History Of Adverse Childhood Experiences Research Articles

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.

Cuidándome: A trauma-informed and cultural adaptation of a chronic disease self-management program for Latina immigrant survivors with a history of adverse childhood experiences and depression or anxiety symptoms.

To develop a cultural and trauma-informed mental health self-management program for immigrant Latina survivors of adverse childhood experiences with depression or anxiety symptoms. Guided by Barrera's five-stage process for cultural adaptation, we collaborated with multiple stakeholders including clinical psychologists, community health workers, and Latina immigrant women with a history of adverse childhood experiences and depression or anxiety to transform a chronic disease self-management program to be trauma informed, culturally appropriate, and focus on self-management of depression and anxiety symptoms. Adaptations included translating program materials to Spanish, education on how early life adversity and trauma may impact mental health, virtual delivery, more frequent and shorter sessions, and addition of graphics and written prompts in workbook materials. For the facilitator's manual, culturally relevant vignettes and guidance were added to guide participants through activities and adapt sessions based on participant needs. Barrera's five-stage process was useful for adapting a program to be both trauma and culturally informed for an underserved population disproportionately affected by trauma and limited access to mental health services. The adaptation demonstrated acceptability with Latina immigrant women and the promise of utilizing unlicensed personnel and technology for increasing the reach of mental health support. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Crecimiento y desarrollo puberal en niñas adoptadas de Rusia: seguimiento de 12 años

Introduction: the objectives were to provide longitudinal data on growth and determine the age of thelarche and menarche in girls adopted from Russia. Material and methods: prospective cohort study in 24 girls from Russia adopted in Spain in the 2002-2010 period, who were followed up for 12 years. The history of adverse childhood experiences was collected by reviewing pre-adoption medical records. We recorded standardised measurements of weight, height and head circumference and the age at thelarche and menarche. The mean values were compared with reference standards. Results: Salient history: preterm birth (33.3%), low birth weight (41.7%), prenatal alcohol exposure (45.8%), abuse and neglect (54.2%). Initial evaluation: mean age, 3 years (standard deviation [SD] 1.6) years; weight z-score (z), −1.35; height z, −2.42; head circumference z −1.77. One year after adoption, there was significant catch-up growth in weight (z +0.68), height (z +0.98), and head circumference (z +0.76). Temporal trends in growth: no weight delay from age 7 years; height continued to recover until age 10 (z −0.40) and remained stable until age 15 (z −0.46); the delay was greater compared to weight at every timepoint. The mean age at onset of thelarche was 9.9 years (SD 0.8) with a height of 135.4 cm (z −0.43). The mean age at menarche was 11.9 years (SD 0.7) years, with a height of 147.6 cm (z −0.44). Conclusions: the pattern of growth and development was characterized by severe delay in linear growth and a moderate delay in weight and head circumference at the time of adoption, rapid, significant and prolonged catch-up growth, acceleration of pubertal development with early thelarche and menarche and an incomplete recovery of linear growth.

Access to and perceived unmet need for mental health services and support in a community sample of UK adolescents with and without experience of childhood adversity.

Children and adolescents with a history of adverse childhood experiences (ACEs) are more likely than their peers to develop mental health difficulties, but not enough is known about their help-seeking behaviours and preferences. We aimed to determine whether ACEs are associated with access to and perceived unmet need for mental health services and support amongst secondary school students. We used multi-level logistic regression with data from the 2020 OxWell Student Survey to assess whether ACEs were associated with (1) prior access to mental health support and (2) perceived unmet need for mental health services in a community sample of English secondary school students. We assessed ACEs as a cumulative score from the Center for Youth Wellness Adverse Childhood Experiences Questionnaire: Teen Self-Report version and accounted for current mental health difficulties as measured by the 25-item Revised Children's Anxiety and Depression Scale (RCADS). Our analysis included 2018 students across 64 schools, of whom 29.9% (598/2002) reported prior access to mental health support. Of those not reporting prior access, 34.1% (469/1377) reported a perceived unmet need for services. In the unadjusted models, cumulative ACE scores were significantly positively associated with both prior access to mental health support (odds ratio (OR)=1.36; 95% confidence interval (CI): 1.29-1.43) and perceived unmet need for mental health services (OR=1.47; 95% CI: 1.37-1.59), meaning that students who had experienced adversity had a greater chance of having previously accessed support as well as perceiving an unmet need for services. After adjusting for mental health difficulties and other sociodemographic variables, cumulative ACE scores were positively associated with prior access (adjusted OR (aOR)=1.25; 95% CI: 1.17-1.34 with a significant interaction between RCADS and ACE scores, aOR=0.88; 95% CI: 0.84-0.93) as well as perceived unmet need (aOR=1.32; 95% CI: 1.21-1.43 with a significant interaction between RCADS and ACE scores, aOR=0.85; 95% CI: 0.78-0.91). Although it is encouraging that adolescents with experience of adversity are more likely than their peers with similar levels of depression and anxiety symptoms to have accessed mental health support, there remains a concern that those who have not accessed support are more likely to perceive an as-yet unmet need for it. Mental health support must be available, accessible and acceptable to all who need it, especially for those groups that traditionally have not accessed services, including the more marginalised and vulnerable populations.

Lifetimes of Vulnerability: Childhood Adversity, Poor Adult Health, and the Criminal Legal System.

On average, incarcerated people have higher rates of poor health, mental illness, and histories of adverse childhood experiences (ACEs) than the general population. This mixed-methods analysis examines the relationship between ACEs and poor adult health among a sample of formerly incarcerated people. The quantitative analysis (N = 122) shows childhood adversity is associated with various health conditions in adulthood, although the strength of this relationship varies by the kinds of ACEs respondents encountered. The qualitative analysis of life history timelines (N = 42) reveals two pathways relating ACEs to poor health and legal system involvement: (1) violence and victimization and (2) drug use as a coping mechanism. Unaddressed mental health challenges in the aftermath of adversity emerged as an important precursor to both pathways. Prisons lack a meaningful consideration of these early life events and the social structures that result in the high rates of vulnerable people in its care.

A virtual mother-infant postpartum psychotherapy group for mothers with a history of adverse childhood experiences: open-label feasibility study

ObjectivesMothers with a history of adverse childhood experiences (ACE) are at elevated risk for postpartum mental illness and impairment in the mother-infant relationship. Interventions attending to maternal-infant interactions may improve outcomes for these parents and their children, but barriers to accessing in-person postpartum care limit uptake. We adapted a postpartum psychotherapy group for mothers with mental illness (e.g., mood, anxiety, trauma-related disorders) and ACE for live video-based delivery, and evaluated feasibility, acceptability, and preliminary efficacy in an open-label pilot study.MethodsWe recruited adults with children (6–18 months) from a perinatal psychiatry program in Toronto, Canada. The intervention was a live video-based 12-week interactive psychotherapy group focused on maternal symptoms and maternal-infant relationships. The primary outcome was feasibility, including feasibility of recruitment and retention, fidelity of the intervention, and acceptability to patients and group providers. Maternal clinical outcomes were compared pre- to post-intervention, as secondary outcomes.ResultsWe recruited 31 participants (mean age 36.5 years (SD 3.9)) into 6 groups; 93.6% (n = 29) completed post-group questionnaires, and n = 20 completed an optional post-group acceptability interview. Mean weekly group attendance was 83% (IQR 80–87); one participant (3.2%) dropped out. All group components were implemented as planned, except for dyadic exercises where facilitator observation of dyads was replaced with unobserved mother-infant exercises followed by in-group reflection. Participant acceptability was high (100% indicated the virtual group was easy to access, beneficial, and reduced barriers to care). Mean maternal depressive [Edinburgh Postnatal Depression Scale: 14.6 (SD 4.2) vs. 11.8 (SD 4.2), paired t, p = 0.005] and post-traumatic stress [Posttraumatic Stress Disorder Checklist for DSM-5: 35.5 (SD 19.0) vs. 27.1 (SD 16.7)], paired t, p = 0.01] symptoms were significantly lower post vs. pre-group. No differences were observed on mean measures of anxiety, emotion regulation or parenting stress.ConclusionsRecruitment and retention met a priori feasibility criteria. There were significant pre- to post-group reductions in maternal depressive and post-traumatic symptoms, supporting proceeding to larger-scale implementation and evaluation of the intervention, with adaptation of dyadic exercises.

ACEs and social risk factors in patients with opioid use disorder

ABSTRACT Background Individuals who experience childhood trauma may be more likely to misuse substances. The influence of social risk factors increases the frequency of opioid use. Understanding the linkages between childhood trauma, opioid use disorder, and social risk factors has the potential of improving poor health outcomes. The performance of specific role groups on office-based addition teams in documenting social risk factors in the electronic medical record had not been studied. Methods This retrospective chart review was conducted across three primary care practices at an urban academic medical center. Results The majority of our sample reported at least one social risk factor. Those patients with an advanced practice nurse and/or navigator on their team were more likely to report food insecurity and to have documentation related to involvement with the legal system. Recovery coaches were most likely to document the lack of housing stability as compared to other members of the team. Conclusions The incidence of documentation related to housing stability, food insecurity, and involvement with the legal system for patient’s engaged in an OBAT program should alert interprofessional clinicians on the team to assess for a history of adverse childhood experiences.

Adjudicated Adolescents Located on a State Sex Offender Registry Website as Adults: Common Denominators

ABSTRACT This is a landmark study, the first to use a listing on a state sex offender registry website as a predictive variable for tracking adult recidivism of male adolescents adjudicated for sex offenses, and the longest to follow a cohort of these youth after discharge from a secure residential treatment program. Upon admission, the sample (N = 145) were assessed by JSORRAT-II and MEGA ♪ , two contemporary standardized, validated risk assessment tools for assessing youth who have engaged in sexually abusive behavior. They were then followed once discharged for 17.08 years into adulthood (mean follow-up = 14.0 years, SD = 1.71). Recidivism rate was 6.2% (defined as a listing for the subject on the California Megan’s Law Sex Offender Registry Website). The study offers a baseline for future studies that use a state sex offender registry website as a predictive variable for recidivism. Shared common denominators of recidivists and non-recidivists were risk level (i.e. most were High Risk or Very High Risk on MEGA ♪ ); and having a history of adverse childhood experiences other than sexual abuse (i.e. child neglect/emotional abuse and exposure to domestic violence). A history of sexual abuse, experienced by twice as many non-recidivists as recidivists, differentiated the sample. Recidivists also had fewer protective factors than non-recidivists, as assessed by the MEGA ♪ upon admission to the facility. The mean age of recidivists was younger than non-recidivists, suggesting they may have been removed from their home at an early age, and/or had an early onset of persistent coarse sexual improprieties and/or sexually abusive behaviors that persisted into adulthood. The results highlight the importance of integrating trauma-informed interventions in treatment programs for those individuals who are sexually abusive that have a history of multiple adverse childhood experiences.

Case report: The Circle Game

The authors present a rare case of a family in which both the mother, and four decades later the son, committed second-degree murder while suffering from major mental illnesses. The mother had successfully used a mental disorder defence and it was likely that the son who had raised the defence would have qualified also. The mother has a history of adverse childhood experiences. The son had also experienced various severe childhood adversities, though there were no functional impairments, personality dysfunction, suicidality or violent crimes until the onset of treatment-resistant schizoaffective disorder around age 18. His earlier comorbidities included sport-related traumatic brain injuries, sickle cell trait, severe burns, and tardive dyskinesia. His comorbidities around the material time included occasional cannabis use and dementia pugilistica. While awaiting court ruling on criminal responsibility, additional stressors triggered significant deterioration of his schizoaffective disorder and the court found him unfit to stand trial. During rehabilitation, he was severely injured by another accused, which subsequently led to his demise. This case is the first report of intergenerational mental disorder defence and involved almost every facet of criminal forensic psychiatry, which highlights the need for further research on the association between intergenerational ACEs and intergenerational risk for criminal behaviour from a comprehensive and longitudinal perspective.

Adverse Childhood Experiences and Preventive Cervical Cancer Screening Behavior.

To examine associations between a history of adverse childhood experiences (ACEs) and receiving preventive cervical cancer screening and to investigate whether number and type of ACE exposures were predictive of cervical cancer screening uptake. Data were from 11,042 adults who completed the 2020 Texas Behavioral Risk Factor Surveillance System survey. The U.S. Preventive Services Task Force guidelines were used to indicate whether individuals had received cervical cancer screening at recommended intervals. Multiple logistic regression analysis was used to predict the likelihood of not having received the recommended preventive cancer screening by number and type of ACE exposures. Chi-square analysis was used to determine associations among demographic characteristics, cancer screening uptake, and ACE number and type. Individuals with one to three ACEs and those with six or more ACEs were statistically more likely not to have received the recommended cervical cancer screenings compared to those with zero ACEs. A history of physical ACEs was associated with 3.88 times the likelihood of not having received the recommended cervical cancer screening. To promote timely cervical cancer screening and prevent retraumatization of patients with a history of ACEs, providers should implement trauma-informed care principles in their healthcare settings.

Digital mental health interventions for anxiety and mood disorders patients: A 24-week follow-up

BackgroundDigital psychoeducational interventions have been used for self-monitoring symptoms and self-care for outpatients with affective and anxiety disorders associated with a history of adverse childhood experiences (ACEs). Outpatients with affective and anxiety disorders were recruited for digital mental health interventions (smartphone app and e-book) with treatment as usual. MethodsParticipants were evaluated at baseline and at 24-week follow-up with digital mental health interventions. Participants were assessed by questionnaire and scales (the 17-item Hamilton Depressive Rating Scale (HDRS17), Hamilton Anxiety Rating Scale (HAM-A), Adverse Childhood Questionnaire, Sheehan Disability Scale, Quality of Life, Perceived StressScale, and by anthropometric measures. Results153 participants were classified into two groups: (n = 110) participants reported having experienced at least three ACEs (<4ACEs) and (n = 43) reported having experienced four or more (≥4ACEs). At baseline, the ≥ 4ACEs group presented significantly more unstable relationship, lower quality of life, more functional impairment, more perceived stress, higher HAM-A and HDRS17 scores than < 4ACEs group. After 24 weeks, digital psychoeducational interventions improved the practice of physical activity in both groups. Digital technologies improved severity of depressive symptoms in the < 4ACEs group and decreased functional impairment in the ≥ 4ACEs group. Higher scores on HAM-A were associated with more ACEs, HDRS17 > 7 and lack of physical activities. ConclusionThese findings highlight the importance of screening for ACEs to use digital psychoeducational interventions for reducing depressive symptoms and improving physical activities in outpatients with mood and anxiety disorders.

Adverse childhood experiences in early life increase the odds of depression among adults with multiple sclerosis.

Adverse childhood experiences are demonstrated risk factors for depression, a common co-morbidity of multiple sclerosis, but are understudied among people with multiple sclerosis. Estimate the association between adverse childhood experiences and depression among 1,990 adults with multiple sclerosis. Participants were members of Kaiser Permanente Northern California from two studies between 2006 and 2021 and were diagnosed with multiple sclerosis by a neurologist. Adverse childhood experiences were assessed using two instruments, including the Behavioral Risk Factor Surveillance System. Participants self-reported ever experiencing a major depressive episode. Meta-analysis random effects models and logistic regression were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) to assess the relationship between adverse childhood experiences and a history of depression across study samples. Adverse childhood experiences were expressed as any/none, individual events, and counts. Models adjusted for sex, birth year, race, and ethnicity. Exposure to any adverse childhood experiences increased the odds of depression in people with multiple sclerosis (OR: 1.71, 95% CI: 1.21-2.42). Several individual adverse childhood experiences were also strongly associated with depression, including "significant abuse or neglect" (OR: 2.79, 95% CI: 2.11-3.68). Findings suggest that adverse childhood experiences are associated with depression among people with multiple sclerosis. Screening for depression should be done regularly, especially among people with multiple sclerosis with a history of adverse childhood experiences.

Project-Based Learning and Perceived Overlap of Self-Regulation and Project-based Learning Techniques for Students with Adverse Childhood Experiences: A Case Study

The purpose of this qualitative case study was to explore the perception of educators transitioning from a traditional learning environment to a project-based learning (PBL). Teachers’ perception of student self-regulation in ages from 8 to 17 were captured. Data were collected from 1-1 interviews with five participants with Missouri teacher certification ranging in grade levels from elementary to high school working with a total of 175 students within a mental health residential school throughout Missouri. Additional data were collected from daily logs, participant interviews, behavioral logs, and regulation logs from classrooms of students with the same background as teacher participants over the last four school years, 2018-22, of teachers who have taught project-based learning units. Daily logs, regulation logs, behavioral logs, and participant interview responses were manually coded twice and then coded a third time using electronic coding via NVivo to ensure bias from Dr Foster was not present. This study supports using project-based learning units with students who have a history of adverse childhood experiences (ACEs). While study findings support the teacher perception that project-based learning activities increase self-regulation from interview responses, regulation logs, and daily logs data could not triangulate this perceived relationship. These findings support the importance of relationships with students with ACEs during PBL to increase self-regulation.

Racial inequities and addiction research

What accounts for variation across racial and ethnic groups in drug use and harms related to substance use? While explanatory mechanisms for racial and ethnic disparities include differential access to and use of health services, a myriad of other factors, including racism and historical trauma, contribute to drug-related disparities. Furthermore, the addiction scientific workforce, like the full biomedical research enterprise, lacks diversity. This deficit undercuts U.S. scientific leadership and is a major challenge for the field. To address these entrenched problems, the National Institute on Drug Abuse (NIDA) is prioritizing research on health disparities and supporting multiple efforts to enhance scientific workforce diversity. Studies on substance use trends and emerging threats must measure disparities and track progress in reducing disparities, but also acknowledge the limitations of race and ethnicity-based data. Researchers must take the bold step of proposing studies that elucidate causal mechanisms which have the potential to be ameliorated by novel policies and practices. Critically, the impact of racism on all aspects of the substance use trajectory must be assessed to better tailor prevention, harm reduction, treatment, and recovery-support interventions to the specific circumstances of those who need them. Particular attention should be given to people who are incarcerated, who are experiencing homelessness, and who have a history of adverse childhood experiences. Training the next generation of the addiction science workforce needs to address structural barriers to participation with partnerships between funders, such as NIDA, and grantee organizations.

Maternal adverse childhood experiences and behavioral problems in preschool offspring: the mediation role of parenting styles

BackgroundMaternal history of adverse childhood experiences (ACEs) has been found to be associated with children’s health outcomes. However, the underlying mechanisms were unclear. This study aimed to examine the association between maternal ACEs and behavioral problems in their preschool offspring and to explore the potential mediating role of maternal parenting styles in the association.MethodsA cross-sectional study was conducted involving 4243 mother-child dyads in Chengdu, China. Mothers completed the Adverse Childhood Experiences-International Questionnaire (ACE-IQ) to assess their history of ACEs (i.e., physical abuse, emotional abuse, physical neglect, emotional neglect, witnessing domestic violence, household substance abuse, household mental illness, incarcerated household member, parental separation or divorce, parental death, bullying, and community violence), the short Egna Minnen Beträffande Uppfostran Parent Form (S-EMBU-P) to evaluate their parenting styles (i.e., emotional warmth, rejection, and overprotection), and the 48-item Conners’ Parent Rating Scale (CPRS-48) to measure behavioral problems in their children. Logistic regression models were established to examine the association between cumulative number of maternal ACEs and children’s behavioral problems. The mediating role of parenting styles in this association was explored by generalized structural equation models (GSEM).ResultsOf the participating mothers, 85.8% (n = 3641) reported having experienced at least one type of ACE. Children of mothers with ≥2 ACEs showed a significantly increased risk of behavioral problems across all dimensions, including conduct problems, learning problems, psychosomatic problems, impulsive-hyperactive, anxiety, and hyperactivity index, in both crude and adjusted models (all p-values < 0.05). Dose-response patterns were also observed between the cumulative number of maternal ACEs and children’s behavioral problems. In addition, maternal parenting styles of rejection emerged as a significant mediator, accounting for approximately 8.4–15.0% of the associations.ConclusionsOur findings indicated an intergenerational association of maternal ACEs with behavioral problems in preschool offspring, which was mediated by maternal parenting styles of rejection. Early screening and targeted intervention strategies are critical to mitigate the downstream consequences of maternal ACEs on young children’s outcomes. Providing support and resources to improve parenting skills may prove beneficial.

Suicidal Ideation Among Medical and Nursing Students.

Suicidal ideation is a major predictor of suicide attempts. The present study was conducted to compare the prevalence of suicidal ideation and its risk factors among medical and nursing students in Nepal. An online survey was carried out among a cohort of medical and nursing students of Lumbini Medical College using questions derived from General Health Questionnaire-28 and Patient Health Questionnaire-9. 153 medical and 148 nursing students participated in the study. Lifetime suicidal ideation was present in 20.6%(n=62) medical and 13.95%(n=42) nursing students. Suicidal ideation in the last one year was present in 48 medical and 36 nursing students. There were higher odds of suicidal ideation in medical students who had parental neglect, psychiatric disorder, physical and sexual abuse, substance abuse, and academic performance dissatisfaction (p<0.05), whereas the odds were higher in nursing students with psychiatric disorder, parental demands, alcohol consumption, and academic performance dissatisfaction but was not statistically significant. Thematic analysis of the responses for open-ended question for reasons for previous suicide plans or attempts among four medical and eight nursing students revealed relationship issues, history of adverse childhood experiences, academics-related circumstances, and other individual problems as suicide antecedents. Periodic motivational speeches and counselling sessions during all the semesters of professional schooling would help decrease suicidal ideation. Mental health awareness programs for medical and nursing students should be aimed at reducing mental illness-associated stigma and promoting timely professional help-seeking behavior.

Informing youth-centred opioid agonist treatment: Findings from a retrospective chart review of youths' characteristics and patterns of opioid agonist treatment engagement in a novel integrated youth services program.

Youth ages 12-24 account for approximately 20% of overdoses and yet are poorly reached by opioid agonist treatment (OAT), the most widely recommended treatment for opioid use disorder (OUD). This study contributes to understanding this critical gap by describing youths' patterns of OAT engagement at a novel integrated youth-specific OAT program. A retrospective chart review was carried out on electronic medical records of n = 23 youth with OUD accessing a community-based integrated youth services (IYS) centre. Data abstraction focused on four domains: sociodemographic, social determinants of health, patterns of OAT engagement, and other services utilized. Youths' mean age was 22.6 years (SD = 2.1), with a mean age of first opioid use of 17.4 (SD = 2.7). Youth reported extensive histories of adverse childhood experiences, concurrent mental and physical health complications, and poly-substance use. All youth were offered OAT and 83% initiated treatment with buprenorphine/naloxone, methadone, or slow-release oral morphine. Among those initiating OAT, 42.1% were considered stable on OAT. To our knowledge, this is the first empirical study to describe youths' OAT engagement in an integrated youth-specific OAT program. Our findings demonstrated that a high proportion of youth with OUD initiated OAT in this novel program with varying degrees of OAT stability. These findings can be used to inform the development and implementation of youth-specific and integrated OAT. To account for the novelty of this area of study and small sample sizes, future collaborative efforts across IYS initiatives should be considered, including mixed method approaches to understand outcomes and experiences.

The association between adverse childhood experiences and perinatal depression symptom trajectories

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

(080) The Impact of Adverse Childhood Experiences on the Experience of Endometriosis

Abstract Introduction Endometriosis affects an estimated one in ten people assigned female at birth (AFABs) worldwide (WHO, 2021), yet it remains understudied. In the present study, I examine the impact of adverse childhood experiences (ACEs) on the experience of living with endometriosis. Endometriosis is a chronic disease characterized by tissue similar to the lining of the uterus growing outside of the uterus. Symptoms can include severe pelvic pain especially during menstruation, pain with intercourse and bowel movements/urination, nausea, fatigue, and infertility, and can have a profound effect on quality of life (Gao et al., 2006). There is presently no cure, with surgical excision being the gold standard for treatment; however, this is costly, often ineffective for long-term relief, and largely inaccessible (WHO, 2021). Although endometriosis is not classified as a sexual health disorder, it can have an enormous impact on sufferers' sexual function, including, but not limited to, painful sex, desire/libido, and satisfaction (Yang et al., 2021). There is limited research on the impact of ACEs on the experience of living with endometriosis. The existing literature, however, suggests that there is a link between trauma, the development of endometriosis, and the associated symptoms. One longitudinal study (1989-2013) found that out of a sample of 60,595 premenopausal women, there were 3,394 cases of confirmed endometriosis (5.6%); However, there was a 79% increased risk of confirmed endometriosis for women reporting severe-chronic abuse of multiple types. This suggests a potential link between childhood abuse and the development of endometriosis (Harris et al., 2018). Furthermore, the connections between abuse and endometriosis were stronger among women presenting without known infertility, who are more likely to be symptomatic with respect to pain, illustrating that patients who have experienced abuse could be more likely to experience more pain (Harris et al., 2018). Thus, studying the relationship between ACEs and the experience of endometriosis is an important step in unraveling these possible causal connections. Objective The goal of the present study was to determine how a history of adverse childhood experiences affects AFABs’ experience of living with endometriosis. Methods Ten participants between the ages of 18-50 who have a confirmed diagnosis of endometriosis and reside in southern California were invited to take an online Qualtrics survey. Participants' adverse childhood experiences were measured using the ACEs Questionnaire (Felitti el al., 1998). The impact of endometriosis on participants’ lives was measured using the Endometriosis Impact Questionnaire (EIQ; Moradi et al., 2019). Results Preliminary results suggest that the greater the number of adverse childhood experiences, the more severe the impact of endometriosis on participants' lives. I am presently collecting a larger sample that will allow for regression analysis. Conclusions This study will make a valuable contribution to the psychological, public health, and women’s sexual health literatures that will help practitioners better understand, interact with, and treat patients with a history of ACEs. Disclosure No

Foster parents’ history of adverse childhood experiences, adult attachment, and parenting stress

BackgroundConnections between parents’ trauma histories, adult attachment, and parenting stress are well established; those who have experienced trauma are more likely to have higher levels of insecure attachment (Jacobvitz & Reisz, 2019) and are more vulnerable to parenting stress (Steele et al., 2016) These processes in foster parents are understudied, even though they care for vulnerable children. This study examined relations between foster parents adverse childhood experiences (ACEs), adult attachment, and parenting stress. This is important to address because foster parents care for vulnerable children who can present unique stressors to caregivers. ObjectiveExamine links between ACEs, adult attachment, and parenting stress in foster parents. Participants & settingParticipants were 55 foster parents from central Texas, US, recruited from a larger RCT study. MethodsParticipants completed the ACEs questionnaire, Experiences in Close Relationships questionnaire, and Parenting Stress Inventory. ResultsFoster parents who reported higher total ACEs were more likely to report higher levels of attachment avoidance and higher levels of overall parenting stress. Foster parents who reported experiencing childhood emotional abuse reported higher levels of attachment anxiety. Those who reported experiencing childhood sexual abuse reported higher levels of parental distress. Lastly, those who reported higher levels of attachment anxiety reported higher levels of parental distress and defensive responding. ConclusionsACEs are an important factor for foster parents, particularly for parenting stress. It is crucial that appropriate support is provided to help foster parents manage parenting stress and provide optimal care for their foster children.