Cumulative Adversity Research Articles

Functional brain network organization and multidomain resilience to neighborhood disadvantage in youth.

Though youth living in disadvantaged neighborhoods experience greater risk for poor behavioral and mental health outcomes, many go on to show resilience in the face of adversity. A few recent studies have identified neural markers of resilience in cognitive and affective brain networks, yet the broader network organization supporting resilience in youth remains unknown, particularly in relation to neighborhood disadvantage. Moreover, most studies have defined resilience as the absence of psychopathology, which does not consider growing evidence that resilience also includes positive outcomes across multiple domains (e.g., social, academic). We examined associations between brain network organization and multiple resilience domains in a sample of 708 twins (7-19 years old) recruited from neighborhoods with above-average poverty levels. Graph analysis on functional connectivity data from resting-state and task-based functional magnetic resonance imaging was used to characterize features of intrinsic whole-brain and network-level organization, from which we explored associations with resilience in three domains: psychological, social, and academic. Fewer connections between a brain network involved in self-referential processing (i.e., default mode network) and the subcortical system were associated with greater social resilience. Further, greater whole-brain functional integration (i.e., efficiency) was associated with better psychological resilience among youth with relatively lower levels of cumulative adversity exposure. Alternatively, lower whole-brain efficiency and higher whole-brain robustness to disruption (i.e., assortativity) were associated with greater psychological and social resilience among youth with relatively higher levels of cumulative adversity. These findings advance support for multidimensional resilience models and reveal distinct neural mechanisms supporting resilience to neighborhood disadvantage across specific domains in youth. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Patterns of early childhood adversity and neighborhood deprivation predict unique challenges in adolescence: A UK birth cohort study.

This study applies a comprehensive bioecological perspective to address a significant gap in the childhood adversity literature by employing latent profile analysis to examine the impact of diverse combinations of early childhood adversities and protective factors on adolescent psychosocial and behavioral outcomes. Drawing from the United Kingdom's Millennium Cohort Study (N = 19,444), we identified eight unique profiles of early childhood adversity and protective factors. These profiles provide a nuanced understanding of adversity combinations and allow for differentiation between groups with similar profiles. Latent profile membership was a significant predictor of all adolescent outcome variables, indicating that profiles differed significantly from one another on psychosocial and behavioral outcomes (Wald values ranged from 10.10-623.22; p < .001). Some findings support the cumulative risk model, indicating that exposure to multiple early adversities increases the likelihood of adverse outcomes. However, we also found that specific adversities, such as parental psychopathology, parental alcohol use, and neighborhood deprivation, uniquely impact adolescent outcomes. This study highlights the necessity for tailored interventions and policies to support children with distinct early life experiences, emphasizing the importance of addressing both cumulative and specific adversities at multiple levels to prevent psychosocial and behavioral problems in adolescence.

Sexual Abuse, Commercial Sexual Exploitation, and Cumulative Adversity Among Sexually Diverse and Non-Sexually Diverse Girls in the Juvenile Justice System

ABSTRACT Despite awareness about high rates of sexual abuse among girls in the juvenile justice system, little is known about the additional risk conferred upon sexually diverse (SD) youths, as well as the combined vulnerability of sexual abuse and commercial sexual exploitation of children (CSEC) – frequently a survival behavior amplifying disproportionate juvenile justice contact among SD and non-SD juvenile justice-involved (JJI) girls. In a sample of JJI-girls, we compared SD (n = 52) with non-SD (n = 46) JJI-girls on sexual victimization (e.g. sexual abuse occurring within different relationship-types, CSEC), and broader developmental adversity burden disadvantage (cumulative trauma/loss exposure-types) and distress (posttraumatic stress disorder [PTSD]; cumulative stressor-reactivity, grief-specific, and adversity-related symptoms), health distress/impairment, and sexual and physical health-risk indicators. While comparable on childhood sexual abuse frequency, SD JJI-girls reported greater cumulative sexual abuse severity across relationship-types, higher sexual abuse within non-familial contexts, and more CSEC involvement. They also reported more social determinants of health (e.g. trauma/loss exposure-types) and showed elevations on all health-risk indicators, and most cumulative adversity burden indicators, despite comparable PTSD severity. Our findings emphasize the need to consider multiple sexual victimization facets, including the combined vulnerability of sexual abuse and CSEC, and utilize cumulative developmental assessment approaches among youths vulnerable to maltreatment and exploitation.

Neural processing of audiovisual and painful analogue trauma and its relationship with subsequent audiovisual and pain intrusions

ABSTRACT Background: Posttraumatic stress disorder and medically unexplained pain frequently co-occur. While pain is common during traumatic events, the processing of pain during trauma and its relation to audiovisual and pain intrusions is poorly understood. Objective: Here we investigate neural activations during painful analogue trauma, focusing on areas that have been related to threat and pain processing, and how they predict intrusion formation. We also examine the moderating role of cumulative lifetime adversity. Methods: Sixty-five healthy women were assessed using functional magnetic resonance imaging. An analogue trauma was induced by an adaptation of the trauma-film paradigm extended by painful electrical stimulation in a 2 (film: aversive, neutral) x 2 (pain: pain, no-pain) design, followed by 7-day audiovisual and pain intrusion assessment using event-based ecological momentary assessment. Intrusions were fitted with Bayesian multilevel regression and a hurdle lognormal distribution. Results: Conjunction analysis confirmed a wide network including anterior insula (AI) and dorsal anterior cingulate cortex (dACC) being active both, during aversive films and pain. Pain resulted in activation in areas amongst posterior insula and deactivation in a network around ventromedial prefrontal cortex (VMPFC). Higher AI and dACC activity during aversive>neutral film predicted greater audiovisual intrusion probability over time and predicted greater audiovisual intrusion frequency particularly for participants with high lifetime adversity. Lower AI, dACC, hippocampus, and VMPFC activity during pain>no-pain predicted greater pain intrusion probability particularly for participants with high lifetime adversity. Weak regulatory VMPFC activation was associated with both increased audiovisual and pain intrusion frequency. Conclusions: Enhanced AI and dACC processing during aversive films, poor pain vs. no-pain discrimination in AI and dACC, as well as weak regulatory VMPFC processing may be driving factors for intrusion formation, particularly in combination with high lifetime adversity. Results shed light on a potential path for the etiology of PTSD and medically unexplained pain.

A - 56 Cumulative Childhood Adversity Is Linked with Reduced Cognitive Performance during Late Childhood to Adolescence

Abstract Objective History of adverse childhood experiences (ACEs) has been linked with poorer cognitive performance in young adulthood and cognitive decline in older adults; however, few studies have examined these relationships during childhood and adolescence, which are key periods for neurocognitive development. The current study investigated the longitudinal relationships between ACEs and cognitive performance during late childhood/adolescence. Method 10,827 participants (ages = 9–15.5 years old; 48% female) were included from the Adolescent Brain Cognitive Development Study. Cumulative ACE scores were created using annual parent and child reports of youth’s exposure to ACEs from baseline (ages 9–10) to Year 4 follow-up (ages 13–15). Cognitive performance was assessed using the NIH Toolbox (completed at baseline, Year 2, and Year 4). Separate linear mixed-effects models examined associations between ACEs and cognitive performance while accounting for time, age, sex assigned at birth, caregiver education, household income, pubertal status, internalizing and externalizing symptoms, and random effects of subject and family/twin status. Additional analyses tested for interactions with time. Results Greater ACEs were associated with poorer cognitive performance on tasks measuring verbal (p’s &amp;lt; 0.001) and visual (p &amp;lt; 0.001) memory, working memory (p = 0.01), cognitive flexibility (p = 0.004), processing speed (p &amp;lt; 0.001), and language (p’s &amp;lt; 0.001), above and beyond covariates. ACEs were not associated with attention (p = 0.09). Cognitive performance improved over time; however, compared to baseline, youth with greater ACE history at Year 4 demonstrated poorer attentional performance (p = 0.008). Conclusions Findings suggest that ACEs influence cognitive performance during key neurodevelopmental periods, and future work should assess clinical utility of targeted cognitive remediation in youth with adversity history.

Cumulative adversity and survival in the wild.

Protecting populations contending with co-occurring stressors requires a better understanding of how multiple early-life stressors affect the fitness of natural systems. However, the complexity of such research has limited its advancement and prevented us from answering new questions. In human studies, cumulative risk models predict adult health risk based on early adversity exposure. We apply a similar framework in wild yellow-bellied marmots (Marmota flaviventer). We tested cumulative adversity indices (CAIs) across different adversity types and time windows. All CAIs were associated with decreased pup survival and were well supported. Moderate and acute, but not standardized CAIs were associated with decreased lifespan, supporting the cumulative stress hypothesis and the endurance of early adversity. Multivariate models showed that differences in lifespan were driven by weaning date, precipitation, and maternal loss, but they performed poorly compared with CAI models. We highlight the development, utility, and insights of CAI approaches for ecology and conservation.

How immigration detention harms children: A conceptual framework to inform policy and practice.

This paper identifies the multiple adversities and trauma experienced by children who are detained after seeking asylum. A conceptual framework identifies the specific impact of immigration detention on the psychosocial development and mental health of refugee children that can inform policy and prevent additional migration-related trauma. The paper draws on international evidence about the impact of childhood adversity, challenges faced by all displaced children, and the additional negative consequences of immigration detention. It integrates socioecological, temporal, and relational approaches to identify the pathways through which detention of forcibly displaced children causes preventable harm. The public health and human rights implications are identified. The framework draws on Bronfenbrenner's socioecological model and has the child, their development, and experience at the center. Refugee children are exposed to cumulative adversity during displacement, flight, and resettlement. Immigration detention is associated with multiple additional adversities and human rights violations. International and national contexts and the detention environment impact on family functioning and directly on the child's well-being. Immigration detention is a preventable and profoundly negative reception experience for already vulnerable children. It is unavoidably associated with multiple additional adverse exposures with significant health and public health consequences. The proposed framework demonstrates adversity in each socioecological sphere of the detained child's life and across time. The framework can inform migration, child protection, and public health policy. Advocacy and political action to end this practice are urgently required to prevent further harm. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Episodic foresight, episodic memory, and executive functions in children engaged with Child Protective Services: The role of cumulative risk

Previous studies have determined that exposure to risk and adversities may impair children’s cognitive abilities. In particular, children engaged with Child Protective Services (CPS) seem to be at greater risk for enhanced detrimental effects resulting from the cumulative risk factors to which they are exposed. However, little is known about children’s future thinking when they face adverse circumstances, and it is not clear how the associations among episodic foresight abilities, episodic memory, and executive functions work with children under such circumstances. The current study describes the episodic foresight abilities of CPS-involved school-aged children, its association with other cognitive abilities, and how this association is affected by the exposure to cumulative risk and adversity factors. Episodic foresight, episodic memory, executive functions, and a composite of cumulative risk factors were analyzed in a sample of 95 school-aged children engaged with CPS in Portugal. Results suggest the detrimental effect of cumulative risk on the episodic foresight abilities of CPS-involved children. Episodic memory and cognitive flexibility were significant predictors of episodic foresight abilities, and cumulative risk exposure moderated the relation between episodic memory and episodic foresight. The current study provides a better understanding of the influences of multiple adversities on CPS-involved children’s episodic foresight abilities and related cognitive outcomes.

Can countries shape the association between cumulative adversity and old-age health?

The present study examined the relationships of Lifetime Cumulative Adversity (LCA) and country inequalities, as well as the interactions between them, with the self-rated health (SRH) in old age. Using data from the Survey of Health, Aging and Retirement in Europe (SHARE), the study regressed self-rated health on Lifetime Cumulative Adversity and country-level inequality indices across European countries in two points in time. The analysis also considered adversity-inequality interactions, controlling for confounders. The sample was comprised of 28,789 adults, aged 50 to 80, from 25 European countries and Israel. The findings pointed out that LCA is negatively associated with SRH, but democracy and welfare regimes modify the ill effects of LCA on health. These effects are reduced as the LCA level increases. The effects remained significant over two measurement time-points over three years, showing that life-course trajectories may be shaped by individual accumulated risk exposure to stress, along with inequalities at the society level. The study provides constructive and important guidance for decreasing the harmful effect of lifetime adversity in old age, by the modification of the country's welfare policies.

Children dually involved with statutory child protection and juvenile justice in Australia: A developmental cascade framework

Children who experience dual involvement by child protection and juvenile justice statutory systems have poorer life outcomes attributable to higher levels of disadvantage and more complex needs compared to single system involved children. Literature regarding dual involved children in high income, western, and democratic nations are largely based on US studies. Whilst child protection and juvenile justice systems across the United States, United Kingdom, Canada, New Zealand, and Australia have somewhat similar legislative systems, cohort outcomes and relationships between risk factors and offending trajectories for dual involved children are influenced by differing legislative, geographic, and demographic contexts. Compared to international literature, significant gaps exist regarding the Australian context. Further, within Australia, there are no evaluated specific responses and/or strategies directed towards supporting this highly vulnerable cohort towards increased long-term positive outcomes. This is the first comprehensive review of Australian studies that examines the characteristics of children who have had dual involvement with juvenile justice and child protection agencies within Australia. Using a thematic analysis twenty-five studies with dual involved samples were analysed, examining the individual, familial, environmental, and systemic factors that contribute to the likelihood of children becoming involved in both child protection and juvenile justice systems within Australia. Six thematic factors emerged that characterised the trajectories of dual involved children: cumulative and destabilising adversity; maltreatment timing and type; offending onset and context; educational disadvantage and disengagement; co-occurring challenges; and First Nations overrepresentation. Our findings are applied to Developmental Systems Theory, extending on previous literature to depict an Australian first developmental cascade framework illustrating the context specific pathways of dual involved children and opportunities for intervention in Australia. The discussion highlights and compares differences between Australian and international contexts with the intention of emphasising key areas for future research, and policy and practice reform. This is important because of the nuanced differences between dual involved characteristics across different legislative and geographic contexts, with particular relevance to the experiences of First Nations children and families. Future research, policy and practice would benefit from continued reforms that focus resources on co-ordinated system responses and cohort specific services; namely, culturally appropriate diversion strategies that promote behavioural de-escalation and educational engagement.

The role of social support in reducing the long-term burden of cumulative childhood adversity on adulthood internalising disorder

PurposePrevious research indicates that social support is protective for the mental health outcomes of exposure to childhood adversity. However, the impact of social support as a protective factor following exposure to cumulative childhood adversity is understudied with prospective longitudinal data. The aim of this present study was to examine how social support mediates the impact of cumulative exposure to childhood adversity on internalising disorder in adulthood.MethodsThe Christchurch Health and Development Study (CHDS) is a general population birth cohort, born in 1977 and representative of Christchurch, New Zealand at the time of the cohort members’ birth. The present study used a generalised estimating equations (GEE) framework to analyse direct associations between a cumulative measure of childhood adversity (CA) and internalising disorders (major depression, and any anxiety disorder), and indirect associations through social support.ResultsResults indicated a dose-dependent relationship between increased exposure to CA and worsened odds of a diagnosis for major depression and any anxiety disorder, respectively. There was also a significant mediating effect of social support on the direct associations between CA and both major depression (OR (95%CI) =0 .98 (0.97, 0.99), p < 001) and any anxiety disorder (OR (95%CI) = .98 (0.97, 0.99), p < 001).ConclusionThe findings indicate that social support reduces the impact of childhood adversity on adult mental health, and is therefore a target for future work examining potential interventions following CA.

Editorial perspective: protective factors following cumulative childhood adversity.

Adverse childhood experiences can have a significant impact on adult psychosocial outcomes. However, negative outcomes are not inevitable, and protective factors can interrupt the realisation of negative developmental trajectories and result in positive adaptation in spite of childhood adversity. Interventions that promote social support, encourage education and academic achievement, and address specific personality and dispositional factors are likely to beneficial for those with experience of childhood adversity. Holistic assessment that considers both neurodevelopmental conditions and trauma symptoms is also important for promoting resilience and avoiding assumptions that mental and behavioural problems in children with cumulative adversity are purely 'social'.

Pathways between adverse childhood experiences and viral suppression among male HIV-infected adolescents in South Africa

ABSTRACT Fewer adolescents achieve viral suppression compared to adults. One impediment may be a history of adverse childhood experiences (ACEs). To better develop targets and timeframes for intervention, this study created more robust estimates of the impact of cumulative adversity on viral suppression, tested whether the association is sensitive to the timing of adversity, and simultaneously tested several potential mechanisms. We focus on males, who have lower viral suppression than females and who may contribute to disproportionate incidence among young women. We recruited 251 male perinatally HIV-infected adolescents aged 15–19 from HIV clinics in Soweto, South Africa. Adversity was captured using the Adverse Childhood Experience – International Questionnaire (ACE-IQ). Viral load was measured using blood samples; viral suppression was defined as <20 copies/mL. Indicators of medication adherence, depression, post-traumatic stress disorder (, and substance misuse were captured. A series of pathway analysis were performed. Our sample experienced a median of 7 lifetime and 4 past-year adversities. Less than half (44%) exhibited viral suppression. Adversity demonstrated a significant association with suppression; depression mediated the association. Primary prevention of adversity among children living with HIV is paramount, as is addressing the subsequent mental and behavioral health challenges that impede viral suppression among adolescents.

Further exploring the impact of cumulative lifetime adversity on life satisfaction, psychological flourishing, and depressive symptoms

Current research provides conflicting views of the relationship between cumulative lifetime adversity and dispositional functioning. We examined this relationship in a sample of adults (N = 1009), conducting the analysis three ways: by utilizing a sum score of adversity across all ages; examining events that occurred before and after age 18 separately; and assessing this relationship using empirically-derived domains of adversity. Results indicate that the type of adversity has a unique impact on future well-being. These findings underscore that adversity’s unique impact on well-being is influenced by the way in which adversity is operationalized, more so than by the timing of adverse events. Results highlight the importance of clarifying the nuanced relationship between adverse life events and mental health in future research.

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

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

The longitudinal reciprocal association between depression and physical activity in old age: The role of lifetime cumulative adversity

ObjectiveThis study investigated the reciprocal nature of the depression–physical activity relationship with reference to lifetime cumulative adversity (LCA), over a period of 8 years across 5 time points in aging. MethodBased on data from the Survey of Health Ageing and Retirement in Europe (SHARE), the sample included 21,996 participants between the ages of 50 and 100 years (M = 65.5, SD = 9.1). The analysis was designed as a random intercept cross-lagged panel model. The trajectories measured were depression and physical activity. The independent variable, LCA, was created by the sum of stressful events, and the analyses controlled for background characteristics. ResultsThe findings revealed that physical activity significantly reduced the risk for depression at two time points along the study, whereas depression significantly reduced future physical activity during the entire period examined. Further, a higher level of LCA was associated with lower baseline levels of physical activity and higher levels of depression (β = −0.04, p < 0.001; β = 0.12, p < 0.001; respectively). ConclusionsThe results support a bidirectional relation between physical activity and depression, with stronger evidence for depression to physical activity. Interventions targeting the vulnerable population with a history of cumulative adversity, and utilizing techniques to mitigate depressive symptoms, may help to decrease the risk for physical inactivity and other health consequences in this population.

Adverse childhood experiences, mental illness, HIV and offending among female inmates in Durban, South Africa.

Childhood adversities and adult trauma are common among female inmates. Associations have been documented with childhood adversities and mental illness, personality disorders, human immunodeficiency virus (HIV) and violent offending. However, no such study had been conducted in South Africa (SA), despite the high prevalence of HIV and trauma in SA. To measure the prevalence of childhood adversities and adult trauma; and to determine if there is a relationship between childhood adversities, mental illness, personality disorders, HIV and violent offending among female inmates. The study was conducted at the largest correctional centre in Durban, KwaZulu-Natal, South Africa. This cross-sectional, descriptive study randomly recruited 126 female inmates. The World Health Organization's Adverse Childhood Experiences- International Questionnaire (WHO ACE-IQ) was used to measure childhood adversities; the Structured Clinical Interview for the Diagnostics and Statistical Manual-5 Research Version (SCID 5-RV) was used to diagnose mental illness; and a structured questionnaire was used to measure adult trauma. Human immunodeficiency virus data was confirmed from prison medical records. Elevated rates of individual childhood adversities and adult trauma were found. Associations were found between cumulative childhood adversities and post-traumatic stress disorder (PTSD), alcohol use disorder, substance use disorder, borderline personality disorder, and HIV. Female inmates are a highly traumatised population. Prison mental health services should provide trauma-informed and trauma-focussed care to improve inmates' mental health outcomes and decrease recidivism. This study contributes to the emerging literature on adverse childhood experiences (ACEs) and their associations among incarcerated female populations, in a low- and middle-income, South African setting.

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

Introduction: Adverse childhood experiences (ACEs) are linked to adult morbidity and mortality. However, it is unknown whether the patterning of adverse childhood experiences (ACEs), individually and in combination, confer health risk distinct from a cumulative adversity score. This study evaluates whether individual and comorbid ACE exposures within a cumulative risk score are equally associated with current smoking and lifetime history of depression. Methods: Cross-sectional analysis of ACE assessments in the Behavioral Risk Factor Surveillance System from 21 states in 2019 (n=115,183) and 23 states in 2020 (n=120,416). We modeled cumulative ACE scores and the 5 most common distinct ACE components that comprise a given ACE score, up to a cumulative score of 4. We compared ACE components, adjusted for covariates. Results: Across both samples 23% and 57-58% of persons reported 1 ACE or 2 or more ACEs, respectively. In 2019 smoking prevalence was 10.4% for persons reporting zero ACEs and 14.2% for persons reporting one ACE. When the single ACE was experiencing parental divorce, smoking was higher (16.6%) compared to when the single ACE 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 ACE, respectively, whereas it was 26.6% if the single ACE was living with a mentally ill household member and 11.0% when the ACE was experiencing parental divorce. This heterogeneity was replicated in 2020 data. Additional heterogeneity was observed for higher cumulative ACE scores. Conclusions: Cumulative ACE scores mask substantial health risk heterogeneity which can be delineated by examining distinct components of cumulative ACE scores.

Associations between Social Adversity and Biomarkers of Inflammation, Stress, and Aging in Children

BackgroundPrior work has found relationships between childhood social adversity and biomarkers of stress, but knowledge gaps remain. To help address these gaps, we explored associations between social adversity and biomarkers of inflammation (interleukin-1β [IL-1β], IL-6, IL-8, tumor necrosis factor-alpha [TNF-α], and salivary cytokine hierarchical “clusters” based on the three interleukins), neuroendocrine function (cortisol, cortisone, dehydroepiandrosterone, testosterone, and progesterone), neuromodulation (N-arachidonoylethanolamine, stearoylethanolamine, oleoylethanolamide, and palmitoylethanolamide), and epigenetic aging (Pediatric-Buccal-Epigenetic clock).MethodsWe collected biomarker samples of children ages 0–17 recruited from an acute care pediatrics clinic and examined their associations with caregiver-endorsed education, income, social risk factors, and cumulative adversity. We calculated regression-adjusted means for each biomarker and compared associations with social factors using Wald tests. We used logistic regression to predict being in the highest cytokine cluster based on social predictors.ResultsOur final sample included 537 children but varied based on each biomarker. Cumulative social adversity was significantly associated with having higher levels of all inflammatory markers and with cortisol, displaying a U-shaped distribution. There were no significant relationships between cumulative social adversity and cortisone, neuromodulation biomarkers or epigenetic aging.ConclusionOur findings support prior work suggesting that social stress exposures contribute to increased inflammation in children.ImpactOur study is one of the largest studies examining associations between childhood social adversity and biomarkers of inflammation, neuroendocrine function, neuromodulation, and epigenetic aging. It is one of the largest studies to link childhood social adversity to biomarkers of inflammation, and the first of which we are aware to link cumulative social adversity to cytokine clusters. It is also one of the largest studies to examine associations between steroids and epigenetic aging among children, and one of the only studies of which we are aware to examine associations between social adversity and endocannabinoids among children. Clinical Trial Registration: NCT02746393

“They had clothes on their back and they had food in their stomach, but they didn't have me”: The contribution of parental mental health problems, substance use, and domestic violence and abuse on young people and parents

BackgroundThe parental risk factors of mental health problems, substance use, and domestic violence and abuse each individually negatively impacts children's health and developmental outcomes. Few studies have considered the lived experience and support needs of parents and children in the real-world situation where these common risks cluster. ObjectiveThis study explores parents' and young people's lived experiences of the clustering of parental mental health problems, parental substance use, and domestic violence and abuse. MethodsSemi-structured interviews were conducted with 18 mothers, 6 fathers, and 7 young people with experiences of these parental risk factors. Transcribed interviews were analysed using reflexive thematic analysis. ResultsFour themes were developed, 1) cumulative adversity, 2) the impact of syndemic risk, 3) families navigating risk, and 4) family support. Parents and young people described family situations of stress wherein they experienced cumulative impact of multiple parental risk factors. Parents sought to navigate stressors and parent in positive ways under challenging conditions, often impeded by their own childhood trauma and diminished confidence. Parents and young people spoke of the need for, and benefits of having, support; both as a family and as individuals, to successfully address this trio of parental risks and the related impact. ConclusionsThis study highlights the high level of stress families experience and the efforts they go to mitigate risk. Services and interventions need to reflect the complexity of multiple needs and consider both the whole family and individuals when providing support.