Adverse Experiences Research Articles

Understanding Australia’s teacher shortage: the importance of psychosocial working conditions to turnover intentions

AbstractAustralian policymakers are currently attempting to address an ‘unprecedented teacher shortage’. Through a survey of 905 teachers in Australian government schools, this paper examines some of the key factors influencing the career intentions of teachers in Australian government schools. Drawing upon the concept of the psychosocial work environment from the field of occupational health, this analysis examines the relationship between key workplace demands, workplace resources, teachers’ experiences and attitudes towards work, teachers’ mental health outcomes, and their intentions to either remain in or leave their roles. The results reveal significant relationships between teachers’ intentions to leave their roles and challenging working conditions, adverse work experiences, as well as heightened levels of stress, burnout, and depressive symptoms. In contrast, remaining in their role was associated with factors indicative of a supportive psychosocial work environment, such as job recognition, trust in management, organisational justice, positive work experiences, and lower levels of mental health difficulties. The study underscores the urgent need to understand and assess the psychosocial work environments of teachers, and for multi-level strategies that address both protective and risk factors.

Associations of prenatal stress with 5-year-old children's executive function in a low socioeconomic status population.

Prenatal stress has a significant, but small, negative effect on children's executive function (EF) in middle and high socioeconomic status (SES) households. Importantly, rates and severity of prenatal stress are higher and protective factors are reduced in lower SES households, suggesting prenatal stress may be particularly detrimental for children's EF in this population. This study examined whether prenatal stress was linked to 5-year-old's EF in a predominantly low SES sample and child sex moderated this association, as males may be more vulnerable to adverse prenatal experiences. Participants were 132 mother-child dyads drawn from a prospective prenatal cohort. Mothers reported on their depression symptoms, trait anxiety, perceived stress, everyday discrimination, and sleep quality at enrollment and once each trimester, to form a composite prenatal stress measure. Children's EF was assessed at age 5 years using the parent-report Behavior Rating Inventory of Executive Function - Preschool (BRIEF-P) Global Executive Composite subscale and neuropsychological tasks completed by the children. Mixed models revealed higher prenatal stress was associated with lower BRIEF-P scores, indicating better EF, for females only. Higher prenatal stress was associated with lower performance on neuropsychological EF measures for both males and females. Results add to the limited evidence about prenatal stress effects on children's EF in low SES households.

A clinical audit of patient outcomes in real-world acupuncture practice.

Clinical auditing represents a valuable and cost-effective method for the collection of patient outcomes and is increasingly being used to inform clinical guidelines. The aim of this clinical audit was to assess patient outcomes across a small subset of acupuncture practitioners and private practices in the United Kingdom. The Measure Yourself Medical Outcomes Profile (MYMOP) questionnaire and the Patient Global Impression of Change (PGIC) scale were used as outcome measures. Additional questions assessed adverse events and patient experience with care. Clinical data were collected utilising an electronic patient-reported outcome measures (ePROMs) system. Baseline data were collected for a total of 233 health complaints (from 232 patients), of which 45.9% were musculoskeletal and 26.2% were psychological. Follow-up outcomes data were available for 144 health complaints (61.8% completion rate). For PGIC responses, >90% of health complaints were reported as at least 'minimally improved'. This was reduced to >51% when controlling for missing data. There was a gradual improvement in both mean MYMOP scores (24.5%-43.0%) and PGIC responses of 'very much improved' (12.3%-56.3%) over a 6-month period. A clinically significant improvement (>1 point change, p ⩽ 0.001) was seen in mean MYMOP scores compared to baseline from 4 to 8 weeks and symptom 1 MYMOP scores from 1 to 4 weeks. A moderately strong, negative correlation was seen between outcome measures (r = -0.507, p < 0.001). The majority of patients reported clinically meaningful improvements for their main health complaints/symptoms, which appeared to be sustained in the medium to long-term.

Racial diversity at work: a psychodynamic perspective

This study aimed to provide new insights for diversity management by applying the psychodynamic principles of defence mechanisms and basic assumption mentality. Diversity is an important part of modern society and organisations. However, the evidence of diversity management remains inconsistent. Two opposing social theories have primarily been the focus of the scientific literature. Some scholars argue that these theories may be insufficient as they do not necessarily account for more covert forms of discrimination and experiences. We adopt a psychodynamic perspective because it has long promoted the influence of covert behaviours and subjective experiences. Ten participants were recruited using the purposeful sampling method. Participants identified as either being White, Black, Asian, or Other which was one of the three main inclusion criteria. The second being participants had no formal managerial authority and all worked in racially diverse teams in different organisations. Participants were recruited from organisations in The UK, The Netherlands, Belgium, Austria, and Australia. Individual interviews lasted 20–30 minutes and were conducted using Microsoft Teams and transcripts were coded using Nvivo 12. Interpretative phenomenological analysis (IPA) was applied to uncover themes and psychodynamic principles were applied to make sense of participants lived experiences. The findings suggest that participants’ anxieties were exacerbated by socio-environmental factors and adverse workplace experiences that negatively interfered with job performance and relationships in the workplace. Ethnic minorities reported more stressors primarily due to a conflict and discrepancy between the self and their work environment. Reducing uncertainty, leadership emotional competence, and effectively managing work boundaries were protective factors. Recommendations and limitations are discussed.

Disentangling Support for Violent and Non-violent Radicalization among Adolescents: A Latent Profile Analysis.

Although support for violent and non-violent radicalization can co-occur, only a few adolescents who support non-violent radicalization also support or engage in violent acts. Yet, little is known about what factors are associated with adolescents' paths towards or away from violent and/or non-violent radicalization. Within a socio-ecological and positive youth development framework, this study investigates profiles of support for violent and non-violent radicalization among adolescents attending high schools in Quebec (Canada) and whether such profiles are differently associated with experiences of social adversity, school-, family- and peer-related factors and psychological distress. Adolescents (N = 1911; Mage = 15.7; SDage = 0.98; 48.7% girls) completed an online survey during school hours. A Latent Profile Analysis on scores of support for violent and non-violent radicalization was conducted. A multinomial logistic regression was used to explore the associations between profiles and variables of interest. We identified six profiles of adolescents. The heterogeneity of profiles suggested multiple and complex combinations of support for violent and non-violent radicalization as well as their co-existence in some but not all profiles. Adolescents who reported less discrimination, more positive school experiences and more family support were less likely to belong to profiles that supported violence. Primary prevention efforts in the field of support for violent radicalization must adopt a socio-ecological and social justice approach and consider the diversity of adolescents' profiles, attitudes and experiences.

Longitudinal patterns of adversity from childhood to adolescence: Examining associations with mental health through emerging adulthood using a random-intercept latent transition analysis.

Childhood adversity can have detrimental impacts on life course mental and physical health. Timing, nature, severity, and chronicity of adversity are thought to explain much of the variability in health and developmental outcomes among exposed individuals. The current study seeks to characterize heterogeneity in adverse experiences over time at the individual, family, and neighborhood domains in a cohort of predominantly Black children (85% Black and 15% White, 46.2% girls, 67.2% free/reduced lunch in first grade), and to examine associations with mental health from sixth grade to age 26. Participants were part of a randomized universal preventive interventions trial in first grade with prospective follow-up through early adulthood. Separate models characterized heterogeneity in adversity in elementary, middle, and high schools. Changes in adversity over time and relationships with mental health (anxiety, depression, suicidal behaviors) were investigated using a random-intercept latent transition analysis (RI-LTA). We identified three-class solutions in early childhood, middle school, and high school. Generally, both a higher and a lower poly-adversity class were observed at each time point, with varying nature of adversity characterized by the third class. RI-LTA indicated prevalent within-individual changes in adverse exposure over time and differential associations with mental health and suicidal behaviors. Results suggest that treating adverse exposures as a static construct may limit the ability to characterize salient variation over time. Identifying complexity in adverse experiences and their relation to health and well-being is key for developing and implementing effective prevention and early intervention efforts to mitigate negative effects through the life course. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

A Scale for Measuring Positive and Negative Experiences of Psychotherapy (PNEP): First Psychometric Findings of a New Instrument for Monitoring Clients' Experiences.

Clients' adverse experiences during psychotherapy are rarely monitored in clinical practice or research trials. One obstacle here is the lack of a measure to gauge both positive and negative experiences during psychotherapy. We developed and evaluated a new instrument for measuring such experiences. The Positive and Negative Experiences of Psychotherapy (PNEP) questionnaire was developed based on pilot data, a literature review, and two existing scales for measuring primarily adverse experiences during psychotherapy. Mental healthcare clients (N = 200) anonymously completed and evaluated the PNEP. Subsequently, a sample of professionals (N = 34) who underwent psychotherapy in the context of their training filled in the PNEP twice, with a 2-week interval in between. The positive and negative experiences subscales of the PNEP were found to possess excellent internal consistencies (αs ≥ 0.90). The PNEP test-retest reliability was 0.93 for the positive experiences subscale and 0.78 for the negative experiences subscale. For the positive subscale, four factors were extracted: symptom reduction and positive well-being, high quality of therapy and therapeutic relation, personal growth and acceptance and interpersonal functioning. For the negative subscale, exploratory factor analysis suggested a three-factor solution: escalation of symptoms and emotional distress, low quality of therapy and therapeutic relation and (self-)stigmatization and dependency. Participants related a median of 13 positive and six negative therapy experiences to their most recent treatment. The most frequently endorsed negative experiences were having more negative thoughts and memories, feeling emotionally overwhelmed and an increase in stress due to the therapy. A minority of participants (10.5%) reported no negative treatment experiences. In the field of psychotherapy, the evaluation of risks and benefits is crucial for assessing safety and effectiveness. The PNEP could be a promising instrument for achieving this objective, although further research is needed to replicate and expand upon the current findings.

The Reliability of Traumatic and Adverse Experiences.

The Reliability of Traumatic and Adverse Experiences.

Comparing the multivariate relationships of conceptual adversity models and structural brain development in adolescent girls: A registered report.

Adverse experiences throughout development confer risk for a multitude of negative long-term outcomes, but the processes via which these experiences are neurobiologically embedded are still unclear. Adolescence provides an opportunity to understand how these experiences impact the brain's rapidly changing structure. Two models are central to current adversity conceptualizations: a cumulative risk model, where all types of experiences are combined to represent accumulating stress, and a dimensional model, where certain features of experience (e.g., threat or deprivation) exert unique neurophysiological influence. In this registered report, we extended upon previous research by using a form of representational similarity analysis to examine whether the dimensional and cumulative risk models of adversity predict cortical thinning in frontoparietal and frontotemporal networks and volumetric changes in subcortical regions throughout adolescence. Drawing from a longitudinal sample of 179 adolescent girls (ages 10-13 years at the first wave) from Lane County, Oregon, United States, and up to four waves of follow-up data, we found that operationalizing adversity by similarity in threat and deprivation provided better prediction of brain development than similarity in overall adversity. However, these dimensions do not exhibit unique associations with developmental changes in the hypothesized brain changes. These results underscore the significance of carefully defining adversity and considering its impact on the entire brain. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Cardiac Remodeling in Aged Rats after Early-life Chronic Stress: Sex-specific Outcomes and Associations with Metabolic Parameters

Cardiovascular disease is the leading cause of death worldwide. Additionally, the incidence of cardiovascular disease varies both across the lifespan and between sexes. While multiple factors influence the development and progression of cardiovascular pathology, prolonged stress is a prominent risk factor for adverse cardiac events. However, the interactions between stress, sex, and aging that impact cardiac susceptibility remain to be determined. To this end, we examined hypertrophy of the aged myocardium in a sex- and stress-specific manner. We hypothesized that sex and stress history would interact to predict cardiac outcomes and that susceptibility/resilience would associate with behavioral, endocrine, and metabolic parameters assessed across the lifespan. In this study, rats were either exposed to chronic variable stress (CVS) in late adolescence (n = 36/sex) or remained as unstressed controls (n = 24/sex). Rats were subsequently challenged with a forced swim test (FST) and glucose tolerance test (GTT) before ageing to 15 months. The FST and GTT were then repeated prior to tissue collection. Cardiac tissue was processed for histological analysis and quantification of ventricular morphology. The data indicated that early-life chronic stress had sex-specific consequences on the aged left ventricle as CVS females had greater concentric hypertrophy. Based on the level of inward remodeling, rats were then classified as susceptible or resilient. Multiple behavioral and endocrine factors in young and aged animals significantly interacted with hypertrophy, including coping behaviors and glucocorticoid responses to hyperglycemia. However, correlations with hypertrophy were only present in males. Male rats that were not exposed to CVS had a positive association between baseline corticosterone and hypertrophy. Alternatively, CVS males had a positive correlation between visceral adiposity and hypertrophy. Thus, sex-specific cardiac susceptibility/resilience relates to endocrine and metabolic measures depending on stress history. This outcome suggests that adverse experiences can have lasting impacts on homeostatic adaptation. Ultimately, these results highlight the importance of sex and prior stress exposure for disparities in cardiovascular risk. NIH R01 HL 150559 (B Myers) NIHH F30 OD032120 (C Dearing) Pilot Translation Research Program grant from the University of Cincinnati (B Myers). This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Machine Learning-Based Approach to Predict Last-Minute Cancellation of Pediatric Day Surgeries.

The last-minute cancellation of surgeries profoundly affects patients and their families. This research aimed to forecast these cancellations using EMR data and meteorological conditions at the time of the appointment, using a machine learning approach. We retrospectively gathered medical data from 13 440 pediatric patients slated for surgery from 2018 to 2021. Following data preprocessing, we utilized random forests, logistic regression, linear support vector machines, gradient boosting trees, and extreme gradient boosting trees to predict these abrupt cancellations. The efficacy of these models was assessed through performance metrics. The analysis revealed that key factors influencing last-minute cancellations included the impact of the coronavirus disease 2019 pandemic, average wind speed, average rainfall, preanesthetic assessments, and patient age. The extreme gradient boosting algorithm outperformed other models in predicting cancellations, boasting an area under the curve value of 0.923 and an accuracy of 0.841. This algorithm yielded superior sensitivity (0.840), precision (0.837), and F1 score (0.838) relative to the other models. These insights underscore the potential of machine learning, informed by EMRs and meteorological data, in forecasting last-minute surgical cancellations. The extreme gradient boosting algorithm holds promise for clinical deployment to curtail healthcare expenses and avert adverse patient-family experiences.

Can Adverse Event Patterns Inform Shared Decision-Making in ADHD Treatment? A Systematic Review of Evidence From Registration Trials for FDA-Approved Treatments in Adults.

Adult patients and clinicians are faced with several pharmacological options to manage attention-deficit/hyperactivity disorder (ADHD). If types or rates of adverse experiences vary among these options, these differences could inform the shared decision-making process. To discern differentiating evidence-based patterns of risk, we analyzed data from FDA package labels for drugs approved to treat adult ADHD and reports from the registration trials used to create these labels. Three analyses of adverse effects were conducted: placebo-corrected occurrence at rates of 1 in 5, 10, and 20 participants, association with discontinuation, and uniqueness of occurrence within the treatment options. Among the 7 agents approved to treat adult ADHD, the number of types of side effects experienced during a mix of fixed and flexible-dose studies was greatest among the nonstimulant medications, but the stimulant medications had higher rates of occurrence of side effects. The minimum frequency at which all medications had adverse events was 1 in 10 participants. Overall discontinuation rates did not differ among the stimulant medications nor between stimulants and nonstimulants. To our knowledge, this is the first study to compile and compare data from all FDA registration trials for medications approved to treat adult ADHD. This article describes a process by which readily available adverse event reporting data can be used as a tool to inform shared clinical decision-making. While differences in the methodology and outcome reporting of the trials included may limit generalizability, the number of individual patients included and the completeness of the discontinuation data can be used to inform discussions with patients about the relative likelihood of adverse experiences and other patient concerns.

Unlocking online language education: Opportunities, challenges, and recommendations

Advances in technology have significantly augmented the potential of online education, particularly during crises, such as COVID-19, earthquakes, hurricanes, and floods. This qualitative survey study ascertains 150 English-as-a-foreign language (EFL) learners' perceptions of the efficacy of online language education in a preparatory school of a state university after the Kahramanmaraş earthquake in Türkiye in 2023. Data were gathered via an online survey with open-ended inquiries to elicit favourable and adverse experiences and recommendations from students. In order to ensure the thorough and systematic analysis of the collected data, a rigorous methodological approach was employed. Specifically, the data were analyzed through content analysis, facilitated by the MAXQDA. The research outcomes revealed that the participants appreciated online language education for its time-saving nature, comfort, ease of attendance, access to recorded sessions, teacher support, and cost-effectiveness. However, some students also considered online education ineffective and reported challenges, such as technical issues, diminished concentration, lack of motivation and discipline, limited interaction, and class participation. EFL learners also provided suggestions for improving the curriculum, assessment methods, and instructors’ teaching approaches.

A Narrative Review of the Efficacy of Interventions for Emotional Dysregulation, and Underlying Bio-Psycho-Social Factors.

In this narrative, comprehensive, and updated review of the literature, we summarize evidence about the effectiveness of interventions aimed at reducing emotion dysregulation and improving emotion regulation in children, adolescents, and adults. After introducing emotion dysregulation and emotion regulation from a theoretical standpoint, we discuss the factors commonly associated with emotion regulation, including neurobiological and neuropsychological mechanisms, and the role of childhood adverse experiences and psycho-social factors in the onset of emotion dysregulation. We then present evidence about pharmacological and non-pharmacological interventions aiming at improving emotion dysregulation and promoting emotion regulation across the lifespan. Although our review was not intended as a traditional systematic review, and the search was only restricted to systematic reviews and meta-analyses, we highlighted important implications and provided recommendations for clinical practice and future research in this field.

Advancing health equity for Indigenous peoples in Canada: development of a patient complexity assessment framework.

Indigenous patients often present with complex health needs in clinical settings due to factors rooted in a legacy of colonization. Healthcare systems and providers are not equipped to identify the underlying causes nor enact solutions for this complexity. This study aimed to develop an Indigenous-centered patient complexity assessment framework for urban Indigenous patients in Canada. A multi-phased approach was used which was initiated with a review of literature surrounding complexity, followed by interviews with Indigenous patients to embed their lived experiences of complexity, and concluded with a modified e-Delphi consensus building process with a panel of 14 healthcare experts within the field of Indigenous health to identify the domains and concepts contributing to health complexity for inclusion in an Indigenous-centered patient complexity assessment framework. This study details the final phase of the research. A total of 27 concepts spanning 9 domains, including those from biological, social, health literacy, psychological, functioning, healthcare access, adverse life experiences, resilience and culture, and healthcare violence domains were included in the final version of the Indigenous-centered patient complexity assessment framework. The proposed framework outlines critical components that indicate the presence of health complexity among Indigenous patients. The framework serves as a source of reference for healthcare providers to inform their delivery of care with Indigenous patients. This framework will advance scholarship in patient complexity assessment tools through the addition of domains not commonly seen, as well as extending the application of these tools to potentially mitigate racism experienced by underserved populations such as Indigenous peoples.

Breathing Uneasily: Employees' Stories of Coping With Poor Indoor Air Quality in the Workplace.

This phenomenological study aimed to elucidate the lived experiences of employees suffering from poor indoor air quality (IAQ) in their university workplace. It addresses gaps in understanding IAQ's personal impacts from occupants' perspectives. Prior research on sick building syndrome and indoor air pollution utilized quantitative methods to assess physical health outcomes. However, few studies have adopted qualitative approaches to uncover the meanings ascribed to adverse IAQ experiences and their influences on psychosocial well-being. In-depth semi-structured interviews were conducted with five university employees who attributed their chronic illnesses to poor IAQ in their 60-year-old office building with a history of IAQ concerns. Verbatim transcripts were analyzed using qualitative techniques including thematic coding to extract key themes conveying shared experiences. Employees depicted the building itself as fundamentally "sick" and stigmatized, compelling complex coping behaviors hindering productivity. Communication breakdowns, mistrust in leadership, and strained workplace relationships were prevalent. A sense of betrayal, powerlessness, and a sense of detachment from the workplace emerged with home as a refuge. Although technically adequate, poor IAQ profoundly damaged perceived health, quality of life, relationships, and satisfaction. The accounts emphasize IAQ's psychosocial dimensions, advancing theoretical links between indoor environments and well-being. Supportive policies, transparency, communication, participatory processes, and human-centered strategies emerge as ways to nurture productivity, well-being, and organizational health.

The Influence of Stress and Binge-Patterned Alcohol Drinking on Mouse Skeletal Muscle Protein Synthesis and Degradation Pathways.

Adverse experiences (e.g., acute stress) and alcohol misuse can both impair skeletal muscle homeostasis, resulting in reduced protein synthesis and greater protein breakdown. Exposure to acute stress is a significant risk factor for engaging in alcohol misuse. However, little is known about how these factors together might further affect skeletal muscle health. To that end, this study investigated the effects of acute stress exposure followed by a period of binge-patterned alcohol drinking on signaling factors along mouse skeletal muscle protein synthesis (MPS) and degradation (MPD) pathways. Young adult male C57BL/6J mice participated in the Drinking in the Dark paradigm, where they received 2-4 h of access to 20% ethanol (alcohol group) or water (control group) for four days to establish baseline drinking levels. Three days later, half of the mice in each group were either exposed to a single episode of uncontrollable tail shocks (acute stress) or remained undisturbed in their home cages (no stress). Three days after stress exposure, mice received 4 h of access to 20% ethanol (alcohol) to model binge-patterned alcohol drinking or water for ten consecutive days. Immediately following the final episode of alcohol access, mouse gastrocnemius muscle was extracted to measure changes in relative protein levels along the Akt-mTOR MPS, as well as the ubiquitin-proteasome pathway (UPP) and autophagy MPD pathways via Western blotting. A single exposure to acute stress impaired Akt singling and reduced rates of MPS, independent of alcohol access. This observation was concurrent with a potent increase in heat shock protein seventy expression in the muscle of stressed mice. Alcohol drinking did not exacerbate stress-induced alterations in the MPS and MPD signaling pathways. Instead, changes in the MPS and MPD signaling factors due to alcohol access were primarily observed in non-stressed mice. Taken together, these data suggest that exposure to a stressor of sufficient intensity may cause prolonged disruptions to signaling factors that impact skeletal muscle health and function beyond what could be further induced by periods of alcohol misuse.

Dimensions of early life adversity and their associations with functional brain organisation

Abstract Early life adversity is associated with differences in brain function and an elevated risk for poor mental health. Using data from children aged 10 (N = 5,798) from the Adolescent Brain Cognitive Development (ABCD) cohort, we investigated how adversity relates to functional brain organisation using a network neuroscience approach. We derived four data-driven categories of adversity by fitting a mixed graphical model: household/community instability, physical/sexual abuse, parental neglect, and financial difficulties. Analyses revealed that multiple forms of adversity were associated with reduced clustering and increased assortativity across the entire brain and that these local measures of organisation captured greater adversity-related variance than mesoscale measures like modularity. The most pronounced effects were in the somatosensory and subcortical networks. Financial difficulties showed the strongest and most widespread associations with brain organisation, with evidence of a mediating effect of assortativity on the association between financial difficulties and internalising symptoms. Adding race as a covariate attenuated most brain-adversity relationships, suggesting that experiences of adversity are strongly related to race/ethnicity in the ABCD sample. These results demonstrate that different forms of adversity are associated with both shared and unique variations in functional brain organisation, highlighting its potential significance for explaining individual differences in mental health outcomes following early life adversity.

Risk and protective factors for self-harm and suicide behaviours among serving and ex-serving personnel of the UK Armed Forces, Canadian Armed Forces, Australian Defence Force and New Zealand Defence Force: A systematic review.

Self-harm and suicide behaviours are a major public health concern. Several factors are associated with these behaviours among military communities. Identifying these factors may have important implications for policy and clinical services. The aim of this review was to identify the risk and protective factors associated with self-harm and suicide behaviours among serving and ex-serving personnel of the United Kingdom Armed Forces, Canadian Armed Forces, Australian Defence Force and New Zealand Defence Force. A systematic search of seven online databases (PubMed, Web of Science, Embase, Global Health, PsycINFO, PTSDpubs and CINAHL) was conducted alongside cross-referencing, in October 2022. Following an a priori PROSPERO approved protocol (CRD42022348867), papers were independently screened and assessed for quality. Data were synthesised using a narrative approach. Overall, 28 papers were included: 13 from Canada, 10 from the United Kingdom, five from Australia and none from New Zealand. Identified risk factors included being single/ex-relationship, early service leavers, shorter length of service (but not necessarily early service leavers), junior ranks, exposure to deployment-related traumatic events, physical and mental health diagnoses, and experience of childhood adversity. Protective factors included being married/in a relationship, higher educational attainment, employment, senior ranks, and higher levels of perceived social support. Adequate care and support are a necessity for the military community. Prevention and intervention strategies for self-harm and suicide behaviours may be introduced early and may promote social networks as a key source of support. This review found a paucity of peer-reviewed research within some populations. More peer-reviewed research is needed, particularly among these populations where current work is limited, and regarding modifiable risk and protective factors.

Children With Special Health Care Needs: An Analysis of National Survey of Children's Health Database.

Background Children with Special Health Care Needs (CSHCN) represent a diverse pediatric population requiring healthcare services beyond typical childhood needs. This study analyzes data from the 2016-2020 National Survey of Children's Health Database to elucidate demographic patterns, prevalence rates, and nuanced factors influencing the health and well-being of CSHCN. Methods This retrospective observational study focuses on children aged 0-17 who are identified as CSHCN based on Maternal and Child Health Bureau criteria. A comprehensive analysis of the National Survey of Children's Health (NSCH) database examines key variables, including health outcomes, healthcare utilization, parental-reported health status, and socio-demographic factors. Stratified random sampling ensures national representation. Results The study encompassed 40,335 patients, revealing that 14.6% (CI: 14.0-15.3, n=6,445) of CSHCN received care in a well-functioning system. Across age groups, 19.1% (CI: 14.0-15.3, n=6,445) of CSHCN aged 0-5 received ongoing treatment, contrasting with 5.7% (CI: 5.2-6.2, n=1,599) in the 12-17 years group. Males exhibited a prevalence of 15% (CI: 14.1-15.9, n=3,674), and females had 14.2% (CI: 13.2-15.2, n=2,771). Racial disparities were noted; non-Hispanic Native Hawaiian/Other Pacific Islander children had a 3% (CI: 1.1-8.1, n=6) prevalence. Across Federal Poverty Level categories, prevalence ranged from 12.5% (CI: 11.5-13.6, n=1,753) to 17.7% (CI: 16.6-18.9, n=2,856). Notably, 18.5% (CI: 17.4-19.7, n=3,515) of children without adverse experiences were CSHCN. Among CSHCN in two-parent currently married households, 15.9% (CI: 15.0-16.8, n=4,330) received treatment, while those in unmarried households had a prevalence of 12.9% (CI: 10.5-15.7, n=335). CSHCN with parents born in the United Statesshowed a prevalence of 15.4% (CI: 14.7-16.1, n=5,257). Conclusion This study provides valuable insights into the prevalence and demographic patterns of CSHCN. Limitations include potential recall bias and the retrospective study design. Despite these constraints, the findings lay a foundation for future research and targeted interventions, fostering a deeper understanding of the evolving landscape of pediatric healthcare in the United States.