Adverse Childhood Experiences Scores Research Articles

Interactional effects of adverse childhood experiences, psychopathy, and everyday sadism on Internet trolling

Internet trolling is defined as maladaptive and antisocial behavior on the Internet. This exploratory study examined the interactional effects of adverse childhood experiences (ACEs) and “dark” personality traits, including psychopathy and everyday sadism, on engaging in Internet trolling. Japanese participants (N = 447, 51.2 % women) completed questionnaires assessing Internet trolling, ACEs, and dark personality traits. The results showed that ACEs, psychopathy, and everyday sadism were positive predictors of Internet trolling. Moreover, hierarchical regression analyses indicated that these dark personality traits were significantly associated with increased Internet trolling only in individuals with high ACE scores. These results suggest that ACEs moderate the effects of dark personality traits on Internet trolling. I discuss the implications of these findings for strategies to reduce antisocial Internet behavior.

The association between adverse childhood experiences and insomnia symptoms from adolescence to adulthood: Evidence from the Add Health study

ObjectivesAdverse childhood experiences are potentially traumatic events that occur up to age 17, including abuse, neglect, and household dysfunction. Such trauma often results in chronic stress and poor sleep health, which are linked to negative health outcomes across the lifespan. This study examines the longitudinal association between adverse childhood experiences (ACEs) and insomnia symptoms from adolescence to adulthood. MethodsData from the National Longitudinal Study of Adolescent to Adult Health were used to examine the association between ACEs and insomnia symptoms (trouble falling asleep or staying asleep, dichotomized based on self-reported frequency of 3 times per week or more). We used weighted logistic regression to examine the association between cumulative ACE score (0, 1, 2-3, 4+), 10 specific ACEs, and insomnia symptoms. ResultsOf 12,039 participants, 75.3% experienced at least one adverse childhood experience and 14.7% experienced 4 or more. We found specific adverse childhood experiences, including physical abuse, emotional abuse, neglect, parental incarceration, parental alcoholism, foster home placement, and community violence were associated with experiencing insomnia symptoms throughout the entire 22-year follow-up period from adolescence to mid-adulthood (p < .05), while childhood poverty was only associated with insomnia symptoms in mid-adulthood. The number of adverse childhood experiences showed a dose-response association with insomnia symptoms in adolescence (1 adverse childhood experience: adjusted odds ratio (aOR)=1.47 [1.16, 1.87], 4+ adverse childhood experiences: aOR= 2.76, [2.18, 3.50]), early adulthood (1 adverse childhood experience: aOR= 1.43 [1.16, 1.75], 4+ adverse childhood experiences: aOR= 3.07 [2.47, 3.83]) and mid-adulthood (1 adverse childhood experience: aOR= 1.13 [0.94, 1.37], 4+ adverse childhood experiences: aOR= 1.89 [confidence interval: 1.53, 2.32]). ConclusionsAdverse childhood experiences are associated with an increased risk for insomnia symptoms across the lifespan.

Adverse Childhood Experiences and Resilience Among Cis-gendered Heterosexual and LGBTQIA+ Individuals in India

Background: In 2018, India decriminalized same-sex relationships, marking a major victory for the LGBTQIA+ community. However, it’s well known that only policy reforms are not enough for revolutionary changes. One starting point is the exploration of the quality of life, health, and wellness of these populations through careful research and examining the threats they are facing today so that early interventions can be initiated to improve the conditions and reduce the pain. Objective: To assess whether a relationship exists between adverse childhood experiences (ACE) and resilience in cis- gender heterosexual and LGBTQIA+ individuals in India and whether a significant difference exists between the two samples in their measures of the same. Method: Online forms were circulated through various social media platforms, the sample consisted of 81 participants (48 cis-gender heterosexual individuals, 33 LGBTQIA+ individuals) within the age range of 18-25 years residing in Urban areas of India. The forms consisted of two questionnaires: The ACEs Questionnaire, and Brief Resilience Scale (BRS). For Data analysis, the Pearson Product moment correlation, and the Non-parametric Kruskal-Wallis H test were carried out. Results &amp; Conclusion: Findings reveal a negative correlation between ACE and resilience amongst cis-gender heterosexuals r(46) = 0.47, p &lt; .01, a negative correlation between ACE and resilience amongst the LGBTQIA+, r(31) = 0.13, p = .47, a significant difference between cis-gender heterosexual individuals and LGBTQIA+ individuals in the ACE scores, H (1) = 16.65, p &lt; .01, a significant difference between cis-gender heterosexuals and LGBTQIA+ in the Resilience scores, H (1) = 5.35, p &lt; .05. The results indicate that the LGBTQIA+ individuals did experience more adverse experiences in their childhood as compared to cis-gender heterosexual counterparts, one of the many reasons could be homonegative and trans negative attitudes towards this population. Limitations of the study are that it was only a quantitative study, with a small sample size, and not all communities were equally represented, that is, more data is required from people who identify as pansexual and transgenders. Future directives for researchers are to become gender and culture-informed and conduct deeper research using narrative analysis approaches.

Population attributable fractions of adverse childhood experiences for emotional problems and self-harming behaviors among middle school students in China.

The population attributable fractions of health outcomes attributed to adverse childhood experiences (ACEs) among Chinese middle school students is unknown. Of all the 22,868 middle school students, 29.8 % had exposure to four or more ACEs. Findings showed a graded relationship between ACE scores and those adverse outcomes. The PAFs of six outcomes attributed to experiencing ≥4 ACEs ranged from 23.1 % to 44.2 %. The results emphasized the significance of preventive interventions to alleviate the negative legacies of ACEs.

Adverse childhood experiences and clustering of high-risk behaviors among high school students: a cross-sectional study

ObjectivesThis study assessed the association between adverse childhood experiences (ACEs) and clustering of high-risk behaviors in a sample of high school students. Study designThis was a cross-sectional study. MethodsA sample of students who attended randomly selected classes in 99 high schools completed the 2019 Nevada Youth Risk Behavior Survey (N = 4959). The survey included six ACE measures: (1) physical abuse, (2) sexual abuse, (3) verbal abuse, (4) household physical abuse, (5) household mental illness, and (6) household substance abuse. Students were assigned a cumulative ACE score (range = 0–6). A count of high-risk behavior domains was created using multiple questions across the following domains: (1) violence behaviors, (2) suicidal indicators, (3) non-suicidal self-injury, (4) substance use, (5) high-risk sexual behaviors, (6) poor diet, (7) physical inactivity, and (8) high screen time (range = 0–8). The relationship between ACEs and the count of high-risk behavior domains was assessed using weighted negative binomial regression; incidence rate ratios (IRRs) were calculated adjusting for sociodemographic characteristics. ResultsMore than 40% of the sampled students reported high-risk behaviors across two or more domains. There was a strong, graded relationship between cumulative ACE score and the count of high-risk behavior domains. Compared with students who experienced zero ACEs, there was an increase in the count of high-risk behavior domains among students who experienced one ACE (adjusted IRR [aIRR] = 1.22, 95% confidence interval [CI] = 1.12–1.33), two ACEs (aIRR = 1.57, 95% CI = 1.42–1.73), three ACEs (aIRR = 1.73, 95% CI = 1.54–1.94), four ACEs (aIRR = 2.07, 95% CI = 1.84–2.33), five ACEs (aIRR = 2.69, 95% CI = 2.34–3.10), and six ACEs (aIRR = 2.91, 95% CI = 2.34–3.62). ConclusionTrauma-informed prevention efforts may be an efficient way to address multiple adolescent risk behaviors that cluster.

Adverse Childhood Experiences and Family-Centered Care.

Adverse Childhood Experiences (ACEs) include experiences of child maltreatment and household dysfunction. Prior work has shown that children with ACEs may have suboptimal utilization of preventive health care, including annual well-visits, however little is known about the relationship between ACEs and quality of patient care. Using data from the 2020 National Survey of Children's Health (N = 22,760) a series of logistic regression models estimated associations between ACEs, both individually and cumulatively, and five components of family-centered care. Most ACEs were consistently associated with lower odds of family-centered care (e.g. financial hardship was associated with doctors always spend enough time with children, AOR = 0.53; 95% CI = 0.47, 0.61), except for having a parent or guardian die, which was associated with higher odds. Cumulative ACE score was also associated with lower odds of family-centered care (e.g. doctors always listened carefully to the parent, AOR = 0.86; 95% CI = 0.81, 0.90). These findings emphasize the importance of the consideration of ACEs in the context of family-centered care, and support the need for ACEs screening in the clinical setting. Future work should focus on mechanisms explaining the observed associations.

Adverse childhood experiences and adult outcomes using a causal framework perspective: Challenges and opportunities

BackgroundResearch on the effect of adverse childhood experiences (ACEs) on adult outcomes has typically relied on retrospective assessment of ACEs and cumulative scores. However, this approach raises methodological challenges that can limit the validity of findings. ObjectiveThe aims of this paper are 1) to present the value of directed acyclic graphs (DAGs) to identify and mitigate potential problems related to confounding and selection bias, and 2) to question the meaning of a cumulative ACE score. ResultsAdjusting for variables that post-date childhood could block mediated pathways that are part of the total causal effect while conditioning on adult variables, which often serve as proxies for childhood variables, can create collider stratification bias. Because exposure to ACEs can affect the likelihood of reaching adulthood or study entry, selection bias could be introduced via restricting selection on a variable affected by ACEs in the presence of unmeasured confounding. In addition to challenges regarding causal structure, using a cumulative score of ACEs assumes that each type of adversity will have the same effect on a given outcome, which is unlikely considering differing risk across adverse experiences. ConclusionsDAGs provide a transparent approach of the researchers' assumed causal relationships and can be used to overcome issues related to confounding and selection bias. Researchers should be explicit about their operationalization of ACEs and how it is to be interpreted in the context of the research question they are trying to answer.

Health Insurance Coverage Gaps Among Children With a History of Adversity.

Health insurance stability among children with adverse childhood experiences (ACEs) is essential for accessing health care services. This cross-sectional study used an extensive, multi-year, nationally representative database of children aged 0 to 17 to examine the association between ACE scores and continuous or intermittent lack of health insurance over a 12-month period. Secondary outcomes were reported reasons for coverage gaps. Compared with children having 0 ACEs, those with 4+ ACEs had a higher likelihood of being part-year uninsured rather than year-round private insured (relative risk ratio [RRR]: 4.20; 95% CI: 3.25, 5.43), year-round public insured (RRR: 1.37; 95% CI: 1.06, 1.76), or year-round uninsured (RRR: 2.28; 95% confidence interval [CI]: 1.63, 3.21). Among children who experienced part-year or year-round uninsurance, a higher ACE score was associated with a greater likelihood of coverage gap due to difficulties with the application or renewal process. Policy changes to reduce administrative burdens may improve health insurance stability and access to health care among children who endure ACEs.

Stage 2 Registered Report: Epigenetic Intergenerational Transmission: Mothers’ Adverse Childhood Experiences and DNA Methylation

Individual differences in risk for mental disorders over the lifespan are shaped by forces acting before the individual is born-in utero, but likely even earlier, during the mother's own childhood. The environmental epigenetics hypothesis proposes that sustained effects of environmental conditions on gene expression are mediated by epigenetic mechanisms. Recent human studies have shown that adversities in childhood are correlated with DNA methylation (DNAm) in adulthood. In the current study, we tested the following pre-registered hypotheses: Mothers' adverse childhood experiences (ACEs) are correlated with DNAm in peripheral blood during pregnancy (hypothesis 1) and in cord blood samples from newborn infants (hypothesis 2), and women's depression and anxiety symptoms during pregnancy mediate the association between mothers' ACE exposure and prenatal/neonatal DNA methylation (hypothesis 3). Data were from the Avon Longitudinal Study of Parents and Children Accessible Resource for Integrated Epigenomic Studies substudy. Women provided retrospective self-reports during pregnancy of ACE exposure. We conducted an epigenome-wide association study testing whether mothers' ACE exposure, cumulative score (0-10), was associated with DNAm in maternal antenatal blood and infant cord blood in more than 450,000 CpG (point on DNA sequence where cytosine and guanine base pairs are linked by a phosphate, where methylation usually occurs) sites on the Illumina 450K BeadChip. Analyses for cord blood were separated by infant sex, a pre-registered analysis. Hypothesis 1: In 896 mother-infant pairs with available methylation and ACE exposure data, there were no significant associations between mothers' ACE score and DNAm from antenatal peripheral blood, after controlling for covariates. Hypothesis 2: In infant cord blood, there were 5 CpG sites significantly differentially methylated in relation to mothers' ACEs (false discovery rate [FDR]< .05), but only in male offspring. Effect sizes were medium, with partial eta squared values ranging from 0.060 to 0.078. CpG sites were in genes related to mitochondrial function and neuronal development in the cerebellum. Hypothesis 3: There was no mediation by maternal anxiety/depression symptoms found between mothers' ACEs score and DNAm in the significant CpG sites in male cord blood. Mediation was not tested in antenatal peripheral blood, because no direct association between mothers' ACE score and antenatal peripheral blood was found. Our results show that mothers' ACE exposure is associated with DNAm in male offspring, supporting the notion that DNAm could be a marker of intergenerational biological embedding of mothers' childhood adversity. Epigenetic Intergenerational Transmission: Mothers' Adverse Childhood Experiences and DNA Methylation; https://doi.org/10.1016/j.jaac.2020.03.008.

HPA Axis Variation and ACEs; Childhood Sexual Trauma is Associated with Lower Hair Cortisol in Adulthood

Early life trauma impacts the HPA axis and can manifest as hyperactivity or a blunted activity. This study explored the types of trauma, age of trauma, and possible critical stages of development that impact different types of HPA axis function. 84 Participants were recruited and provided a hair sample. They then completed a modified adverse childhood experiences (ACE) questionnaire, including the age and duration at which each ACE was experienced. Participants were randomly assigned to either a stress group that was presented with an anticipated stressor, or a control group that was not. Saliva samples were collected before and after experiencing their assignment group. No significant relationships were found between stressor, ACE score, and cortisol reactivity. Independent sample t-tests compared hair cortisol levels of those who endorsed each of the ACE indices and those who did not. Sexual trauma was the only type of trauma that was significantly related to hair cortisol. Years sexual abuse occurred was related to blunted hair cortisol, with the age group of 5-7 being the only age bracket related to lower hair cortisol. Sexual trauma was related to blunted hair cortisol, with specific considerations for the ages 5-7 pointing to a potential critical stage of development. With diversity in how cortisol results from HPA axis activation, this information suggests it’s necessary to consider the heterogeneity of stress responses potentially presenting as both hyperactive and blunted function of the HPA axis while simultaneously considering the type, quantity, and age of trauma experienced.

Specific Adverse Childhood Experiences and Homelessness are Associated with Increased Risk for Attention Deficit Hyperactivity Disorder in a Nationally Representative Sample

This study examines associations of homelessness and specific Adverse Childhood Experiences (ACEs) on Attention Deficit Hyperactivity Disorder (ADHD). Unlike prior research focusing on the number of ACEs, our study hypothesized that there are specific types of high-risk ACEs associated with ADHD, and that homelessness further increased such risk association. Data samples obtained from the National Longitudinal Study of Adolescent to Adult Health, and measures of ACEs derived from measures used in the CDC-Kaiser ACE study were used to test the associations. Survey based logistic regression analysis identified which specific high-risk ACES were associated with ADHD. The specific high-risk ACEs were summed, then used with homelessness and demographics as covariates to adjust a survey based logistic regression model for the assessment of relative risk, namely the odds ratios of ACE scores and homelessness associated with ADHD. Three ACEs (sexual abuse, emotional abuse, and mental illness in the household) were associated with increased risk of ADHD by 67%, 76% and 89%, respectively. The addition of homelessness and any one of the identified high-risk ACEs was strongly associated with almost a 5.0-fold risk of lifetime ADHD diagnosis. The assessment of these ACEs and homelessness should be included when screening patients for ADHD.

Adverse Childhood Experiences and Arrest Rates among Individuals with Serious Mental Illnesses.

Adverse childhood experiences (ACEs) are linked to both poor mental health and adverse social outcomes, including arrest and incarceration. Furthermore, individuals with serious mental illnesses (SMI) are known to have high rates of childhood adversity and are overrepresented in all facets of the criminal justice system. Few studies have examined the associations between ACEs and arrests among individuals with SMI. We examined the impact of ACEs on arrest among individuals with SMI while controlling for age, gender, race, and educational attainment. In a combined sample from two separate studies in different settings (N = 539), we hypothesized that ACE scores would be associated with prior arrest, as well as rate of arrests. The prevalence of prior arrest was very high (415, 77.3%) and was predicted by male gender, African American race, lower educational attainment, and mood disorder diagnosis. Arrest rate (number of arrests per decade, which thus accounted for age) was predicted by lower educational attainment and higher ACE score. Diverse clinical and policy implications include improving educational outcomes for individuals with SMI, reducing and addressing childhood maltreatment and other forms of childhood or adolescent adversity, and clinical approaches that help clients reduce the likelihood of arrest while addressing trauma histories.

0136 Decreased Sleep Efficiency May Link Adverse Childhood Experiences with Increased Visceral Adiposity

Abstract Introduction Poor sleep has been shown to negatively impact cardiometabolic health. Adverse Childhood Experiences (ACEs), potentially traumatic events occurring within the first 18 years of life, have been linked to both poor sleep and cardiometabolic disease in adulthood. Evidence is needed to understand whether poor sleep plays a mechanistic role in the link between ACE exposure and cardiometabolic risk. The purpose of this study was to examine associations of ACE exposure with self-reported sleep efficiency (SE%) and waist circumference (WC). Methods In 25 young adults (21F/4M; mean±SD, age=25±5 y), we assessed ACE exposure using the 10-item ACE Questionnaire and SE% as the reported average sleep duration relative to time-in-bed from the Pittsburgh Sleep Quality Index. We measured WC, a known cardiometabolic risk factor, as a surrogate of visceral adiposity. We used multiple linear regression analyses to examine associations between ACE exposure, SE%, and WC adjusted for sex. We then utilized ANCOVA analyses to examine the possible mechanistic effect of SE% on the relationship between ACE exposure and WC. For these analyses, participants with 0-1 ACEs were categorized as low-ACE exposure (ACE-low) and participants with 2+ ACEs were categorized as moderate-to-high ACE exposure (ACE-mh). Results Following adjustment for sex, ACE score predicted SE% (β=-0.53, p=0.009) and WC (β=0.52, p=0.01), and SE% predicted WC (β=-0.44, p=0.03). Similarly, ANCOVA analyses indicated that ACE-mh was associated with greater WC than ACE-low, adjusted for sex (adjusted means ± 95% CI, 0.86 ± 0.07 m vs. 0.78±0.06 m; p=0.049). However, the effect of ACE group on WC was no longer significant following inclusion of SE% as a covariate (0.84 ± 0.07 m vs. 0.80 ± 0.07 m; p=0.29). Conclusion Both ACEs and sleep efficiency are associated with visceral adiposity. Further, SE% may serve as a mechanistic biobehavioral link between ACE exposure and increased visceral adiposity in young adults. These preliminary findings warrant further investigation with implications for sleep interventions as a possible preventative approach to reduce cardiometabolic risk in individuals exposed to ACEs. Support (if any) Research reported in this publication was partly supported by the NCATS of the NIH (UL1TR002537) and by the Injury Prevention Research Center through the CDC (R49 CE003095).

The association between adverse childhood experiences and perinatal depression symptom trajectories

Having a history of adverse childhood experiences is associated with an increased risk for treatment-resistant depression in the general population. Whether this relationship is true in the perinatal context is unknown. This study aimed to examine the association between adverse childhood experiences and the trajectories of antenatal and postpartum depression among people enrolled in a perinatal collaborative care program for mental healthcare. This retrospective cohort study included all pregnant and postpartum people who were referred to and enrolled in a perinatal collaborative care program for mental healthcare and who delivered at a single, quaternary care institution between March 2016 and March 2021. Individuals referred to the collaborative care program were linked with a care manager and had access to evidence-based mental health treatment such as a psychiatric consult, pharmacotherapy, and psychotherapy. All individuals enrolled in the collaborative care program underwent adverse childhood experience screens at intake. A score of >3 on the validated Adverse Childhood Experiences Questionnaire was defined as a high adverse childhood experience score. Depression symptom monitoring occurred via electronic Patient Health Questionaire-9 screening every 2 to 4 weeks, and escalation of care was recommended for those without evidence of improvement. Antenatal depression trajectories were determined by comparing the earliest available prenatal Patient Health Questionaire-9 score closest to the time of referral to collaborative care with the latest Patient Health Questionaire-9 score before delivery. Postpartum trajectories were determined by comparing the earliest postpartum Patient Health Questionaire-9 score after delivery with the latest score before 12 weeks' postpartum. Depression trajectories were categorized as improved, stable, or worsened based on whether the Patient Health Questionaire-9 scores changed by at least 2 standard deviations (ie, 5 points on the Patient Health Questionaire-9 scale). Bivariable and multivariable analyses were performed. Of the 1270 people who met the inclusion criteria, 294 (23.1%) reported a high adverse childhood experience score. Those with a high adverse childhood experience score were more likely to experience a worsened antenatal depression trajectory than those with a low adverse childhood experience score (10.3% vs 4.3%; P=.008). This association persisted after adjusting for potential confounders (adjusted odds ratio, 2.39; 95% confidence interval, 1.05-5.46). There was no significant difference in the postpartum depression trajectories between those with a high and those with a low adverse childhood experience score. Having a high adverse childhood experience score is associated with a worsened antenatal depression trajectory for those enrolled in a collaborative care program. Given its high prevalence, future research should evaluate effective modalities of perinatal depression prevention and treatment specific for pregnant people with a history of adverse childhood experiences.

Adverse childhood experiences and human immunodeficiency virus testing among adults with human immunodeficiency virus risk behaviours.

Adverse childhood experiences (ACEs) have been associated with poor HIV testing in adulthood yet, they have not been extensively described in those at increased risk for HIV. Cross-sectional analysis data (n=204,231) on ACEs and HIV testing were obtained from the 2019-2020 Behavioural Risk Factor Surveillance Survey. Weighted logistic regression models were used to access the association of ACEs exposure, ACEs score, and ACEs type with HIV testing among adults with HIV risk behaviours, and stratified analysis was also performed to examine gender differences. The results indicated the overall rate of HIV testing was 38.8% and was higher among those with HIV risk behaviours (64.6%) than those without (37.2%). In populations with HIV risk behaviours, the negative association of HIV testing with ACEs exposure, ACEs score, and ACEs type was identified. Relative to those without ACEs, adults who were exposed to ACEs might decrease the rate of HIV testing, participants with ≥4 ACEs scores were less likely to have HIV testing, and childhood exposure to sexual abuse had the greatest impact on HIV testing. For both males and females, childhood exposure to ACEs was associated with lower odds of HIV testing and ACEs score ≥4 had the most robust associations with HIV testing. For males, those who experienced witnessed domestic violence had the lowest odds of HIV testing but the odds of engaging in HIV testing for females were the lowest among those who experienced childhood sexual abuse.

The role of adverse childhood experiences in suicide among sexual minority undergraduate students

This study explores the rates and odds of adverse childhood experiences (ACEs) and their relationship to suicide attempts in a sample of undergraduate students (n = 924, 71.6% women), comparing lesbian, gay and bisexual (LGB) youth to their heterosexual counterparts. Using propensity score matching, we matched 231 sexual minority and 603 heterosexual participants at a ratio of 1:3, based on gender, age, socioeconomic status, and religious beliefs. Sexual minority participants reported a significantly higher ACE score (M = 2.70 vs. 1.85; t = 4.93; p <.001; d = .391) and higher rates of all but one type of ACEs than their heterosexual counterparts. They also reported a higher prevalence and risk of suicide attempts (33.3% vs. 11.8% respectively, odds ratio = 3.73; p < .001). In logistic regression analysis, sexual minority status, emotional abuse and neglect, bias attack, having a household member with mental health problems, bullying and cyberbullying were significantly associated with suicide attempts.

Screening for adverse childhood experiences among young people using drugs in Vietnam: related factors and clinical implications.

Research evidence shows a strong association between adverse childhood experiences (ACEs) and later-life substance use. But little is known about the prevalence and impact of ACEs among young people using drugs (YPUD) in Vietnam. A cross-sectional study using respondent-driven sampling and peer recruitment methods was conducted among YPUD aged 16-24 in three cities in Vietnam. Eligible participants were screened for ACEs using the ACE-IQ, tested for HIV and hepatitis C, and assessed for sociodemographic and behavioral characteristics. Data were collected on 553 individuals whose median age was 20: 79% were male, 18.3% women and 2.7% transgender. Methamphetamine use was reported by 75.8% of participants. 85.5% reported at least one ACE and 27.5% had four ACEs or more. An ACE score of 4 or higher was associated with female and transgender, lower educational level, methamphetamine use, buying sex, depression, psychotic symptoms and expressed need for mental health support. ACEs were found to be very common among YPUD in Vietnam. It is therefore strongly recommended that these young people should be provided with a comprehensive and secure assessment and care that includes not only essential harm reduction and addiction treatment needs but also addresses their mental health needs.

Associations between adverse childhood experiences and obstetrical outcomes in a predominantly Black-identifying and low-income pregnant population

Recent literature indicates that adverse childhood experiences have been associated with poor obstetrical outcomes, including pregnancy loss, preterm birth, and low birthweight. Several studies have been conducted in primarily self-identified White individuals who report middle to high income levels. Less is known about the impact of adverse childhood experiences on obstetrical outcomes in minority-identifying and low-income populations, who are known to experience a greater number of adverse childhood experiences and are at higher risk of maternal morbidity. This study aimed to examine associations between adverse childhood experiences and a broad range of obstetrical outcomes among predominantly Black-identifying pregnant persons who have low income and live in an urban area. This is a single-center retrospective cohort study of pregnant persons referred to a mental healthcare manager because of elevated psychosocial risks identified by screening tools or provider concerns during the study period from April 2018 to May 2021. Pregnant persons aged <18 years and those who did not speak English were excluded. Patients completed validated mental and behavioral health screening tools including the Adverse Childhood Experiences Questionnaire. Medical charts were reviewed for obstetrical outcomes, including preterm birth, low birthweight, hypertensive disorders of pregnancy, gestational diabetes mellitus, chorioamnionitis, sexually transmitted infection, maternal group B streptococcus carrier status, type of delivery, and attendance of a postpartum visit. Associations between high (≥4) and very high (≥6) of 10 adverse childhood experience score and obstetrical outcomes were analyzed using bivariate analysis and multivariate logistic regression, adjusting for confounding factors (significant at P<.05 in bivariate analysis). Our cohort included 192 pregnant persons, of whom 176 (91.7%) self-identified as Black or African American and 181 (94.8%) had public insurance (used as a proxy for low income). Adverse childhood experience score ≥4 was reported by 91 (47.4%) individuals and score ≥6 by 50 (26%). On univariate analysis, adverse childhood experience score ≥4 was associated with preterm birth (odds ratio, 2.17; 95% confidence interval, 1.02-4.61). Adverse childhood experience score ≥6 was associated with hypertensive disorders of pregnancy (odds ratio, 2.09; 95% confidence interval, 1.05-4.15) and preterm birth (odds ratio, 2.29; 95% confidence interval, 1.05-4.96). After accounting for chronic hypertension, associations between adverse childhood experience score and obstetrical outcomes were no longer significant. Approximately half of the pregnant persons referred to a mental healthcare manager had a high adverse childhood experience score, underscoring the high burden of childhood trauma on populations facing long-standing systemic racism and barriers to healthcare access. High and very high adverse childhood experience score may be associated with chronic health conditions that predate pregnancy and can alter obstetrical outcomes. Obstetrical care providers have a unique opportunity to mitigate risk of associated poor health outcomes during preconception and prenatal care by screening for adverse childhood experiences.

As simple as possible, but not simpler: Revisiting the International Trauma Questionnaire (ITQ) complex PTSD items omitted in the shortened version

BackgroundThe risks of oversimplification of the symptomatology of Complex PTSD (CPTSD) have been highlighted in the literature. ObjectiveTo re-examine 10 items representing disturbances in self-organization (DSO) that were deleted from the original 28-item version of the International Trauma Questionnaire (ITQ) when creating the current 12-item version. Participants and settingAn online convenience sample of 1235 MTurk users. MethodsOnline survey comprising the fuller 28-item previous version of the ITQ, Adverse Childhood Experiences (ACEs) questionnaire, and PTSD Checklist for DSM-5 (PCL-5). ResultsFirst, averaged endorsement of the 10 omitted items was lower than the 6 retained DSO items (d’ = 0.34). Second, the 10 omitted DSO items accounted for incremental variance over and correlated equivalently to the 6 retained items with the PCL-5. Third, only the 10 omitted DSO items (r-part = 0.12) while not the 6 retained DSO items (r-part = −0.01) independently predicted ACE scores and, eight of these ten omitted DSO items differentiated higher ACE scores even among the subset of 266 participants who endorsed all 6 of the retained DSO items, most with medium effect sizes. Fourth, exploratory principal axis factor analysis differentiated two latent variables within the fuller set of 16 DSO symptoms, with the strongest indicators of the second factor, namely uncontrollable anger, recklessness, derealization, and depersonalization, being unmeasured within the 6 retained DSO items. Moreover, scores on both factors independently predicted both PCL-5 and ACE scores. ConclusionsThere are conceptual and pragmatic advantages to revisiting a more content-valid and comprehensive conceptualization of CPTSD and DSO, partially as may be measured by the recently deleted items from the original and fuller length ITQ.

Association Between ACEs and Postoperative Pain After Gynecologic Surgery [ID: 1377683

INTRODUCTION: Adverse childhood experiences (ACEs) are instances of abuse or household dysfunction that occur prior to 18 years of age. Numerous studies have demonstrated an increased risk of morbidity and mortality with increasing ACE scores. An association between ACEs and chronic pelvic pain has also been described; however, data for acute pain are lacking. This study evaluates the relationship between ACEs and acute postoperative pain after benign minimally invasive hysterectomies. METHODS: Institutional review board approval was obtained at a large academic health center. Consenting participants completed the ACEs survey prior to hysterectomy. Patient data were collected by retrospective chart review, including postoperative care unit pain scores. Descriptive statistics, Kruskal-Wallis tests, and Spearman’s correlation coefficients were utilized for analysis. Enrollment is ongoing with a recruitment goal of 112 participants. RESULTS: Preliminary analysis included 47 participants. Average patient age was 39.2±11.4 years. The average ACE score was 3.5±2.9 and 46.8% of participants had high ACE scores, defined as 4 or more. Although not statistically significant, patients with high ACE scores trended towards higher pain scores and morphine milligram equivalents (MME) usage. Maximum pain scores and required MME were 5.86 and 16.50 MME in the high-ACE group versus 4.88 and 7.50 MME in the low-ACE group, respectively (P=.41, P=.40). CONCLUSION: High ACE scores are greater than threefold more prevalent in our surgical study population compared to previously reported general population rates. Although preliminary data suggest ACE scores and postoperative pain are not associated, further data are needed.