History Of Adverse Childhood Experiences Research Articles

An Interview With Addiction Psychiatrist Dr. Christoffel Le Roux

An Interview With Addiction Psychiatrist Dr. Christoffel Le Roux

Child maltreatment reporting in the general population: Examining the roles of community, collective efficacy, and adverse childhood experiences.

According to bystander theory, factors such as the community environment, collective efficacy, and history of adverse childhood experiences could be related to likelihood of reporting or intervening against maltreatment. An online survey was conducted with 946 general population Californians obtained through mixed-mode random probability and quota-based recruitment methods. Using an experimental vignette design, participants were randomly assigned to two scenarios: a) potential child abuse occurring in their neighborhood; b) potential child abuse in an unfamiliar neighborhood. Weighted multivariate logistic regression models assessed relationships between the vignette condition, collective efficacy, appraisal of the behavior, and likelihood of reporting or intervening. The results suggested that perceiving the vignette as occurring in your own neighborhood was associated with lower odds of viewing the behavior as appropriate and considering it abusive. Higher collective efficacy scores were associated with lower odds of viewing the incident as inappropriate but higher odds of personally intervening. Adverse childhood experiences were positively related to reporting the incident to child protective services and intervening. Bystanders may be more likely to give parents in their own neighborhood "the benefit of the doubt" by viewing their abusive behaviors as less severe, potentially leading to underreporting. Neighborhood collective efficacy might increase willingness to personally intervene, but not contact systems such as child protective services or police, suggesting that enhanced trust in communities does not extend to these institutions. Our findings have implications for neighborhood and education interventions to enhance understanding of and willingness to intervene on behalf of children.

Screening for childhood adversity among adult primary care patients.

Over half of Americans reports a history of adverse childhood experiences (ACEs), which have been associated with many chronic health conditions. Yet primary care providers infrequently screen patients for ACEs and fail to consider the relationship between ACEs and adult health. Therefore, the purposes of this study were to test the effectiveness and feasibility of a screening interview for ACEs and to confirm the prevalence of ACEs among individuals with chronic health conditions. Screening interviews were conducted with 71 adults in a primary care setting. Patients' ACE history, nurse practitioner comfort with screening, time to screen, and patient follow-up care recommendations were gathered through questionnaires. Adverse childhood experience prevalence was analyzed by descriptive statistics. Relationships between ACEs, number of clinic visits, time to screen, and follow-up care recommendations were analyzed by bivariate statistics. Over half of participants reported more than four ACEs, with ACEs common among participants with chronic health conditions (93%). Adverse childhood experience scores were positively correlated with number of clinic visits, time to screen, and recommendations for follow-up care. Findings support screening primary care patients for ACEs. Adverse childhood experiences are prevalent among primary care patients with chronic conditions. Using interviews to screen for ACEs in primary care settings is effective and feasible.

Parental Adverse Childhood Experiences and Resilience on Coping After Discharge.

Adults with a history of adverse childhood experiences (ACEs) (eg, abuse) have suboptimal health outcomes. Resilience may blunt this effect. The effect of parental ACEs (and resilience) on coping with challenges involving their children (eg, hospitalization) is unclear. We sought to quantify ACE and resilience scores for parents of hospitalized children and evaluate their associations to parental coping after discharge. We conducted a prospective cohort study at a children's hospital (August 2015-May 2016). Eligible participants were English-speaking parents of children hospitalized on the Hospital Medicine or Complex Services team. The ACE questionnaire measured the responding parent's past adversity (ACE range: 0-10; ≥4 ACEs = high adversity). The Brief Resilience Scale (BRS) was used to measure their resilience (range: 1-5; higher is better). The primary outcome was measured by using the Post-Discharge Coping Difficulty Scale via a phone call 14 days post-discharge (range: 0-100; higher is worse). Associations were assessed by using multivariable linear regression, adjusting for parent- and patient-level covariates. A total of 671 (81% of eligible parents) responded. Respondents were primarily women (90%), employed (66%), and had at least a high school degree (65%); 60% of children were white, 54% were publicly insured. Sixty-four percent of parents reported ≥1 ACE; 19% had ≥4 ACEs. The mean Brief Resilience Scale score for parents was 3.95. In adjusted analyses, higher ACEs and lower resilience were significantly associated with more difficulty coping after discharge. More parental adversity and less resilience are associated with parental coping difficulties after discharge, representing potentially important levers for transition-focused interventions.

Disrupted Executive Function and Aggression in Individuals With a History of Adverse Childhood Experiences: An Event-Related Potential Study.

Here, we explored the functional and neural mechanisms underlying aggression related to adverse childhood experiences. We assessed behavioral performance and event-related potentials during a go/no-go and N-back paradigm. The participants were 15 individuals with adverse childhood experiences and high aggression (ACE + HA), 13 individuals with high aggression (HA), and 14 individuals with low aggression and no adverse childhood experiences (control group). The P2 latency (initial perceptual processing) was longer in the ACE + HA group for the go trials. The HA group had a larger N2 (response inhibition) than controls for the no-go trials. Error-related negativity (error processing) in the ACE + HA and HA groups was smaller than that of controls for false alarm go trials. Lastly, the ACE + HA group had shorter error-related negativity latencies than controls for false alarm trials. Overall, our results reveal the neural correlates of executive function in aggressive individuals with ACEs.

High-ACE Low Wage Workers: Occupational Health Nursing Research and Praxis Through a Trauma-Informed Lens.

Individuals with a history of adverse childhood experiences (ACEs) disproportionately have poor mental and physical health outcomes. These experiences affect individuals across the life span extending beyond health with deleterious impact on work-related outcomes. Low-wage workers are particularly at risk. Social service and health organizations are becoming aware of the extent to which the populations they serve have been affected by these experiences. Employment support programs may serve high-ACE individuals but likely are unaware of their histories and the developmental or health deficits that result and can impinge on successful employment. Occupational health nurses may be well-positioned not only to implement trauma-informed care in workplaces but also to influence the ways in which employment services for this vulnerable group are delivered. The purpose of this article is to consider how ACEs could affect vulnerable workers. The need for trauma-informed research and praxis to advance occupational health nursing is discussed.

The role of adverse childhood experiences as determinants of non-suicidal self-injury among children and adolescents referred to community and inpatient mental health settings

The objectives of this study were to examine the prevalence of, and determine the effect of adverse childhood experiences on non-suicidal self-injury among children and adolescents referred to community and inpatient mental health settings. Data for this study were obtained from the interRAI Child and Youth Mental Health dataset. A total of 2038 children and adolescents aged 8–18 years (M=12.49; SD=2.88, 61.1% males) were analyzed. Binary logistic regression was fitted to identify predictors of non-suicidal self-injury as a function of adverse childhood experiences, depression, and social support while simultaneously controlling for age, gender, type of patient, legal guardianship, marital status of parents/caregivers, history of foster family placement, and mental health diagnoses. Of the 2038 children and adolescents examined, 592 (29%) of this clinical sample engaged in non-suicidal self-injury. In the multivariate logistic regression model, children and adolescents who were physically abused had 49% higher odds of engaging in non-suicidal self-injury and children and adolescents who were sexually abused had 60% higher odds of engaging in non-suicidal self-injury, when compared to their non-abused counterparts. Other predictors of non-suicidal self-injury include: older age, female gender, inpatient status, depression, attention deficit-hyperactivity disorder, disruptive behavior disorder, and mood disorders. Children and adolescents who had some form of social support had a 26% decrease in the odds of engaging in non-suicidal self-injury. Assessment procedures for indicators of mental health, particularly among children and adolescents with a history of adverse childhood experiences, should also take into account non-suicidal self-injury. In addition to bolstering social support networks, addressing depression and related emotion regulation skills in childhood may help prevent future non-suicidal self-injury behaviors.

Suicidal behaviors and associated factors among university students in six countries in the Association of Southeast Asian Nations (ASEAN).

A large data gap remains on suicidal behaviors among youth in the Association of Southeast Asian Nations (ASEAN) countries, despite the increasing rates of suicide in Asian cultures that may be related to rapid economic changes and the loss of social stability. This study was therefore conducted to explore the prevalence of and factors associated with suicidal ideation and suicide attempts among university students in six ASEAN member states. Data were collected in a cross-sectional survey of 4675 undergraduate university students, mean age 20.6 years (SD=2.7), range of 18-30 years, from Cambodia, Indonesia, Malaysia, Myanmar, Thailand and Vietnam. The overall prevalence of ever suicidal ideation and ever suicide attempt among students in this study was 11.7% and 2.4%, respectively. Different rates of these suicidal behaviors were observed across the countries. In multivariable logistic regression models, suicidal ideation was significantly associated with psychosocial factors including childhood sexual abuse, depressive symptoms, involvement in physical fights, and poor academic performance as well as socio-environmental factors including living with parents or guardians and low involvement in organized religious activity. Suicide attempt was significantly associated with childhood sexual abuse, depressive symptoms, low involvement in organized religious activity and being underweight or overweight. Our findings suggest that individual-level strategies for suicide prevention should be targeted toward students with poor academic performance, mental health problems and a history of adverse childhood experiences. Particular attention should be paid to the role of families that could be a potential stressor in the lives of university students.

The Impact of Early Childhood Adversity on Self-Care in Adulthood

This article gives an overview of how Adverse Childhood Experiences (ACE) influence self-management and control of type 2 diabetes in later life. This qualitative multiple case study focused on 20 adults with a history of adverse childhood experiences and type-2 diabetes at two clinical sites in Harlem and the Bronx. In addition to discovering that emotional and physical neglect; physical abuse and separation of a family member(s) were the most common forms of adverse childhood experiences encountered by this group of participants, it became clear from these interviews that participants fell into 3 groups, the Proactive, the Debilitated, and the Deniers. Poignant participant stories are given to reflect each group. A Trauma Informed Primary Care (TIPC) model is discussed as a guideline for healthcare providers to help them work and advocating for this patient population.

The Impact of a History of Adverse Childhood Experiences on Breastfeeding Initiation and Exclusivity: Findings from a National Population Health Survey.

Exclusive breastfeeding is strongly recommended by the World Health Organization. Given the low rate of exclusive breastfeeding in Canada and the increasing reports of a history of adverse childhood experiences, this study sought to investigate the association between a history of adverse childhood experiences and breastfeeding initiation and breastfeeding. Data used for this study were based on the 2011-2012 Canadian Community Health Survey, collected using a cross-sectional survey. The outcome measures were breastfeeding initiation and exclusive breastfeeding for 6 months or more. History of adverse childhood experiences was the main explanatory variable. Multivariable logistic regression models were developed to investigate the effect on breastfeeding initiation and on exclusive breastfeeding in women who gave birth within 5 years before when the surveys were conducted. The study sample included 697 and 633 women for analyses on breastfeeding initiation and breastfeeding, respectively. The proportion of women with breastfeeding initiation and exclusive breastfeeding for up to 6 months in this study were 96.8% and 42.8%, respectively. After controlling for age and highest level of education, having a history of adverse childhood experiences was not significantly associated with breastfeeding initiation (odds ratio [OR] 0.46, 95% confidence interval [CI] 0.10-1.87), but mothers with such history were less likely to exclusively breastfeed for up to 6 months compared with those without (OR 0.53, 95% CI 0.31-0.90). These findings suggest the need for more breastfeeding monitoring programs beyond the hospital environment to provide more support to Canadian mothers, especially those who have experienced adverse childhood experiences or trauma in the past.

P.1.k.004 Historical cohort study in psychiatric emergency care: 2007–2013

The objectives of this study were to examine the prevalence of, and determine the effect of adverse childhood experiences on non-suicidal self-injury among children and adolescents referred to community and inpatient mental health settings. Data for this study were obtained from the interRAI Child and Youth Mental Health dataset. A total of 2038 children and adolescents aged 8–18 years (M = 12.49; SD = 2.88, 61.1% males) were analyzed. Binary logistic regression was fitted to identify predictors of non-suicidal self-injury as a function of adverse childhood experiences, depression, and social support while simultaneously controlling for age, gender, type of patient, legal guardianship, marital status of parents/caregivers, history of foster family placement, and mental health diagnoses. Of the 2038 children and adolescents examined, 592 (29%) of this clinical sample engaged in non-suicidal self-injury. In the multivariate logistic regression model, children and adolescents who were physically abused had 49% higher odds of engaging in non-suicidal self-injury and children and adolescents who were sexually abused had 60% higher odds of engaging in non-suicidal self-injury, when compared to their non-abused counterparts. Other predictors of non-suicidal self-injury include: older age, female gender, inpatient status, depression, attention deficit-hyperactivity disorder, disruptive behavior disorder, and mood disorders. Children and adolescents who had some form of social support had a 26% decrease in the odds of engaging in non-suicidal self-injury. Assessment procedures for indicators of mental health, particularly among children and adolescents with a history of adverse childhood experiences, should also take into account non-suicidal self-injury. In addition to bolstering social support networks, addressing depression and related emotion regulation skills in childhood may help prevent future non-suicidal self-injury behaviors.

A comparison of methods to assess intimate partner abuse 1 year postpartum

Youth and young adults with pain conditions report having a history of adverse childhood experiences (ACEs) more frequently than their healthy peers. The relationship between ACEs and pain before adolescence in population-based settings is not extensively researched.To examine the association between the history of ACEs and bodily pain at 10 years of age.Cross-sectional analysis of 4738 participants of Generation XXI population-based birth cohort, recruited in 2005–06 in Porto, Portugal.Study includes self-reported data on ACEs exposures and bodily pain (pain presence, sites, and intensity a week prior to the interview). Adjusted odds ratios (AOR) and 95% confidence intervals (CI) were obtained from binary and multinomial logistic regression analyses to estimate the likelihood of various pain features according to the extent of exposure to ACEs (i.e., 0 ACEs, 1–3 ACEs, 4–5 ACEs, and ≥ 6 ACEs).Prevalence of pain, multisite, and high-intensity pain a week prior to the interview increased with increasing exposure to ACEs. After controlling for sociodemographic characteristics, children who had experienced ≥6 ACEs were more likely to report pain [AOR 3.18 (95% CI 2.19, 4.74)], multisite pain [AOR 2.45 (95% CI 1.37, 4.40)], and high-intensity pain [AOR 4.27 (95% CI 2.56, 7.12)] compared with children with no ACEs.A dose-response association was observed between the cumulative number of ACEs and reports of pain in 10-year-old children, suggesting that embodiment of ACEs starts as early as childhood and that pain related to ACEs begins earlier than previously reported.

Note from the Editor

Note from the Editor Virginia M. Brennan, PhD, MA Increasingly over the past decade and a half, public health scholars and practitioners have endeavored to involve communities in the planning and execution of programs and research conducted in those communities. Many of the people who read and write for JHCPU work these fields every day. In Part 1 of the present issue (Working with Communities), we venture into some particular communities, guided by people who work there. We learn about a Tennessee program for low-income women’s prenatal care started by students and faculty at Meharry Medical College and Vanderbilt University over forty years ago that continues to this day (Elkins et al.) and about the efforts of Golden Valley Health Centers in California to formally assess the linguistic proficiency of bilingual staff members who serve as interpreters (Nunez de Jaimes et al.). The research section of Part 1 opens with a paper about an interactive mobile tablet application for assessing risk of early childhood caries, called MySmile Buddy (Chinn et al.). A collaborative group of professionals developed and implemented MySmile Buddy; the authors got good results when they tested its utility for community health workers and its acceptability to low-income mothers in New York City. An intervention in Philadelphia is designed to improve the lives and trajectory of victims of interpersonal violence seen in city hospitals (Corbin et al.) Researchers assessed the frequency of post-traumatic stress disorder and a history of adverse childhood experiences among participants, finding them extremely widespread. This information will enable practitioners to tailor their violence-prevention initiatives to fit people with such profiles. Next, we learn from Ahlers-Schmidt et al. what their Spanish-speaking participants in Kansas reported finding most useful in health-related text messages, a form of communication that this community favors (perhaps due to limited access to e-mail). More than English-speakers, the respondents in this study wanted explanations of why certain vaccines were important, and shorthand definitions of medical terms, as well as reminders of appointments and related practicalities. The paper by Jiminez and colleagues on how parental health literacy affects early intervention with at-risk children in hospitals affiliated with the University of Pennsylvania, is related. Gower and colleagues looked into why nearly half the low-income individuals referred for eye exam follow-ups over the course of two years failed to return, finding that transportation and inadequate reminders continue to impede care. This research took place at Physician’s Free Clinic (a specialty clinic) in Columbus, Ohio. Klein et al.’s research also took place in clinic settings in Ohio: these authors report on the successful implementation of a medical-legal partnership that connects families in need to legal aid through pediatrician visits. The three long research papers in the Working with Communities section cover a broad spectrum: The first (Kiesler et al.) is an exploration of the social determinants of health of people working on the backstretch at horse-racing tracks, an old venue where the changing populations of the most needy workers in the U.S. have long put their bodies on the line in tough conditions for very little pay. Today, its denizens tend [End Page x] to be Latino. The Photovoice method is an especially inviting way for community members to work with professional researchers and we see it employed to good effect here. Next, we turn to a different perspective on health inequities: Close and colleagues held focus groups with African American participants in Florida exploring how aware people were of the sharp disparities in infant mortality between African Americans and Whites—in some counties in Florida, Black infant mortality is four times as high as White infant mortality—and discussing people’s ideas about the reasons for these disparities. Here, then, the tangible outcomes are in education, expression, and activation of community members on a critical public health problem. The Working with Communities section concludes with Martin, Howell, et al. on recruiting Latinas into a randomized control trial. The specter of cancer loomed over the Industrial Age and continues to loom over us in the Information Age. Part 2 of this issue (Cancer) contributes...

Association Between Childhood Adversities and Suicide Attempts Among Alcoholic Inpatients in Taiwan

Alcohol dependence is frequently associated with suicide attempts. A history of adverse childhood experiences (ACEs) increases the risk of emotional and behavioral problems in adulthood. Child abuse is reported to increase suicide risk among alcohol-dependent patients. However, other types of ACEs, including ACEs related to family dysfunction that may have exceptional impact among the Chinese, are rarely explored. The contribution of a broad spectrum of ACEs to lifetime risk of suicide attempts among alcoholic inpatients in Taiwan was examined. Family Health History Questionnaires were used to assess ACEs among 194 male alcohol-dependent inpatients admitted for alcohol detoxification. Logistic regression analysis was applied to examine the prediction of ACEs for lifetime risk of suicide attempts. The rate of attempted suicide in this cohort was 27.4%. The prevalence of ACEs was high, with around 90% of participants reporting at least one type of ACE. In the regression analysis, after adjusting for lifetime depression, illicit drug use, and severity of alcohol dependence, having had a battered mother (odds ratio [OR] = 3.99, 95% CI [1.40, 11.34]) and having parents who were separated/divorced (OR = 7.35, 95% CI [1.56, 34.72]) were associated with the risk of suicide attempts, but having experienced physical and sexual abuse were not. A 1-unit increase in childhood adversity raised the likelihood of a suicide attempt by 61% (OR = 1.61, 95% CI [1.16, 2.25]). There is a direct and graded relationship between childhood adversities and lifetime risk of suicide attempts among male alcoholic patients. In Chinese societies, adversities related to parental separation, divorce, and interparental violence may have a specific effect in aggravating suicide risk.

Adverse childhood experiences and sleep disturbances in adults

Sleep disturbances are associated with an increased risk for many chronic diseases and unhealthy behaviors. A history of adverse childhood experiences (ACEs) is also associated with similar adult health outcomes. We studied the relationship between multiple ACEs and the likelihood of experiencing self-reported sleep disturbances in adulthood. We used data from the adverse childhood experiences (ACE) study, a retrospective cohort study of 17,337 adult health maintenance organization members in California who completed a survey about eight ACEs, which included childhood abuse and growing up with various forms of household dysfunction. The self-reported sleep disturbances measured included ever having trouble falling or staying asleep and feeling tired after a good night's sleep. We used an integer count of the number of ACEs (the ACE score) to assess the cumulative impact of these experiences on the likelihood of self-reported sleep disturbances. Thirty-three percent of the cohort reported trouble falling or staying asleep, while 24% reported feeling tired after sleeping. All eight ACE categories were associated with an increased likelihood of self-reported sleep disturbances (p<0.05). Compared to persons with an ACE score of 0, those with an ACE score ≥ 5 were 2.1 (95% CI: 1.8-2.4) times more likely to report trouble falling or staying asleep and 2.0 (95% CI: 1.7-2.3) times more likely to report feeling tired even after a good night's sleep. The trend for increasing odds for both types of self-reported sleep disturbance with increasing ACE scores was statistically significant (p<0.0001). Adverse childhood experiences were associated with self-reported sleep disturbances in adulthood, and the ACE score had a graded relationship to these sleep disturbances. A history of ACEs should be obtained for patients with self-reported sleep disturbances to coordinate services that ameliorate the long-term effects of these events.

Prevalence and correlates of poor sleep quality among medical students at a Nigerian university

Objective : This study aimed to determine the prevalence and factors associated with poor sleep quality among medical students at a Nigerian university. Materials and Methods : In a cross sectional survey, the sleep quality of students (n=255) was assessed using the Pittsburgh Sleep Quality Index (PSQI). In addition to obtaining sociodemographic data, history of adverse childhood experiences and drug use, measures assessing daytime sleepiness, fatigue and psychiatric morbidity were also administered. Results : Almost a third (32.5%) of medical students reported poor quality sleep. The presence of a chronic illness (OR: 5.10, 95% CI: 1.53-17.11, P P P Conclusion: Poor quality of sleep is common among medical students, and is associated with predisposing and several modifiable factors. Strategies to improve sleep quality are suggested.

Adverse Childhood Experiences and Sexual Risk Behaviors in Women: A Retrospective Cohort Study

Adverse childhood experiences such as physical abuse and sexual abuse have been shown to be related to subsequent unintended pregnancies and infection with sexually transmitted diseases. However, the extent to which sexual risk behaviors in women are associated with exposure to adverse experiences during childhood is not well-understood. A total of 5,060 female members of a managed care organization provided information about seven categories of adverse childhood experiences: having experienced emotional, physical or sexual abuse; or having had a battered mother or substance-abusing, mentally ill or criminal household members. Logistic regression was used to model the association between cumulative categories of up to seven adverse childhood experiences and such sexual risk behaviors as early onset of intercourse, 30 or more sexual partners and self-perception as being at risk for AIDS. Each category of adverse childhood experiences was associated with an increased risk of intercourse by age 15 (odds ratios, 1.6-2.6), with perceiving oneself as being at risk of AIDS (odds ratios, 1.5-2.6) and with having had 30 or more partners (odds ratios, 1.6-3.8). After adjustment for the effects of age at interview and race, women who experienced rising numbers of types of adverse childhood experiences were increasingly likely to see themselves as being at risk of AIDS: Those with one such experience had a slightly elevated likelihood (odds ratio, 1.2), while those with 4-5 or 6-7 such experiences had substantially elevated odds (odds ratios, 1.8 and 4.9, respectively). Similarly, the number of types of adverse experiences was tied to the likelihood of having had 30 or more sexual partners, rising from odds of 1.6 for those with one type of adverse experience and 1.9 for those with two to odds of 8.2 among those with 6-7. Finally, the chances that a woman first had sex by age 15 also rose progressively with increasing numbers of such experiences, from odds of 1.8 among those with one type of adverse childhood experience to 7.0 among those with 6-7. Among individuals with a history of adverse childhood experiences, risky sexual behavior may represent their attempts to achieve intimate interpersonal connections. Having grown up in families unable to provide needed protection, such individuals may be unprepared to protect themselves and may underestimate the risks they take in their attempts to achieve intimacy. If so, coping with such problems represents a serious public health challenge.