High Prevalence Of Adverse Childhood Experiences Research Articles

Childhood Adversity and Life Satisfaction in Adults with Alternative Care Experience in 12 Low- and Middle-Income Nations: The Mediating Roles of Individual and Relational Protective Factors and Resilience

Adults with care experience have elevated rates of adverse childhood experiences (ACEs) and a greater likelihood of poor outcomes. Some research has examined how protective factors and resilience impact outcomes among care leavers, but few studies include those from low- and middle-income countries (LMICs). Further, little work has examined the interactive impact of protective factors and resilience in this population. We investigated (a) the prevalence of ACEs among care leavers from LMICs, the mediating roles of (b) resilience and (c) individual and relational protective factors on the relationship between ACEs and life satisfaction, and (d) whether mediation was occurring both in parallel and sequentially. Five hundred forty-two care leavers from twelve LMICs completed an online survey. Participants completed the Brief Resilience Scale, ACEs Questionnaire, and open-ended questions regarding care experiences. Open-ended questions were coded for protective factors. There was a high prevalence of ACEs among care leavers. The relationship between ACEs and life satisfaction was partially mediated by resilience. Individual and relational protective factors partially mediated the relationship between ACEs and life satisfaction. Finally, resilience and protective factors partially mediated the relationship between ACEs and life satisfaction in both parallel and sequential mediation among care leavers from LMICs. Protective factors operate interactively to influence resilience, increasing life satisfaction among care leavers from LMICs.

Childhood trauma, substance use and depressive symptoms in people with HIV during COVID-19.

Adverse childhood experiences (ACEs), substance use, depressive symptoms, and HIV outcomes in people living with HIV (PLWHIV) have not been comprehensively investigated within a single study. The aim of this study was to investigate the prevalence and association of ACEs, substance use, depressive symptoms and human immunodeficiency virus (HIV) outcomes in PLWHIV accessing HIV care during the coronavirus disease 2019 (COVID-19) pandemic. District hospital HIV clinic in South Africa. A total of 196 PLWHIV completed a socio-demographic and clinical questionnaire; an adapted World Health Organization (WHO) Alcohol, Smoking and Substance Involvement Screening Test; WHO ACEs International Questionnaire, and Patient Health Questionnaire. The most common ACEs were having one or no parent, parental separation or divorce (n = 131, 66.8%), exposure to collective (n = 57, 29.1%) and community violence (n = 55, 28.1%), with 40.3% (n = 79) experiencing ≥ 3 ACEs. The most commonly used substances were alcohol (n = 34, 17.3%), tobacco (n = 33, 16.8%), and cannabis (n =13, 6.6%). The prevalence of depressive symptoms was 19.4% (n = 38). Linear regression analyses indicated greater alcohol (adj β = 2.84, p < 0.01), tobacco (adj β = 3.64, p < 0.01) and cannabis use risk scores (adj β = 2.39, p < 0.01) were associated with ≥ 3 ACEs. Logistic regression indicated depressive risk (adjusted odds ratio [OR] = 9.39, 95% confidence interval [CI] 4.78-23.51) was associated with ≥ 3 ACEs. A high prevalence of ACEs, substance use and depressive symptoms exists among PLWHIV, along with an association between cumulative ACEs and both substance use and depressive symptoms. Enhanced screening and management services are recommended to address this triple burden in PLWHIV.

Online Delivery of Interprofessional Adverse Childhood Experiences Training to Rural Providers: Usability Study.

The population health burden of adverse childhood experiences (ACEs) reflects a critical need for evidence-based provider training. Rural children are also more likely than urban children to have any ACEs. A large proportion of providers are unaware of the detrimental effects of ACEs. There is a significant documented need for training providers about ACEs and trauma-informed care, in addition to a demand for that training. The objective was to develop, implement, and evaluate an online ACEs training curriculum tailored to Missouri providers, particularly those in rural areas given the higher prevalence of ACEs. From July 2021 to June 2022, we conducted literature reviews and environmental scans of training videos, partner organizations, clinical practice guidelines, and community-based resources to curate appropriate and tailored content for the course. We developed the ACEs training course in the Canvas learning platform (Instructure) with the assistance of an instructional designer and media designer. The course was certified for continuing medical education, as well as continuing education for licensed professional counselors, psychologists, and social workers. Recruitment occurred via key stakeholder email invitations and snowball recruitment. Overall, 135 providers across Missouri requested enrollment, with 72.6% (n=98) enrolling and accessing the training. Of the latter, 49% (n=48) completed course requirements, with 100% of respondents agreeing that the content was relevant to their work, life, or practice; they intend to apply the content to their work, life, or practice; they feel confident to do so; and they would recommend the course to others. Qualitative responses supported active intent to translate knowledge into practice. This study demonstrated the feasibility, acceptability, and effectiveness of interprofessional workforce ACEs training. Robust interest statewide reflects recognition of the topic's importance and intention to translate knowledge into practice.

The Impact of Adverse Childhood Experiences on College Student Stress and Well-being

This quantitative study explored the relationship between adverse childhood experiences (ACEs) and college student stress and well-being, including the impacts of gender identity and sexual orientation. Participants were undergraduate students ( n = 760) who answered survey questions related to stress, well-being, and ACEs as part of a larger campus climate survey. Researchers found that number of ACEs and gender identity/sexual orientation were independently associated with stress. Having more ACEs was significantly associated with higher stress scores. LGBTQ + participants had the highest stress scores, followed by cisgender heterosexual women and cisgender heterosexual men. Well-being was not significantly associated with ACEs or gender identity/sexual orientation. Results of the study have implications for college student retention. The high prevalence of ACEs and stress indicates the need for services that help students manage stress and increase well-being to improve their ability to persist and succeed in college.

Reactive attachment disorder, disinhibited social engagement disorder, adverse childhood experiences, and mental health in an imprisoned young offender population

BackgroundA high proportion of young people in prison have a history of abuse and neglect, and/or of neurodevelopmental or psychiatric conditions. Despite this, the only two conditions specifically associated with abuse and neglect, Reactive Attachment Disorder (RAD) and Disinhibited Social Engagement Disorder (DSED), have never been included as part of a comprehensive prevalence study. MethodsA cross sectional study, in 110 male inmates aged 16 to 23, examined the prevalence of, and associations between, adverse childhood experiences (ACEs), neurodevelopmental and mental health conditions, including RAD and DSED. OutcomesVirtually all of the young men (96 %) had one or more lifetime neurodevelopmental or mental health conditions, 85.5 % had a current condition, yet less than 3 % reported having received a mental health assessment in prison. High rates of RAD and/or DSED symptoms were found (53.6 %) and 74.5 % had experienced some form of abuse or neglect. InterpretationThere is a high prevalence of ACEs, RAD/DSED, neurodevelopmental and other mental health conditions within this population. Comprehensive clinical assessments are required to ensure appropriate support and staff training is needed to ensure that the full implications of the high prevalence of neurodevelopmental and mental health conditions are understood as part of trauma informed care.

Disparities in HIV Testing among Adults with Adverse Childhood Experiences

Abstract Background It is estimated that more than 13% of persons 13 years and older living with HIV are unaware of their status. 80 percent of new HIV infections are transmitted by people who are not aware they have HIV or not receiving any HIV care in the US, presenting a major public health concern and stressing the importance of enhanced HIV screening. Adverse Childhood Experiences (ACEs) have been shown to be risk factors for HIV transmission and studying the relationship of ACEs and the likelihood of HIV screening is thus important to explore. Methods Using combined data (2019-2021) from the Centers for Disease Control and Prevention (CDC) Behavioral Risk Factor Surveillance System (BRFSS) dataset, adjusted analyses models were constructed to determine the likelihood of adults receiving HIV testing and their past history of ACEs. Results Overall, compared to individuals reporting no ACES, individuals reporting 1 to 3 ACEs were significantly more likely to be tested for HIV. However, despite higher prevalence of ACEs, significantly higher prevalence of men who have sex with men (MSM) remained unaware of their HIV status. Significant disparities in HIV testing were also observed by socio demographic characteristics. Conclusions Healthy People 2030 aims to increase the proportion of persons who know their HIV status to at least 95% by 2025. Our findings highlight the urgent need for targeted interventions that target high risk groups, promote testing benefits, and encourage increased testing among individuals with a history of ACEs. Given the importance of testing to HIV prevention outcomes, more research is needed to unpack the relationship between HIV risk and HIV testing for individuals with a history of childhood adversity. Key messages • New trauma-informed training programs for health care providers are needed to facilitate targeted HIV testing. • Ongoing research is critical to unpack the relationship between HIV risk and HIV testing for individuals with a history of childhood adversity.

The impact of adverse childhood experiences (ACEs) on sleep adequacy for children with special health care needs (CSHCN) in the United States

BackgroundAdverse childhood experiences (ACEs), are associated with poor mental and physical health, risky behaviors, chronic diseases in adulthood, and premature death. ACEs are also associated with poor sleep among children and adults. It is not clear if this association is true for children with special health care needs (CSHCN). ObjectiveTo explore the impact of ACEs on sleep duration among CSHCN, adjusting for demographic, family, and health characteristics. MethodsThis study used a subsample of 17,049 CSHCN from the 2019–2020 National Survey of Children's Health between 4 months and 17 years. Multivariable logistic regression was used to examine if the number of ACEs experienced by a child is associated with a child sleeping the recommended number of hours for their age while controlling for demographic, family, and health characteristics. There was no sign of multicollinearity among the variables of interest. ResultsCSHCN without adequate sleep had a higher prevalence of ACEs. When adjusting for demographic characteristics, children with 1 ACE (aOR: 0.81, 95% CI: 0.69–0.96) or at least 2 ACEs (aOR: 0.60, 95% CI: 0.51–0.71) were less likely to sleep the adequate number of hours. That association was no longer significant when adjusting for family characteristics or BMI. Other significant predictors in the adjusted models include race, poverty level, the highest level of education in households, and caregiver mental health. ConclusionResults demonstrate an inverse relationship between the number of ACEs and the odds of sleep adequacy for CSHCN and highlight racial and economic disparities in sleep adequacy.

Adverse Childhood Experiences Among Lesbian, Gay, Bisexual, and Queer Veterans

Adverse childhood experiences portend vulnerability to numerous physical and mental health concerns across the lifespan. Separate bodies of work suggest that both lesbian, gay, bisexual, and queer individuals and military veterans are more likely to report adverse childhood experiences than their non-lesbian, gay, bisexual, and queer and non-veteran counterparts, respectively. Although lesbian, gay, bisexual, and queer veterans experience health disparities compared with non-lesbian, gay, bisexual, and queer veterans, the prevalence of adverse childhood experiences among individuals with both lesbian, gay, bisexual, and queer and veteran identities is yet unknown. Participants were U.S. military veterans (N=14,461) from 18 states that included Sexual Orientation and Gender Identity and adverse childhood experiences modules in the 2019 and 2020 Behavioral Risk Factor Surveillance System survey. Multivariable logistic regression was used to determine the odds of adverse childhood experiences reported by lesbian, gay, bisexual, and queer veterans compared with those reported by non-lesbian, gay, bisexual, and queer veterans. Analyses were conducted in 2023. While accounting for sociodemographic factors, lesbian, gay, bisexual, and queer veterans were more likely to report living with someone who experienced mental illness (AOR=2.17, 95% CI=1.35, 3.51), emotional abuse (AOR=1.58, 95% CI=1.11, 2.25), and sexual abuse (AOR=2.21, 95% CI=1.29, 3.76) than non-lesbian, gay, bisexual, and queer veterans. With past work indicating that childhood abuse experiences are especially predictive of adverse health in adulthood, these findings suggest that a higher prevalence of adverse childhood experiences among lesbian, gay, bisexual, and queer veterans may contribute to health disparities among this population.

Abstract 10261: Adverse Childhood Experiences Are Linked to High Blood Pressure During the First Trimester and Hypertensive Complications During Pregnancy

Introduction: Adverse Childhood Experiences (ACEs) are associated with impaired vascular function in young adult women, and increased blood pressure and CVD risk later in life. Hypotheses: We hypothesized that exposure to ACEs would be associated with an increased risk of first trimester hypertension and subsequently with hypertensive complications during pregnancy. Methods: Exposure to ACEs, self-reported incidence of first trimester hypertension (HT) and hypertensive complications in pregnancy (HTCs), as well as age, education, chronic health conditions, gravidity and BMI were obtained from women enrolled in a clinic-based longitudinal study of women ages 16-38 who were enrolled in their first prenatal visit. To avoid potential confounding of severe obesity, we restricted analyses to only those women with a BMI &lt;40 kg/m 2 . Consequently, 135 pregnant women (age = 26 ± 6; BMI = 27 ± 6; gravidity = 2.7 ± 1.5) were included in this analysis; however, data from 20 women was missing for HTC incidence (n =115). The sample was diverse (49% Non-White) and had a high prevalence of ACEs (41% with ≥4 ACEs). Logistic regression models were used to examine the association of ACE exposure with the probability of HT and HTCs. Models included: (1) ACEs alone, and (2) ACEs following adjustment for age, BMI, gravidity, Race, and chronic health conditions. Results: Exposure to ACEs predicted HT (OR [95% CI] = 1.32 [1.10 - 1.59]) and HTC (1.26 [1.03 - 1.52]) incidence. Following full adjustment, the odds of HT increased 51% for each additional ACE (1.51 [1.03 - 2.22]). Following full adjustment, the odds of HTC increased 40% for each additional ACE (1.40 [1.06 - 1.83]). In each of the fully adjusted models, only chronic health conditions were also a significant predictor. Conclusions: ACE exposure is an important risk factor for HT and HTC, especially when considered alongside existing chronic health conditions. Screening for ACEs may be a worthwhile public health strategy to identify women at risk for hypertension and hypertensive complications in pregnancy. However, larger scale, longitudinal cohort studies are needed to confirm and to further understand these associations.

Adverse childhood experiences and utilization of preventive healthcare among Generation Z sexual and gender minorities

Historically, sexual and gender minority populations may have faced multiple Adverse Childhood Experiences (ACEs) and their utilization of preventive healthcare is low. However, sociocultural changes in attitudes and policies affecting sexual and gender minority populations signal their broader societal acceptance. We examined the prevalence of ACEs among sexual and gender minority populations belonging to Generation Z (those born between 1990-early 2000s) and their utilization of preventive healthcare to identify areas for health promotion. We used the Philadelphia Expanded ACEs questionnaire as well as questions about demographics and preventive healthcare use in a cross-sectional online survey design. The participants (n = 160) were chiefly female (n = 105, 65.6%) and bisexual (n = 51, 31.9%), while gender non-binary comprised 10.6% (n = 17). Most (93.75%, n = 150) participants reported three or more ACEs. ACEs were significantly associated with preventive healthcare use (p = 0.02). Higher prevalence of ACEs was associated with a 0.05 reduction in preventive healthcare utilization. Despite protective factors such as a comparatively advantaged background (based on their annual household income), health insurance, and college education, high ACEs, sexual orientation, and gender identity remained significantly associated with low utilization of preventive healthcare.

Adverse Childhood Experiences and Current Psychosocial Stressors: Exploring Effects on Mental Health and Parenting Outcomes from a Mother-Baby Partial Hospital Program.

Adverse childhood experiences (ACEs) can detrimentally impact perinatal mental health, birth outcomes, and parenting behaviors. Proximal psychosocial stressors also increase risks to perinatal health and wellbeing. Additional research on effective perinatal mental health programs is needed, especially for individuals and families with historical and concurrent adversity, and those with moderate to severe symptoms. The Mother-BabyDay Hospital at Hennepin County Medical Centerprovides trauma-informed, multi-generation treatment for perinatal women. Data were collected from patients between January 2016 and September 2019. Self-reported depression, anxiety, and maternal functioning assessments were administered pre- and post-treatment. Patients completed the ACE questionnaire and indicators of current psychosocial stressors (i.e., food insecurity, housing insecurity, and social support) at intake. A series of bivariate tests and hierarchical regression models examined relationships among variables, including whether distal and proximal adversity predicted post-treatment symptoms. 159 Perinatal patients consented to research and completed the ACEs questionnaire at first admission. High proportions of patients reported 4+ ACEs and current psychosocial stressors. Effect sizes for associations between ACEs, psychosocial stressors, and self-report symptoms were small to moderate. Individuals with food or housing insecurity entered treatment with higher anxiety. In regression models, the most robust predictors of post-treatment symptoms were pre-treatment symptoms. Effects of ACEs on post-treatment depression and food insecurity on post-treatment maternal functioning approached the adjusted significance cut-off (p < .01). CONCLUSIONSFOR PRACTICE: Current psychosocial stressors and ACEs did not substantially limit post-treatment depression, anxiety, and maternal functioning outcomes. High prevalence of ACEs and psychosocial stressors highlight the need for trauma-informed, multi-generation treatments to improve maternal mental health and parenting capacity.

Examining the Relationship Between Adverse Childhood Experiences and ADHD Diagnosis and Severity.

Although prior research has examined the prevalence of ACEs among children with attention deficit-hyperactivity disorder (ADHD), little is known about the household and family settings of children with ADHD. Our study utilizes a recent nationally representative dataset to examine the association between adverse childhood experiences (ACEs), child and household characteristics, and ADHD diagnosis and severity. Using the 2017-2018 National Survey of Children's Health (NSCH), our sample consisted of children three years of age or older, as this is the youngest age at which the NSCH begins to ask caregivers if a child has been diagnosed with ADHD (n=42,068). Multivariable logistic regression was used to examine the association between ACE type, score, and ADHD and ADHD severity, controlling for child and household characteristics. Children exposed to four or more ACEs had higher odds of ADHD (aOR 2.16; 95% CI 1.72-2.71) and moderate to severe ADHD (aOR 1.89; 95% CI 1.31-2.72) than children exposed to fewer than four ACEs. Other child characteristics positively associated with ADHD included age and public insurance; other Non-Hispanic races compared to Non-Hispanic White had lower odds of ADHD. Of children reported with ADHD, public insurance was also associated with caregiver-reported moderate to severe ADHD. Children with ADHD have a higher prevalence of ACEs, making this study important for understanding the relationship between ACEs and ADHD at the population level.

Adverse childhood experiences (ACEs) and substance use disorder (SUD): A scoping review

BackgroundThe long-term negative effects of adverse childhood experiences (ACEs) and their impact on physical and mental health has been widely studied. However, research about the relationship between ACEs and substance use disorder (SUD) diagnosis in adolescence and adulthood is still scarce. Therefore, this scoping review was conducted to collect the existing research findings to explore the relationship between the experience of ACEs and the diagnosis of SUD later in life. MethodsThe PsycINFO, Medline, Scopus, Web of Science, and Cochrane Library databases were searched. After identifying the records based on eligibility and exclusion criteria, 12 studies were finally selected for inclusion. ResultsMost of the studies were conducted in the USA with adult male and female participants. All studies were cross-sectional in nature and assessed ACEs retrospectively. The main conclusions of the studies were that there is a higher prevalence of ACEs in the population with SUD than in the general population, and a positive association between ACEs and the development and severity of SUD in adolescence and adulthood. ConclusionsIt is difficult to make comparisons between studies and to draw solid conclusions because of the lack of standardized criteria for evaluating ACEs and due to the heterogeneity in the substance types examined. More research is needed to fully elucidate the underlying mechanism of the relationship between ACEs and SUD.

Overall and Gender-specific Associations between Dimensions of Adverse Childhood Experiences and Mental Health Outcomes among Homeless Adults: Associations Générales et Sexospécifiques Entre les Dimensions des Expériences Défavorables de L'enfance et les Résultats de Santé Mentale Chez les Adultes Sans Abri.

The associations between adverse childhood experiences (ACEs) and psychopathology have been well-established in the general population. Research on ACEs in the homeless population has been limited. This study examined whether ACE exposure is associated with specific mental health outcomes among a national sample of homeless adults with mental illness and whether this association varies according to ACE dimension and gender. This cross-sectional study utilized data from a national sample of 2,235 homeless adults with mental illness in Canada to evaluate their sociodemographic characteristics, exposure to ACEs, and mental health outcomes. Exploratory and confirmatory factor analyses were conducted to identify and confirm ACE dimensions (maltreatment, sexual abuse, neglect, divorce, and household dysfunction) from individual ACE items. Multivariable logistic regression was used to examine the associations between total ACE score and ACE dimensions with mental illness diagnoses and psychopathology severity. The mean total ACE score among all study participants was 4.44 (standard deviation [SD]: 2.99). Total ACE score was positively associated with several mental illness diagnoses and psychopathology severity. Unique associations were found between specific ACE dimensions and poor mental health outcomes. The prevalence of almost all ACEs was significantly higher among women. Yet, associations between several ACE dimensions and poor mental health outcomes existed uniquely among men. There are unique and gender-specific associations between specific ACE dimensions and mental health outcomes among homeless adults. Better understanding of the mechanisms underlying these associations is needed to inform screening, prevention, and treatment efforts, particularly given the very high prevalence of ACEs among this vulnerable and marginalized population.

Prevalence of adverse childhood experiences among individuals aged 45 to 85 years: a cross-sectional analysis of the Canadian Longitudinal Study on Aging.

Background:Population-level prevalence estimates for a broad range of adverse childhood experiences (ACEs), which are known to affect health across the lifespan, are currently unavailable in Canada. The purpose of this study was to estimate the prevalence of individual ACEs by sociodemographic factors among middle-aged and older adults.Methods:Data for this cross-sectional analysis were obtained from the first follow-up (2015–2018) of the Canadian Longitudinal Study on Aging (baseline recruitment from 2011 to 2015). Participants included individuals aged 45–85 years and residing in the community in the 10 Canadian provinces. Exposure to ACEs was assessed using a retrospective, self-report questionnaire. Logistic regression was used to obtain the adjusted prevalence estimates of ACEs within groups formed by the sociodemographic characteristics and each variable was adjusted for all other sociodemographic variables.Results:Of the 44 817 participants in the first follow-up, 61.6% (weighted) reported exposure to at least 1 ACE. Exposure to physical abuse (weighted prevalence of 25.7%), intimate partner violence (22.4%) and emotional abuse (21.8%) were the most prevalent types of ACEs. Individuals younger than 65 years (born in 1950–1969), with no postsecondary education or education below a bachelor’s degree, or with annual household income less than $20 000 reported greater exposure to ACEs. Reporting for many ACEs was higher among women and those of nonheterosexual orientation. Overall, British Columbia, Alberta, Manitoba, Ontario and Quebec reported relatively higher prevalence for several examined categories of ACEs.Interpretation:Adverse childhood experiences were highly prevalent across all demographic groups with substantial heterogeneity in the distribution among the middle and older age population. The high prevalence of ACEs and their potential negative consequences on health and well-being emphasize the need to develop and promote trauma-informed care to assist individuals affected by ACEs.

T184. THE ROLE OF ADVERSE CHILDHOOD EXPERIENCES IN THE DEVELOPMENT OF A MORE SEVERE TYPE OF SCHIZOPHRENIA

BackgroundThe prevalence of Adverse Childhood Experiences (ACEs) in psychotic patients ranges from 45 to 91%. Some authors argue that the risk of developing psychosis is higher in subjects who were exposed to multiple types of ACEs and that trauma multiplicity has a negative clinical impact in psychosis, while others argue that specific types of trauma are related to specific features of disease, taking away importance at the dose-response hypothesis.Most of the studies about ACEs and schizophrenia have been conducted in North America or Western Europe and there is a lack of information on this topic in developing regions, excluding the possibility of finding regional differences in ACEs frequency and its consequences. The present research provides information about the prevalence of ACEs in schizophrenic patients and in a control sample, and explores the clinical impact of trauma multiplicity in a schizophrenic adult population of Argentina.MethodsAn observational, multicentric and cross-sectional study was conducted at three different hospitals located in Buenos Aires. One hundred patients with schizophrenia and 50 subjects without a mental disease were recruited. Information about adverse childhood experiences was obtained from the Spanish version of the Adverse Childhood Experiences questionnaire (ACE-Q). Clinical severity of schizophrenia was measured with the Positive and Negative Syndrome Scale (PANSS) and with the hallucination subscale of the Psychotic Symptom Rating Scale (PSYRATS), suicidal behavior with the Columbia-Suicide Severity Rating Scale (C-SSRS), treatment adherence with the Drug Attitude Inventory (DAI-10), global functioning with the Global Assessment Functioning Scale (GAF), theory of mind with the Hinting Task test and emotional processing with the Reading the mind in the eyes test.To analyze the impact of trauma multiplicity on clinical variables of schizophrenia, the patient sample was divided into 2 groups according to the number of ACEs suffered. As a cut-off point, a statistical criterion corresponding to the median number of ACEs was chosen and the sample was divided between those who suffered 0–4 ACEs and those with 5 or more ACEs. Statistical analysis was carried out using SAS software.ResultsThe prevalence of at least one ACE in schizophrenic patients was almost double in comparison with the control group (92% vs 54%). Patients with trauma multiplicity showed a PANSS-N score lower than the group with lower number of ACEs (0–4 ACEs= 24.51 ± 5.17 vs. ≥ 5 ACEs= 21.04 ± 4.22; p= <0.001). PSYRATS score was higher in patients with 5 or more ACEs (0–4 ACEs= 6 points, Q1-Q3: 3–18 vs. ≥ 5 ACEs= 12 points, Q1-Q3: 5–23; p= 0.042). Patients with 5 or more ACEs scored higher in death ideation (0–4 ACEs= 22 (40.00%) vs. ≥ 5 ACEs= 28 (62.22%); p= 0.027). The prevalence of suicidal attempts was also higher (0–4 ACEs= 22 (40.00%) vs. ≥ 5 ACEs= 27 (60.00%); p= 0.047), as well as the median number of suicide attempts (0–4 ACEs= 0 (0–1) vs. ≥ 5 ACEs= 1 (0–2); p= 0.039). Also, women with 5 or more ACEs showed higher suicidal ideation score (0–4 ACEs= 0 (0–1) vs. ≥ 5 ACEs= 2 (0–4); p= 0.035). No other clinical variables under study showed differences between the groups.DiscussionTrauma multiplicity is associated with less negative symptoms, greater suicidal behavior and auditory hallucinations resistant to antipsychotic therapy. Further studies should be done to determine if this might be a specific endophenotype of schizophrenia. The high prevalence of ACEs in our study could be explained by the questionnaire applied, as it includes a large number of ACEs in comparison with others and it could also be linked to regional and cultural characteristics, as there is little information about ACEs prevalence of in South America.

Sleep disturbance mediates the association of adverse childhood experiences with mental health symptoms and functional impairment in US soldiers.

Adverse childhood experiences (ACEs) can have long-term impacts on a person's mental health, which extend into adulthood. There is a high prevalence of ACEs among service members. Further, service members also report frequently experiencing disrupted sleep. We hypothesized that disrupted sleep may serve a mechanistic function connecting ACEs to functional impairment and poorer mental health. In a cross-sectional sample (n=759), we found evidence for an indirect effect of ACEs on mental health outcomes through disrupted sleep. In a different sample using two time-points (n=410), we found evidence for an indirect effect of ACEs on changes in mental health outcomes and functional impairment during a reset period, through changes in disrupted sleep during the same period. Implications, limitations and future research directions are discussed.

Addressing Health and Well-Being Through State Policy: Understanding Barriers and Opportunities for Policy-Making to Prevent Adverse Childhood Experiences (ACEs) in South Carolina.

As adverse childhood experiences (ACEs) become increasingly recognized as a root cause of unhealthy behaviors, researchers, practitioners, and legislators seek to understand policy strategies to prevent and mitigate its effects. Given the high prevalence of ACEs, policies that address ACEs can meaningfully prevent disease in adulthood and improve population health. We sought to understand barriers and opportunities for policies to prevent and mitigate ACEs by exploring state legislator perspectives. Twenty-four current state legislators in South Carolina. In 2018, we conducted semistructured interviews with 24 state legislators. Participants were recruited using maximum variation sampling. The researchers individually analyzed each interview transcript using focused coding qualitative techniques. A high inter-rater agreement was demonstrated (κ = .76 to .87), and discrepancies were resolved through discussion. The data collection and analysis were guided by Multiple Streams Theory, which identifies 3 key components (attention to the problem, decisions about policy options, and the impact of political landscape) that can lead windows of opportunity for passing policies. Legislators identified several factors that can influence the passage of legislation on ACEs: awareness of ACEs; gaps in understanding about what can be done about ACEs; the use of data and stories that contextualize the problem of ACEs; capitalizing on the bipartisanship of children's issues; and linking to current ACEs-related issues on the policy agenda, such as school safety and violence prevention and the opioid epidemic. Public health researchers and practitioners should focus on the factors identified to advocate for policies that prevent ACEs and/or address their health consequences.

Identifying underlying constructs of childhood adversity in a low-income population.

Extensive research has documented the association between adverse childhood experiences (ACEs) and poor outcomes later in life, as well as the high prevalence of ACEs in the American population. Studies consistently find that over half of American adults have experienced at least one ACE. Despite this, research on the long-term impacts of ACEs is challenging due to the complex nature of adversity. Our study aimed to define underlying constructs of adversity, and explore how they changed throughout childhood, in a low-income population. We fielded a survey to Medicaid-enrolled adults in the Portland, OR metropolitan area. Our survey captured different experiences in childhood, including relationships and support, educational challenges, housing and employment stability, neighborhood environment, discrimination, abuse, neglect, and household dysfunction; questions were asked for 6-12 and 13-18 years of age. We then used factor analysis to identify underlying constructs of adversity in the two age ranges. We identified two factors - Inadequate Emotional Support and Instability - in each age range. Inadequate Emotional Support remained consistent in both time periods while the Instability factor changed, expanding from household-centric experiences in childhood to a wider variety of experiences in adolescence. Additionally, a number of variables did not load on either factor in either age range. These results underscore the importance of expanding how we think about instability specifically, and childhood adversity in general.

Adverse Childhood Experiences Related to Poor Adult Health Among Lesbian, Gay, and Bisexual Individuals.

We explored the association of sexual orientation with poor adult health outcomes before and after adjustment for exposure to adverse childhood experiences (ACEs). Data were from the 2012 North Carolina, 2011 Washington, and 2011 and 2012 Wisconsin Behavioral Risk Factor Surveillance System (BRFSS) surveys regarding health risks, perceived poor health, and chronic conditions by sexual orientation and 8 categories of ACEs. There were 711 lesbian, gay, and bisexual (LGB) respondents and 29,690 heterosexual respondents. LGB individuals had a higher prevalence of all ACEs than heterosexuals, with odds ratios ranging from 1.4 to 3.1. After adjustment for cumulative exposure to ACEs, sexual orientation was no longer associated with poor physical health, current smoking, and binge drinking. Associations with poor mental health, activity limitation, HIV risk behaviors, current asthma, depression, and disability remained, but were attenuated. The higher prevalence of ACEs among LGB individuals may account for some of their excess risk for poor adult health outcomes.