Events In Children Research Articles

Economic Burden of Health Conditions Associated With Adverse Childhood Experiences Among US Adults

Adverse childhood experiences (ACEs) are preventable, potentially traumatic events in childhood, such as experiencing abuse or neglect, witnessing violence, or living in a household with substance use disorder, mental health problems, or instability from parental separation or incarceration. Adults who had ACEs have more harmful risk behaviors and worse health outcomes; the economic burden associated with these issues is uncertain. To estimate the economic burden of ACE-associated health conditions among US adults. In this economic evaluation, regression models of cross-sectional survey data from the 2019-2020 Behavioral Risk Factor Surveillance System (BRFSS) and previous studies were used to estimate ACE population-attributable fractions (PAFs) (ie, the fraction of total cases associated with a specific exposure) for selected health outcomes (anxiety, arthritis, asthma, cancer, chronic obstructive pulmonary disease, depression, diabetes, heart disease, kidney disease, stroke, and violence) and risk factors (heavy drinking, illicit drug use, overweight and obesity, and smoking) among the 2019 US adult population. Adverse childhood experience PAFs were used to calculate the proportion of total condition-specific medical spending and lost healthy life-years related to ACEs using Global Burden of Disease Study data. Data analysis was performed from September 10, 2021, to November 29, 2022. Adverse childhood experiences (age <18 years). Monetary valuation of ACE-associated morbidity and mortality using standard US value of statistical life methods and presented in terms of annual and lifetime per affected person and total population estimates at the national and state levels. A total of 820 673 adults, representing 255 million individuals, participated in the BRFSS in 2019 and 2020. An estimated 160 million of the total 255 million US adult population (63%) had 1 or more ACE, associated with an annual economic burden of $14.1 trillion ($183 billion in direct medical spending and $13.9 trillion in lost healthy life-years). This was $88 000 per affected adult annually and $2.4 million over their lifetimes. The lifetime economic burden per affected adult was lowest in North Dakota ($1.3 million) and highest in Arkansas ($4.3 million). Twenty-two percent of adults had 4 or more ACEs and comprised 58% of the total economic burden-the estimated per person lifetime economic burden for those adults was $4.0 million. In this cross-sectional analysis of the US adult population, the economic burden of ACE-related health conditions was substantial. The findings suggest that measuring the economic burden of ACEs can support decision-making about investing in strategies to improve population health.

Association between childhood experiences and mental health in later‐life: Findings from the National Social life, Health, and Aging Project

AbstractBackgroundMiddle age is the central period of life, and it is a time when people face various mental health problems. It has been reported that the experience of childhood has a lifelong effect on mental health in middle age. However, research on positive childhood effects is insufficient, compared to negative childhood.ObjectivesTo investigate associations between childhood experiences and a latent construct of mental health in midlife adults.MethodsThe participants included 770 adults aged 50‐64 who retrospectively reported childhood events, including family life happiness, parent’s education, family’s financial status, childhood health status, family structure, experience of violence, and witness of violence. Second‐order structural equation modelling was used with mental health modelled as a second‐order latent variable with depression, anxiety, loneliness, and stress as first‐order components.ResultsThe study found that family life happiness and healthy childhood were associated with better mental health of midlife, in both the crude (β = −.221, p &lt; 0.001; β = −.201, p &lt; 0.01) and adjusted models (β = −0.128, p &lt; 0.001; β = −0.095, p &lt; 0.05).ConclusionThis is the first study confirming the associations of family life happiness and childhood health with mental health of midlife using second‐order structural equation modeling. Future work would benefit from a prospective investigation of these associations. Keywords:Mental health, Midlife, Childhood, Second‐order structural equation model

P28: Early adverse events and loneliness among older people with depression

Object:Loneliness is experienced by many older people and associated with depressive symptoms. Childhood adverse events have been found to be a predictor of loneliness in young adults. We would like to investigate whether childhood traumatic events are associated with loneliness in older people with depression. We also explored what kinds of traumatic events are more related to loneliness and whether family support will modify the association of interest.Methods:Older adults (≧60 years) with history of major depressive disorder were enrolled from outpatient clinics. Participants cannot be diagnosed as dementia. They received a series of questionnaires, including cumulative illness rating scales, Hamilton depressive and anxiety rating scales (HDRS and HARS), Geriatric depression scale(GDS), Childhood Trauma Questionnaire(CTQ), Chinese version of the family adaptation, partnership, growth, affection and resolve(APGAR), and Mini-mental status examination.Results:Fifty-four participants were enrolled. The average age was 68.8 years and female predominance (83.7%) with mean educational year of 10.4. Univariate analysis was performed first using LS score as dependent variable, and only those variables with p value less than 0.2 were put into multiple linear regression. In the multiple regression model, age, gender, education, GDS, HDAS were entered as covariates and CTQ was treated as independent variable. The results showed that CTQ score was positively associated with LS (ß=0.565, p&lt;0.001). The family support, presented as APGAR score, was not modified the results. In the explore analysis, physical neglect, emotional abuse, emotional neglect also showed positively associated with loneliness in the participants; however, physical abuse and sexual abuse did not have the same findings.Conclusion:Childhood adverse events may be positively associated with loneliness in older people with depressive disorder after adjusting for confounders. We should pay more attention on the childhood traumatic events in these patients. In addition, physical neglect, emotional abuse, emotional neglect rather than physical abuse and sexual abuse seemed to have more impact on the loneliness in these participants. However, some limitations, such as small sample size, recall bias of childhood events, difficulty of recall physical and sexual abuse, and other latent confounders, should be considered before making a final conclusion.

Neighborhood Disadvantage Increases Risk of Adverse Clinical Events in Children with Sickle Cell Disease

Background: Hydroxyurea is the most widely used pharmacologic agent to treat patients with sickle cell disease (SCD). Hydroxyurea treatment has well established effects of inducing expression of fetal hemoglobin (HbF) and a beneficial impact on clinical outcomes such as reduced number of vaso-occlusive (VOC) events, transfusions, and hospitalizations. In non-SCD populations, living in socio-economic disadvantage is a well-established factor for poor health outcomes. However, there is a paucity of data to describe how social stressors impact children with SCD. We hypothesized that socio-economic disadvantage impacts risk of adverse clinical outcomes in pediatric SCD patients even while on hydroxyurea therapy. Methods: We performed a retrospective chart review on 121 pediatric patients with severe SCD genotypes (homozygous HbS and sickle-beta 0 thalassemia) seen at Texas Children's Hospital (TCH) between 2010-2021. All patients were treated with hydroxyurea for a minimum of five years. Adherence to hydroxyurea was assessed through lab markers including absolute neutrophil count and reticulocyte counts. Patients not adherent were excluded from analysis. We examined the incidence of all clinical events for a total of 1026 patient years, including the number of office visits, ER visits, hospitalizations, transfusions, VOC, acute chest syndrome episodes (ACS), acute splenic sequestration (ASS), and febrile illness. We collected laboratory data including absolute neutrophil count, hemoglobin level, and HbF levels for each patient per year they were on hydroxyurea. We used the area deprivation index (ADI) to determine a score of neighborhood disadvantage amongst our cohort of patients. The ADI is a factor-based index which uses 17 US Census variables including poverty, education, and employment. We used individual residential addresses during our observation period to assign a geocode specific to each individual and obtain an ADI score. The ADI scores are ranked from 1-10, with higher ADI rankings reflecting a higher level of disadvantage. Results: All individuals with SCD had a robust response to hydroxyurea within their first year of initiating the drug (&amp;gt;20% HbF). We stratified our cohort based on their ADI scores into low ADI (1-3; n=42); medium ADI (4-6; n=42); and high ADI groups (7-10; n=37), where high ADI is the group with highest levels of disadvantage. All three groups had a similar average duration of hydroxyurea treatment. There were no significant differences in age, sex, or reason given for starting hydroxyurea between the ADI groups. When we examined hydroxyurea response, there was no significant difference in HbF levels at 1 year (23.8 vs. 24.06 %HbF in the low vs. high ADI groups) or after 5 years (19.6 vs. 18.6 % HbF in the low and high ADI groups). Individuals with high ADI did started hydroxyurea at a younger age (2.9 years vs. 4.9 years, p=0.02). We found that any individual living in an area with higher ADI had an increased incidence of adverse clinical events. We calculated the incidence of each clinical event per 100 patient years in our 3 ADI groups and used a conditional maximum likelihood estimate of rate ratio method to compare incidences (Table 1). We found that among individuals living in an area with a higher ADI (more deprived region), there was increased frequency of ER visits, hospitalizations, transfusions, VOC, and ASS. In particular, patients with the highest ADI had a 3 and 5 times higher rate of VOC and ASS, respectively (Table 1). Discussion: While we did not observe an association between ADI and HbF expression, our results show that higher neighborhood disadvantage is associated with poorer clinical outcomes among hydroxyurea-adherent pediatric patients with SCD who maintained a robust response to the drug (&amp;gt;20% HbF). All individuals in our study had a similar number of routine office visits at our clinic but any patient living in an area of high ADI had significantly more ER visits and hospitalizations for VOC and ASS events. While hydroxyurea is shown to reduce hospitalizations and VOC events in pediatric sickle cell patients, we show that neighborhood disadvantage can influence clinical outcomes even among patients who respond to hydroxyurea. More analysis remains in order to better characterize this association, and to understand additional strategies that can be used to reduce clinical events in pediatric patients of lower socioeconomic status.

The Optimal Threshold for Hemoglobin S Percent Level While Performing Regular Blood Transfusion Therapy to Prevent Severe Vaso-Occlusive Pain Events in Children with Sickle Cell Anemia: A Secondary Data Analysis of Participants in the SIT Trial

Introduction: Children with sickle cell disease (SCD) often experience frequent severe acute vaso-occlusive pain events, unresponsive to FDA-approved therapies (hydroxyurea, L-glutamine, crizanlizumab) to decrease the severe acute vaso-occlusive pain event incidence rate. The ASH guidelines for pain management recommend regular blood transfusion therapy after FDA-approved therapies have failed to decrease the high rate of severe acute vaso-occlusive pain events ( The Journal of Pediatrics, 139(6), 785-789). However, unlike regular blood transfusion therapy for primary and secondary stroke prevention, for which the goal hemoglobin S (Hb S) level is ≤ 30% , no optimal Hb S threshold has been established to attenuate the severe acute vaso-occlusive pain event incidence rate. We tested the hypothesis that among children receiving regular blood transfusion therapy with a goal to keep the mean hemoglobin S level &amp;lt; 30%, participants that achieved a mean Hb S level &amp;lt; 30% would have lower rates of severe acute vaso-occlusive pain events requiring hospitalization than children regularly transfused with mean Hb S level &amp;gt; 30%. Evidence to support our hypothesis would provide the first evidence-based guidelines for the optimal hemoglobin S threshold to decrease the acute vaso-occlusive pain event incidence rate in children with sickle cell anemia (HbSS). Methods: The SIT trial was a single-blind clinical trial( Blood Advances, 4(12), 2656-2701), where participants were children with sickle cell anemia randomly allocated to receive regular blood transfusion therapy (transfusion group) or standard care (observation group). Participants receiving regular blood transfusion therapy from the SIT Trial were included in the secondary analysis. Eligibility criteria include participants between 5 and 15 years of age, with no history of stroke, one or more silent cerebral infarcts on magnetic resonance imaging, and a neurologic examination showing no abnormalities. The transfusion therapy goal was to keep the maximum Hb S level &amp;lt; 30%. For the ancillary study, participants were included only in the transfusion arm of the trial. The primary endpoint of this ancillary study was the incidence rate of hospitalization for vaso-occlusive pain episodes among those receiving only regular blood transfusion therapy. We conducted a zero-inflated negative binomial regression analysis to determine the association between the incidence rate for severe acute vaso-occlusive pain events requiring hospitalization and independent covariates, including age at the time of random allocation, sex, and mean hemoglobin S level (&amp;lt; 30% and &amp;gt; 30%). Results: A total of 90 participants received regular blood transfusion therapy in the SIT trial. Among participants transfused, 53 and 37 individuals had a mean Hb S level of &amp;lt; 30% and &amp;gt; 30%, respectively. The median time on transfusions for the groups with Hb S levels of &amp;lt; 30% and &amp;gt; 30% was 2.9 years for both groups. Among the participants, 10.8% (4/37) who had a mean Hb S &amp;lt; 30% and 20.8% (11/53) of those with a mean Hb S &amp;gt; 30% experienced at least one hospitalization for a severe acute vaso-occlusive pain event. The mean hemoglobin S levels in the &amp;lt; 30% and &amp;gt; 30% groups were 25.4% and 37.5%, respectively. The mean hospital rates for severe acute vaso-occlusive pain events in the two groups &amp;lt; 30% and &amp;gt;30% were 9.4 (95% confidence interval 9.4 - 17.2 person-years) and 29.2 per 100 person-years (95% confidence interval, 21.0 - 39.5 person-years), respectively, P = 0.078. In the multivariable analysis, the incidence rate ratio for severe acute vaso-occlusive pain events showed that there was no statistical difference between those with a mean Hb S level in groups &amp;lt; 30% and &amp;gt; 30%, 0.65; P=0.43. Children with a higher baseline hemoglobin level were more likely to achieve a mean hemoglobin S level &amp;lt; 30%. Conclusion: In children with sickle cell anemia, receiving regular blood transfusion therapy with the goal of keeping the mean hemoglobin S level &amp;lt; 30%, achieving a mean hemoglobin S level &amp;gt; 30% was as effective as a mean hemoglobin S level &amp;lt; 30 % in decreasing the incidence rate of severe acute vaso-occlusive pain events requiring hospitalization. Further studies are warranted to identify reliable measures of the efficacy of regular blood transfusion therapy for the reduction of acute vaso-occlusive pain events.

Childhood, adulthood, and cumulative traumatic events experienced from childhood to adulthood and dementia risk: a population-based cohort study

Childhood, adulthood, and cumulative traumatic events experienced from childhood to adulthood and dementia risk: a population-based cohort study

Predicting Obsessive-Compulsive Disorder Events in Children and Adolescents in the Wild using a Wearable Biosensor (Wrist Angel): Protocol for the Analysis Plan of a Nonrandomized Pilot Study.

Physiological signals such as heart rate and electrodermal activity can provide insight into an individual's mental state, which are invaluable information for mental health care. Using recordings of physiological signals from wearable devices in the wild can facilitate objective monitoring of symptom severity and evaluation of treatment progress. We designed a study to evaluate the feasibility of predicting obsessive-compulsive disorder (OCD) events from physiological signals recorded using wrist-worn devices in the wild. Here, we present an analysis plan for the study to document our a priori hypotheses and increase the robustness of the findings of our planned study. In total, 18 children and adolescents aged between 8 and 16 years were included in this study. Nine outpatients with an OCD diagnosis were recruited from a child and adolescent mental health center. Nine youths without a psychiatric diagnosis were recruited from the catchment area. Patients completed a clinical interview to assess OCD severity, types of OCD, and number of OCD symptoms in the clinic. Participants wore a biosensor on their wrist for up to 8 weeks in their everyday lives. Patients were asked to press an event tag button on the biosensor when they were stressed by OCD symptoms. Participants without a psychiatric diagnosis were asked to press this button whenever they felt really scared. Before and after the 8-week observation period, participants wore the biosensor under controlled conditions of rest and stress in the clinic. Features are extracted from 4 different physiological signals within sliding windows to predict the distress event logged by participants during data collection. We will test the prediction models within participants across time and multiple participants. Model selection and estimation using 2-layer cross-validation are outlined for both scenarios. Participants were included between December 2021 and December 2022. Participants included 10 female and 8 male participants with an even sex distribution between groups. Patients were aged between 10 and 16 years, and adolescents without a psychiatric diagnosis were between the ages of 8 and 16 years. Most patients had moderate to moderate to severe OCD, except for 1 patient with mild OCD. The strength of the planned study is the investigation of predictions of OCD events in the wild. Major challenges of the study are the inherent noise of in-the-wild data and the lack of contextual knowledge associated with the recorded signals. This preregistered analysis plan discusses in detail how we plan to address these challenges and may help reduce interpretation bias of the upcoming results. If the obtained results from this study are promising, we will be closer to automated detection of OCD events outside of clinical experiments. This is an important tool for the assessment and treatment of OCD in youth. ClinicalTrials.gov NCT05064527; https://clinicaltrials.gov/study/NCT05064527. DERR1-10.2196/48571.

Validation and measurement invariance of the childhood trauma questionnaire short form among incarcerated men and women in Spain

BackgroundChildhood trauma is highly prevalent among incarcerated individuals and contributes to a range of negative outcomes. Assessing traumatic childhood events in prison settings requires valid, reliable, and effective instruments. Objectives and methodsThis study evaluated the performance of the Childhood Trauma Questionnaire - Short Form (CTQ-SF), originally developed and validated in English, within a sample of incarcerated men and women (n = 1118 and n = 207, respectively) in six Spanish prisons. ResultsThe results indicated that the CTQ-SF had an acceptable fit in our sample. However, the internal consistency of the Physical Neglect subscale was found to be deficient (α = 0.57), especially among women (α = 0.43). This finding aligns with previous research across different contexts, which may signal weaknesses in the original construction of this subscale. The CTQ-SF demonstrated limited invariance between men and women, with only configural invariance being achieved, constraining the comparisons that can be made across sexes. In the absence of scalar invariance, comparisons of factor means to assess severity may be misleading, and caution is recommended when comparing prevalence estimates for men and women in Spanish prisons. Nonetheless, our findings support the convergent validity of the CTQ-SF, as trauma severity showed moderate correlations with depression, anxiety, stress, and aggression. ConclusionsThese results underscore the importance of evaluating the performance of instruments across various cultural contexts and populations to ensure the validity of study conclusions.

Abstract 18157: Temporal Trends in Sex-Related Risk of Cardiac Events in Children With Congenital Long-QT Syndrome

Introduction: Unexplained male predominance during childhood until puberty is observed in long-QT syndrome (LQTS). As cardiac events in LQTS have been linked to the degree of physical activity, we hypothesized that the sex differential previously described may be attenuated by temporal trends in the level of activity in males and females with LQTS during childhood. Methods: The study population comprised 1,356 patients from the Rochester LQTS Registry with LQTS Types 1, 2, or 3 (genetically confirmed or retrospectively identified phenotype positive family members of a genotype positive subject) with follow-up from birth through 14 years. Based on their year of birth, patients were divided into 3 groups by vicennium: 1960-1979, 1980-1999, and 2000-2021. The primary endpoint was a CE defined as nonfatal cardiac arrest, unexplained sudden death, appropriate implantable cardioverter defibrillator shock, or syncope. The age-related incidence of a first CE in each vicennium, with birth used as the time of origin, was determined by the Kaplan-Meier method. The hazard ratio (HR) of experiencing a first CE by sex was calculated using multivariate Cox-regression analysis. Results: In the 1960-1979 cohort the incidence of first CE at age 14 was 28% versus (vs) 14% in boys vs girls, respectively (p&lt;0.001 for the overall difference during follow-up [Figure left panel]). This difference was attenuated in the 1980-1999 cohort as the incidence was 30% vs 25% in boys vs girls, respectively (p=0.150 for the overall difference during follow-up [Figure center panel]). In the 2000-2021 cohort, event rates were lower and the incidence of a CE was similar in both boys and girls (18%; Figure right panel). The HRs for boys vs girls were 2.31 (p&lt;0.001), 1.07 (p=0.684), and 0.95 (p=0.880) in the first, second, and third vicennium, respectively. Conclusions: The strength of sex as a risk factor for cardiac events appears attenuated in contemporary populations of children with LQTS.

Adverse Childhood Experiences and Electronic Cigarette Use among U.S. Young Adults.

(1) Background: Adverse childhood experiences (ACEs), which are potentially traumatic childhood events, have been associated with increased tobacco product use. Less is known about electronic cigarette (e-cigarette) use during young adulthood. This study explored the associations between ACEs and current e-cigarette use among U.S. young adults. (2) Methods: This study was a secondary analysis of 2021 Behavioral Risk Factor Surveillance System data including 2537 young adults aged 18-24 years. Unadjusted and adjusted logistic regression analyses were conducted. (3) Results: Of the participants, 19.2% currently used e-cigarettes, and 22.1% reported 1 ACE, 13.0% reported 2 ACEs, 10.7% reported 3 ACEs, and 30.6% reported ≥4 ACEs. Unadjusted results indicated that participants who experienced 1 ACE (odds ratio (OR) = 1.76, 95% confidence interval (CI) = 1.01-3.07), 2 ACEs (OR = 2.18, 95%CI = 1.24-3.83), 3 ACEs (OR = 2.63, 95%CI = 1.41-4.90), and ≥4 ACEs (OR = 3.69, 95%CI = 2.23-6.09) were at increased odds of reporting current e-cigarette use than participants who experienced 0 ACEs. Adjusted results indicated that participants who experienced 3 ACEs were at 2.20 times higher odds (95%CI = 1.15-4.23) and participants who experienced ≥4 ACEs were at 2.73 times higher odds (95%CI = 1.58-4.71) of reporting current e-cigarette use than participants who experienced 0 ACEs. (4) Conclusions: Young adults exposed to ACEs are at risk of using e-cigarettes.

Childhood emotional abuse and gamebullying among Chinese youths: The mediating roles of mindfulness and Machiavellianism

This study investigated the relationship between childhood emotional abuse and gamebullying among youths, and the roles of mindfulness and Machiavellianism in that relationship. The study sample comprised 504 Chinese youths (female = 51.2%) who completed the Childhood Emotional Abuse Scale, Gamebullying Scale, Mindful Attention Awareness Scale, and Machiavellianism Scale. Path analysis results indicated a history of childhood emotional abuse to predict gamebullying. Mindfulness mediated the relationship with childhood emotional abuse to predict gamebullying to be lower. Machiavellianism mediated the relationship between childhood emotional abuse and gamebullying to be higher. In our sample, demographic variables, including gender and education, did not predict gamebullying. Younger youths had lower levels of gamebullying than older youths. These findings indicate a need to reduce gamebullying among youths with a history of adverse childhood events. Mindfulness healing can be used to lower the negative effects of gamebullying.

International evidence on lived experiences of trauma during homelessness and effects on mental health including substance use: a co-produced qualitative systematic review

BackgroundTrauma is an experience (physical or emotional) that is life-threatening, harmful, or out of the ordinary and has lasting effects on mental health and wellbeing. Much of the information about trauma within homeless populations focuses on events in childhood. Using coproduction principles, we aimed to synthesise qualitative evidence exploring the impact of trauma during adulthood homelessness on mental health, including substance use. MethodsIn this qualitative systematic review, we searched ASSIA, CINAHL, Cochrane, EMBASE, MEDLINE, Proquest theses and dissertations, PsychInfo, Scopus, and Web of Science for studies published from inception until Sept 6, 2022, alongside grey literature from relevant websites. Search terms were developed based on the PICO framework. No language, date, or geographical limits were applied. Any qualitative research reporting experiences of trauma and its impact on mental health during homelessness in adults was eligible. We extracted relevant data (eg, methodology, sample characteristics, homelessness, and findings). People with lived experience of homelessness were provided with bespoke training by the lead researcher. They contributed to refining the review aims, screening, coding, and theme development. Quality was assessed using the CASP Qualitative Studies Checklist. FindingsWe included 26 qualitative papers, including 876 adults experiencing homelessness between ages 18 and 70 years (448 [51%] women and 428 [49%] men). All papers focused on urban settings. Eight papers were from the USA, five from Canada, four from the UK and Australia, three from Brazil, and one from Ethiopia and Iran. A framework synthesis of these 26 papers identified three preliminary themes. People experiencing homelessness make sense of trauma in three ways: internalised understanding, relationality to others, and with a survival lens. Coping strategies for managing feelings of fear, anxiety, and depression included substance use, self-rationalisation, and strategies to feel safe. Finally, when people experienced repeated trauma, they became either dissociated, and accepted their situation, or resilient, wishing to change their circumstances. InterpretationFurther evidence is needed in rural or coastal regions, where people experiencing homelessness may face greater isolation. Trauma rarely takes place in isolation, and often previous experiences of trauma shape how people experiencing homelessness make sense of trauma and cope with it. Support to address coping with the effects of trauma should focus on ensuring people do not become desensitised and prevent deterioration of mental health and substance use. The strength of this review is its coproduction with people with lived experience. Single person data extraction with secondary checks was a limitation. FundingNational Institute for Health and Care Research (NIHR) School for Primary Care Research as part of the Three NIHR Research Schools Mental Health Programme.

Childhood trauma and bipolar affective disorder: Is there a linkage?

Bipolar affective disorder (BPAD) is a major psychiatric illness impairing the quality of life. The etiology of BPAD is influenced by different factors possibly related to gene-environment interactions. Approximately 30% to 50% of individuals with BPAD have experienced some traumatic event in childhood. Serious adverse experiences that children may suffer early in life are often described as childhood trauma (CT). It includes physical, emotional, and sexual abuse and physical and emotional neglect. CT is linked with an elevated risk of developing BPAD. Childhood adversities play a role in modulating the early onset of illness, increased number of depressive episodes, increased suicide attempts, and other clinical severity of BPAD. Hospital-based studies comprising heterogeneous populations had researched the specific role of each trauma subtype as a predisposing factor for BPAD. Identifying and addressing CT through early intervention methods may prevent the future development of chronic disorders like BPAD. This review article is an attempt to explore and highlight the existing literature regarding the association of different subtypes of CT with BPAD.

Towards a relational/compassionate Gestalt understanding of trauma and addiction

"Abstract Traumatic childhood and life events shape how individuals see themselves and the world. When there is a lack of a caring, supportive other to help nurture and process the pain, the wounds of this initial trauma and the various ways of managing the aftermath can become fixed and directly impact relationships, self-perception, coping skills, self-esteem, etc. (Kepner, 2013; Maté, 2010; Taylor, 2014; Van der Kolk, 2015). Unfortunately, a common and initially effective way of managing the impact of trauma and adjusting to the world is through addictive behaviours (Brownell, 2012; Clemmens &amp; Matzko, 2004; Maté, 2010; Matzko, 1997; Pintus, 2017). Such behaviours provide temporary relief and anaesthetise emotional and relational pain. The goal of addiction is to push us away from experiencing unpleasantness, and it briefly allows problems, challenges and discomfort to melt away. Initially, this can be a functional, creative adjustment that helps the individual survive and find a place to belong. Painful experiences can heal through a nurturing, empathetic relationship. However, without a caring other, trauma and addiction become linked and intertwined. Keywords trauma, relational Gestalt, compassion, addiction, creative adjustment, hope, healing"

Experiences of gender-responsive trauma-informed care among female youth in deep-end residential group care facilities

Over the past two decades, research on trauma and adversity and the implementation of trauma-informed care (TIC) has become established in social work, psychiatry, and other helping professions. Girls assigned to restricted out-of-home placements by legal order who use social services frequently have a history of childhood trauma. Whereas the extant literature has examined gender-responsive TIC among victimized women, it has barely addressed educational-rehabilitative work with girls placed in deep-end juvenile facilities. The present study aims to fill this gap by responsive gender-responsive practices of a unique gender-responsive and trauma-informed placement for adolescent girls.The research method was based on threefold database including observations, semi-structured interviews with girls and staff, and drawing data from ongoing documentation of the work in the placement as was documented by the staff.Findings refine eight principles of gender-responsive TIC: relationships, safety, empowerment and voice, trustworthiness, and transparency, perceiving maladaptive behaviors as useful survival skills, peer support, removing social barriers, and reducing re-traumatization.The article proposes a framework set of principles for gender-responsive trauma-informed care and discusses theoretical and practical implementations that are essential for future policies regarding professional work with adolescent girls in deep-end placements. Discussion rises the need for a new refining of guidelines coherent and holistic model for creating gender-sensitive trauma-informed care when working with adolescent girls who experienced adverse childhood events. Studies using controlled designs might examine the effects of such a framework by developing guidelines and action principles as a basis for fostering standardized training for professionals who work with adolescent girls in extreme social exclusion.

Early life factors and grip strength at older ages in two distinct populations in China and England

Abstract Background Early life factors are associated with poor physical and mental outcomes in late life. However how these are associated with grip strength, an objective measure of physical capacity and therefore morbidity and mortality in late life unclear. This analysis therefor explores the long-term effects of adverse childhood socioeconomic experiences and health on grip strength in late life, and how these are mediated by adult factors. Methods Data on early life events, health and socioeconomic factors and grip strength were collected from the China Health and Retirement Longitudinal Study (CHARLS) and English Longitudinal Study of Ageing (ELSA). Participants’ first entry into the survey from waves 1-3 in CHARLS and waves 1-9 in ELSA were included in the analysis. Sex stratified linear regression models were used to explore how early life factors affect grip strength. Childhood events included parental socioeconomic position and childhood health. Results 17,205 participants from CHARLS and 6,692 participants from ELSA were included in this analysis. Unlike ELSA, participants from CHARLS were younger, had lower education, low-income occupation and obese. Low parental education and poor child health perception were negatively associated with grip strength even after controlling for childhood and adult factors (adult socioeconomic position, adult body size, adult health and lifestyle) in men from both studies. While parental occupation was associated with grip strength for both males and females in both studies. Association of SEP and health in childhood with grip strengths at older ages were however explained by body size and adult health factors, and not adult SEP. Key messages • Early life socioeconomic position has a persistent effect of late physical health, even after considering adult health, socioeconomic position and lifestyle. • Early intervention in socioeconomic inequalities might improve health outcomes across the life course.

O018 Improvement in Obstructive Sleep Apnoea Improves Heart Rate response to Obstructive Respiratory events in Children with Down syndrome.

Abstract Background Children with Down syndrome (DS) have a much higher predisposition to obstructive sleep apnoea (OSA) compared to typically developing (TD) children. Children with DS have a lower heart rate (HR) response to respiratory event termination compared with TD children matched for age, sex and OSA severity, but the effect of improvement in OSA severity over time or with treatment is unknown. We compared the HR surge at event termination in children with DS with improved OSA to those with unimproved OSA 2 y following baseline study. Methods 24 children (3-19 y at baseline) were included. Children were grouped into Improved (decrease in obstructive apnoea hypopnoea index (OAHI) to ≤ 50% of baseline OAHI; n=12; 7 treated between studies) and Unimproved (n=12; 2 treated between studies). Beat-to-beat HR was averaged 10s before (pre), during and the peak after (post) each obstructive event during sleep, and expressed as percentage change. Results 583 obstructive events at baseline and 435 at follow up were identified. % change in HR from during the event to post event was greater at follow up (mean±sem, 22.4%±0.9%) than baseline (19.0%±0.8%; p&amp;lt;0.01) in the improved group, but reduced at follow up (16.8%±1.1%) compared with baseline (21.1%±0.7%; p&amp;lt;0.001) in the unimproved group and was greater at follow up in the improved group than in the unimproved group (p&amp;lt;0.001). Conclusion These results suggest that the dampened HR response to events seen in DS is reversible, adding weight to the need for diagnosis and management of OSA in this population.

Childhood life events of women enrolled in the Avon Longitudinal Study of Parents &amp; Children (ALSPAC)

At the time of planning ALSPAC there was accumulating evidence that abuse and other childhood traumas were related to psychiatric problems later in life. In addition, the age at which such trauma occurred was likely to be important in influencing its long-term impact. Detailed data was therefore collected from enrolled women on traumatic events occurring during their own childhoods, along with their age at the time. The questionnaire entitled ‘About Yourself’ was sent out to expectant women who had enrolled in the study, which included a page in the form of a grid (an events diary) with one row per year of childhood and columns for recording where she was living at the time, who was looking after her, and any traumatic events that occurred. These free-text responses were then coded, and any events were assigned a score indicating the level of trauma the event was likely to have caused on a scale of 1 (highly traumatic) to 6 (least traumatic). This paper describes the variety of text data collected and how it was coded. The ALSPAC study has a great deal of follow-up data collected on the original respondents, as well as on their parents and grandparents, partners, offspring and their grandchildren, providing huge potential for analyses on the antecedents and outcomes of adverse childhood events across multiple generations.

B - 58 Cognitive Emotion Regulation as a Mediator between Childhood Trauma and Parenting Stress.

Determine the relationship between adverse childhood events (ACE), emotion regulation (ER) during the perinatal period, and parenting stress. Pregnant individuals were recruited through an electronic medical record database and word of mouth as part of the COVID-19 and Perinatal Experiences Study to complete online surveys about their experiences during the COVID-19 pandemic. Longitudinal data were collected from 349 participants from pregnancy through 12months postpartum. A structural equation modeling approach was utilized to assess ACEs and ER's direct and indirect effects on parenting stress. A path mediation model was utilized. Models were estimated using Mplus 8.8. Missing data were handled using full information maximum likelihood. Latent factors of cognitive reappraisal (CR) and expressive suppression were independently modeled as the mediators between ACES and parenting stress. The expressive suppression model showed good fit (CFI = 0.982; TLI = 0.966; SRMR = 0.039), and the CR model showed adequate fit (CFI = 0.911; TLI = 0.86; SRMR = 0.047). There was a significant positive effect of ACEs on expressive suppression (β= 0.104, 95% CI [0.048, 0.159], p = 0.002) and expressive suppression on parenting stress (β= 0.098, 95% CI [0.032, 0.164], p = 0.015). We found a significant negative effect of ACEs on CR (β= -0.061, 95% CI [-0.110, -0.013], p = 0.039) (Fig. 1). and of CR on parenting stress (β= -0.101, 95% CI [-0.167, -0.013], p = 0.013) (Fig. 2). This analysis supports the hypothesis that experiencing adverse events during childhood can impact parenting stress through a change in both adaptive and maladaptive cognitive emotion regulation strategies.

A - 80 The Role of Adverse Childhood Events and Personality Traits Among Individuals with Functional Neurological Symptom Disorder (FND).

There is an established link between early life trauma and avoidant and anxious attachment in patients with FND.1,2,3 These attachment styles are linked to histrionic (HPD), avoidant (APD), borderline (BPD), and dependent personality disorders (DPD)0.5 The current study seeks to explore the relationship between adverse childhood experiences and personality characteristics among individuals diagnosed with FND. A retrospective analysis of patients diagnosed with FND who completed neuropsychological evaluation was conducted. The outcome measures include the Adverse Childhood Experiences Scale (ACES) and Minnesota Multiphasic Personality Inventory, 3rd Edition (MMPI-3). Composite scores for the ACES and BPD, HPD, APD, and DPD were obtained by calculating equally weighted sum of predetermined component scores on the MMPI-3 based on the DSM-5.6 Spearman correlations were calculated to determine the association between ACES and PD composites. Analysis was conducted with 21 patients, 86% were female, 71% identified as white, and mean sample age was 41.59years (SD = 12.48). 57.14% had elevated ACES score. Mean composite PD scores were BPD - 55.97 (SD = 7.58), HPD - 53.93 (SD = 9.17), APD - 59.26 (SD = 9.71), and DPD - 59.75 (SD = 10.80). The correlations were positive and statistically significant (p < =0.05) across all four PD for ACES Q1 (emotional abuse) and Q4 (unsupportive environment). The results highlight that the ACES can be beneficial in identifying patients with FND who may have, or are at risk, of developing PD. These results also provide targets for treatment including maladaptive attachment styles.