abuse, caregiver warmth, and family or household challenges. Complete case ordinal logistic regression and mixed models associated risky family (exposure) with CVH (outcome), adjusting for age, sex, race, and alcohol use.

RESULTS

The sample (n=2074) had a mean age of 25.3 (±3.5) years and 56% females at baseline. The median risky family was 10 with ideal CVH (≥12) met by 288 individuals at baseline (28.4%) and 165 (16.3%) at year 20. Longitudinally, for every 1-unit greater risky family, the odds of attaining high CVH (≥10) decreased by 3.6% (OR, 0.9645 [95% CI, 0.94-0.98]). Each unit greater child abuse and caregiver warmth score corresponded to 12.8% lower and 11.7% higher odds of ideal CVH (≥10), respectively (OR, 0.872 [95% CI, 0.77-0.99]; OR, 1.1165 [95% CI, 1.01-1.24]), across all 20 years of follow-up. Stratified analyses by income in adulthood demonstrated associations between risky family environment and CVH remained significant for those of the highest adult income (>$74k), but not the lowest (<$35k).

CONCLUSIONS

Although risky family environmental factors in childhood increase the odds of poor longitudinal adult CVH, caregiver warmth may increase the odds of CVH, and socioeconomic attainment in adulthood may contextualize the level of risk. Toward a paradigm of primordial prevention of cardiovascular disease, childhood exposures and economic opportunity may play a crucial role in CVH across the life course.

Editorial: Unsettling 'settled' science - the importance of questioning received wisdom about the causes of mental health and neuro-developmental conditions

The papers included in this year's Annual Research Review represent a heterogenous mix of concerns, zooming out, in some cases, to summarize the state of the science for a particular condition or developmental process and zooming in, in other cases, to identify effects of specific (and timely) risk factors for child and adolescent mental health. These papers highlight where the field has made significant strides in advancing our understanding of etiology or mechanisms of change or stability and they highlight how much is left to learn about the causes of psychopathology and the conditions under which developmental trajectories are maintained or disrupted.

Adverse Childhood Experiences and Frequent Headache by Adolescent Self-Report

BACKGROUND

The association between exposure to adverse childhood experiences (ACEs) and increased headache in adults has been well characterized. Childhood adversity and its effect on headache in children have not been as robustly investigated. This study examines the relationship of self-reported ACEs to frequent headache in an adolescent cohort.

METHODS

We performed a retrospective cohort study using data from the National Longitudinal Study of Adolescent to Adult Health Wave I (n = 20,745) to examine self-reported ACE exposures and their relationship to frequent headache.

RESULTS

The study population was composed of 20,745 participants; 50.6% male and 49.4% female. The mean age of respondents was 15.9 years (range 12 to 21 years, standard error: 0.12 years). Frequent headache was reported in 29.3% of respondents, and 45% of respondents reported one or more ACE exposures. For each increase in cumulative ACE score, odds of frequent headache increased by 1.22 (95% confidence interval [CI] 1.15 to 1.30). The ACEs that individually showed an association with frequent headache after adjusting for demographic factors were lack of maternal warmth (odds ratio [OR] 1.40, 95% CI 1.12 to 1.74, P = 0.002), lack of paternal warmth (OR 1.47, 95% CI 1.20 to 1.81, P < 0.001), paternal alcoholism (OR 1.21, 95% CI 1.05 to 1.40, P = 0.007), suicide attempt of family member (OR 1.51, 95% CI 1.22 to 1.87, P < 0.001), and living in an unsafe neighborhood (OR 1.22, 95% CI 1.06 to 1.39, P = 0.004).

CONCLUSIONS

Several ACE exposures were associated with frequent headache in adolescents. An increase in cumulative ACE exposure increased the odds of having frequent headache.

Risk factors for disruptive behaviours: protocol for a systematic review and meta-analysis of quasi-experimental evidence

INTRODUCTION

Disruptive behaviour disorders, including oppositional defiant disorder and conduct disorder, are a common set of diagnoses in childhood and adolescence, with global estimates of 5.7%, 3.6% and 2.1% for any disruptive disorder, oppositional defiant disorder and conduct disorder, respectively. There are high economic and social costs associated with disruptive behaviours and the prevalence of these disorders has increased in recent years. As such, disruptive behaviours represent an escalating major public health concern and it is important to understand what factors may influence the risk of these behaviours. Such research would inform interventions that aim to prevent the development of disruptive behaviours. The current review will identify the most stringent evidence of putative risk factors for disruptive behaviour from quasi-experimental studies, which enable stronger causal inference.

METHODS AND ANALYSIS

The review will be carried out according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. An electronic search of references published between 1 January 1980 and 1 March 2020 will be conducted using Medline, Embase, PsycINFO and Web of Science. Initial abstract and title screening, full-text screening and data extraction will be completed independently by two reviewers using Evidence for Policy and Practice Information (EPPI)-Reviewer 4 software. Quasi-experimental studies in the English language examining the association between any putative risk factor and a clearly defined measure of disruptive behaviour (eg, a validated questionnaire measure) will be included. We will conduct meta-analyses if we can pool a minimum of three similar studies with the same or similar exposures and outcomes.

ETHICS AND DISSEMINATION

The proposed review does not require ethical approval. The results will help to identify risk factors for which there is strong evidence of causal effects on disruptive behaviours and also highlight potential risk factors that require further research. The findings will be disseminated via publication in a peer-reviewed scientific journal and through presentations at international meetings and conferences.

PROSPERO REGISTRATION NUMBER

CRD42020169313.

Neural correlates of depression in women across the reproductive lifespan - An fMRI review

INTRODUCTION

Depressive disorders in women emerge largely during transitions in their reproductive aging cycle, which can be attributed to internal endocrine possesses that affect emotion-associated brain circuits. A review was performed to outline the neural basis in depression during female puberty, premenstrual dysphoric disorder (PMDD), postpartum depression disorder (PPD) and perimenopausal depression disorder.

METHODS

For this review, Web of science, Pubmed and PsychInfo databases were searched for functional brain imaging studies addressing reproductive cycle-related mood disorder. The results are summarized and discussed within a broader theoretical framework of major depression disorder (MDD) to determine how reproductive-sensitive phases contribute to affective symptoms and how they relate to the neurobiology of MDD.

RESULTS

Neural activation patterns of all depressive disorders related to female reproductive cycle, except for puberty depression, differ from these observed in MDD. While the PMDD results are widely divergent, the activation patterns in PPD show general hypoactivation in all respects.

LIMITATIONS

Systematic comparisons between the diverse depression disorders are impeded by the heterogeneous experimental protocols used on different samples, reproductive aging stages and depression types.

CONCLUSION

Given that hormonal fluctuations strongly influence the development of a reproductive cycle-related depression, it is possible that the hormonal and neural patterns are indicative of distinct mood disorder with phase specific biotypes, that only show behavioral similarities to MDD. Understanding the similarities and differences in the neural functioning of female cycle-related mood disorders evaluated against MDD might help elucidate the role of neuroendocrine involvement in development of depression in women, and potentially facilitate the search for prevention and treatment approaches for women' reproductive-related depressions.

Special Editorial: Open science and the Journal of Child Psychology & Psychiatry - next steps?

The JCPP works at the cutting edge of clinical science to publish ground-breaking research across the full range of topics in the field of child psychology and psychiatry. As JCPP editors, who are also active researchers in our own right, we are conscious of the threat posed to our field by what has come to be known as the reproducibility crisis - the fact that many published findings, initially trumpeted as important developments in the field, cannot be replicated and are therefore likely to be spurious (Nature Human Behaviour, 1, 2017, 21). The JCPP is conscious of its responsibility to play its part in addressing this issue as best it can. The roots of the problem are complex and its causes multifaceted. As one part of its response, the JCPP embraces the principles of open science and encourage preregistration of study protocols. Furthermore, we are working towards implementing new systems to promote preregistration with the hope of increasing scientific transparency and accountability and reducing the risks of selective reporting and posthoc rationalisation of findings (Journal of Child Psychology & Psychiatry, 59, 2018, 1).

Promises and pitfalls in the development of biomarkers that can promote early intervention in children at risk

The cost to individuals and to society of psychopathology that emerges in childhood is substantial. Children whose problems are undiagnosed or inadequately treated struggle in school, experience rejection by peers, and become a source of stress for caregivers and teachers. As adults, their mental health problems tend to recur and their cognitive difficulties persist. Clinicians hold a well-founded belief that early identification of children who are at risk for psychopathology is the key to prevention.

The View From Down Here

In this article, graduate students and one faculty member respond to the innovative methods presented in this issue. We identify three theoretical and methodological tensions that shape our interest in and willingness to work with these methods. The first questions whether the strengths of doing qualitative research outweigh the limitations. The second involves feminist research ideals and how attainable they are. The third explores epistemological tensions between qualitative and quantitative research. Although intrigued by the data these methods generated and by their underlying epistemology, we question the status of certain qualitative research in psychology. We contend that the criteria by which qualitative research is evaluated must be made more explicitly before quantitatively trained researchers will incorporate these methods into their own work.

Child-rearing antecedents of intergenerational relations in young adulthood: a prospective study

Data gathered from mothers on parenting and family climate when almost 1,000 children in the Dunedin, New Zealand, longitudinal study were 3, 5, 7, 9, 13, and 15 years of age were used to predict intergenerational relations between young adult children (age 26) and their middle-aged parents. Analyses focused on distinct developmental epochs revealed greater prediction from the middle-childhood and early-adolescent periods than from the early-childhood years: most indicated that more supportive family environments and child-rearing experiences in the family of origin forecasted more positive and less negative parent-child relationships (in terms of contact, closeness, conflict, reciprocal assistance) in young adulthood, though associations were modest in magnitude. Some evidence indicated that (modestly) deleterious effects on intergenerational relations of experiencing relatively unsupportive child-rearing environments in 1 but not 2 (of 3) developmental periods studied could be offset by relatively supportive family environments in the remaining developmental periods.

Why are children born to teen mothers at risk for adverse outcomes in young adulthood? Results from a 20-year longitudinal study

This 20-year longitudinal study showed that the young adult offspring of teen mothers are at risk for a range of adverse outcomes including early school leaving, unemployment, early parenthood, and violent offending. We tested how much the effect of teen childbearing on offspring outcomes could be accounted for by social selection (in which a woman's characteristics that make her an inadequate parent also make her likely to bear children in her teens) versus social influence (in which the consequences of becoming a teen mother also bring harm to her children, apart from any characteristics of her own). The results provided support for both mechanisms. Across outcomes, maternal characteristics and family circumstances together accounted for approximately 39% of the effect of teen childbearing on offspring outcomes. Consistent with a social-selection hypothesis, maternal characteristics accounted for approximately 18% of the effect of teen childbearing on offspring outcomes; consistent with a social-influence hypothesis, family circumstances accounted for 21% of the teen childbearing effect after controlling for maternal characteristics. These results suggest that public policy initiatives should be targeted not only at delaying childbearing in the population but at supporting individual at-risk mothers and their children.

Child-rearing antecedents of intergenerational relations in young adulthood: a prospective study

Data gathered from mothers on parenting and family climate when almost 1,000 children in the Dunedin, New Zealand, longitudinal study were 3, 5, 7, 9, 13, and 15 years of age were used to predict intergenerational relations between young adult children (age 26) and their middle-aged parents. Analyses focused on distinct developmental epochs revealed greater prediction from the middle-childhood and early-adolescent periods than from the early-childhood years: most indicated that more supportive family environments and child-rearing experiences in the family of origin forecasted more positive and less negative parent-child relationships (in terms of contact, closeness, conflict, reciprocal assistance) in young adulthood, though associations were modest in magnitude. Some evidence indicated that (modestly) deleterious effects on intergenerational relations of experiencing relatively unsupportive child-rearing environments in 1 but not 2 (of 3) developmental periods studied could be offset by relatively supportive family environments in the remaining developmental periods.

Gender differences in moral orientation: a meta-analysis

C. Gilligan's (1982) critique of L. Kohlberg's theory of moral reasoning and her assertion that two modes of moral reasoning (justice and care) exist have been the subject of debate within the field of psychology for more than 15 years. This meta-analysis was conducted to review quantitatively the work on gender differences in moral orientation. The meta-analysis revealed small differences in the care orientation favoring females (d = -.28) and small differences in the justice orientation favoring males (d = .19). Together, the moderator variables accounted for 16% of the variance in the effect sizes for care reasoning and 17% of the variance in the effect sizes for justice reasoning. These findings do not offer strong support for the claim that the care orientation is used predominantly by women and that the justice orientation is used predominantly by men.

Plasma concentrations of lidocaine resulting from instillation of lidocaine jelly into genitourinary tract prior to cystoscopy

Plasma concentrations of lidocaine were measured over a period of three hours following the instillation of lidocaine jelly (Xylocaine 2% Jelly) into the genitourinary tract of 30 patients (15 male, 15 female) scheduled for cystoscopy. The mean quantity of jelly instilled was 21.4 Gm (11-27.5 Gm) and of lidocaine HCl administered thereby 428 mg (218-550 mg). Plasma concentration reached measurable levels in only 5 cases, never exceeding 0.2 microgram/ml.