Lifetime Adversity Research Articles

Quality of Life Among Senior Citizens in Bhutan.

This study explored associations between quality of life (QOL), spirituality, social integration, chronic diseases, and lifetime adversity among people aged 60 years and older in Bhutan. Adults aged 60 to 101 years (n = 337) completed face-to-face interviews. The main measure included the World Health Organization QOL questionnaire and Adverse Childhood Experiences International Questionnaire. The social relationships domain of QOL had the highest mean. Frequent back pain, memory decline, depression, mobility impairment, insomnia, and lung diseases were commonly reported and negatively related to QOL. Compared with women, men reported fewer physical and mental health problems and better QOL. Multivariate analysis revealed that cumulative health problems, psychological distress, and social connectedness contributed significantly to overall QOL. The measure of spirituality was negatively associated with QOL, which is not conclusive and suggests the need for more research especially when the influence of spiritualism is highly visible in the everyday lives of Bhutanese people. The significance of these findings is discussed in relation to care for elderly people in Bhutan.

Integrating male sexual diversity into violence prevention efforts with men and boys: evidence from the Asia-Pacific Region

Men’s perpetration of gender-based violence remains a global public health issue. Violence prevention experts call for engagement of boys and men to change social norms around masculinity in order to prevent gender-based violence. Yet, men do not comprise a homogenous category. Drawing on probability estimates of men who report same-sex practices and preferences captured in a multi-country gender-based violence prevention survey in the Asia-Pacific region, we test the effects of sexuality-related factors on men’s adverse life experiences. We find that sexual minority men face statistically higher risk of lifetime adversity related to gender-based violence, stemming from gender inequitable norms in society. Sexuality is thus a key axis of differentiation among men in the Asia-Pacific region, influencing health and wellbeing and reflecting men’s differential engagement with dominant norms of masculinity. Integrating awareness of male sexual diversity into gender-based violence prevention interventions, particularly those that work with boys and men, and bridging violence prevention programming between sexual minority communities and women, are essential to tackle the root drivers of violence.

Adversity-induced relapse of fear: neural mechanisms and implications for relapse prevention from a study on experimentally induced return-of-fear following fear conditioning and extinction.

The efficacy of current treatments for anxiety disorders is limited by high relapse rates. Relapse of anxiety disorders and addiction can be triggered by exposure to life adversity, but the underlying mechanisms remain unexplored. Seventy-six healthy adults were a priori selected for the presence or absence of adverse experiences during childhood (CA) and recent past (RA; that is, past 12 months). Participants underwent fear conditioning (day 1) and fear extinction and experimental return-of-fear (ROF) induction through reinstatement (a model for adversity-induced relapse; day 2). Ratings, autonomic (skin conductance response) and neuronal activation measures (functional magnetic resonance imaging (fMRI)) were acquired. Individuals exposed to RA showed a generalized (that is, not CS− specific) fear recall and ROF, whereas unexposed individuals showed differential (that is, CS+ specific) fear recall and ROF on an autonomic level despite no group differences during fear acquisition and extinction learning. These group differences in ROF were accompanied by corresponding activation differences in brain areas known to be involved in fear processing and differentiability/generalization of ROF (that is, hippocampus). In addition, dimensional measures of RA, CA and lifetime adversity were negatively correlated with differential skin conductance responses (SCRs) during ROF and hippocampal activation. As discriminating signals of danger and safety, as well as a tendency for overgeneralization, are core features in clinically anxious populations, these deficits may specifically contribute to relapse risk following exposure to adversity, in particular to recent adversity. Hence, our results may provide first and novel insights into the possible mechanisms mediating enhanced relapse risk following exposure to (recent) adversity, which may guide the development of effective pre- and intervention programs.

Which category of lifetime adversity accelerates physical impairment among Israeli older adults?

Preliminary evidence suggests that exposure to lifetime cumulative adversity is related to faster increase in physical impairment with time, especially when depressive symptoms are present. Nevertheless, it is still unclear whether different adversity categories accelerate impairment. The current study capitalized on the unique accounts of adversity available in the Israeli component of the Survey of Health, Ageing and Retirement in Europe (SHARE-Israel) by focusing on different categories of adversity, while accounting for their interaction with depressive symptoms in predicting trajectories of physical impairment (i.e., chronic medical conditions and disability). Data of 1665 participants (mean age=63.08, SD=10.04 at Wave 1) were drawn from the first three waves of SHARE-Israel. Respondents reported exposure to bereavement (e.g., experiencing the death of a spouse), war and terrorism (e.g., being wounded in terrorist attack), and victimization (e.g., being a victim of abuse or assault). Other measures assessed depressive symptoms, chronic medical conditions, and disability. Growth-curve models showed that bereavement and exposure to war and terrorism were related to specific measures of physical impairment. Moreover, three-way interactions showed that clinical level of depressive symptoms coupled with exposure to either bereavement or war and terrorism predicted a faster increase in chronic medical conditions and disability. The findings offer a differentiated outlook on the effect of adversity on age-related increase in physical impairment. Practitioners should consider that older adults previously exposed to bereavement, war and terrorism are at risk for a hastened physical decline, especially when they suffer from depressive symptoms.

Polyvictimization and Youth Violence Exposure Across Contexts

PurposeThe current research used latent class analysis to uncover groups of youth with specific victimization profiles and identify factors that are associated with membership in each victimization group. MethodsThis study used data from National Survey of Children Exposure to Violence II. Random digit dialing and address-based sampling were used to obtain a nationally representative sample of 2,312 youth ages 10–17 years. Phone interviews, averaging 55 minutes in length, were conducted with caregivers to obtain both consent and background information and then with youths themselves. ResultsSix groups of youth emerged: (1) nonvictims (26.4%), (2) home victims (8.4%), (3) school victims (20.8%), (4) home and school victims (21.3%), (5) community victims (5.4%), and (6) polyvictims (17.8%). Polyvictims were likely to have been victimized in multiple settings by multiple perpetrators and experienced the most serious aggravating characteristics, including incidents involving a weapon, injury, or a sexual component. Youth in the polyvictim class experienced the highest number of different victimizations types in the past year and had the most problematic profile in other ways, including greater likelihood of living in disordered communities, high probabilities of engaging in delinquency of all types, elevated lifetime adversity, low levels of family support, and the highest trauma symptom scores. ConclusionsThe study supports the contention that a core basis of the particularly damaging effects of polyvictimization is the experience of victimization across multiple domains of the child's life.

Plasma apolipoprotein E and severity of suicidal behaviour

There is evidence for association between low cholesterol levels and suicidal behaviour. Since apolipoprotein E (ApoE) is involved in the cholesterol metabolism in both the periphery and in the central nervous system; it may be of particular interest in the neurobiology of suicidal behaviour. Furthermore, hypothalamic–pituitary–adrenal (HPA) axis function, one of the main biological systems implicated in both suicidal behaviour and early-life adversity, affect ApoE levels. Very few studies have assessed plasma ApoE in relation to suicidal behaviour. The purpose of this study was to investigate levels of ApoE in plasma in relation to the severity of suicidal behaviour and life-time adversity in the form of exposure to interpersonal violence in suicide attempters. A total of 100 suicide attempters (67 women and 33 men) were enroled in the study. Information on earlier suicide attempts and age at onset of suicidal behaviour was gathered using the Karolinska Suicide History Interview. The Karolinska Interpersonal Violence Scale was used to assess exposure to interpersonal violence. Plasma ApoE was measured by immunonephelometry according to accredited routines. Patients with at least one earlier suicide attempt had significantly higher ApoE levels compared to suicide attempters debuting with suicidal behaviour at inclusion in the study. A higher number of earlier suicide attempts was significantly correlated with higher plasma ApoE levels. Age at onset was significantly negatively correlated with ApoE after adjusting for age. ApoE showed a significant positive correlation with exposure to interpersonal violence as a child in male suicide attempters. Our findings indicate that ApoE may be related to stress and trauma and the temporal severity of suicidal behaviour.

Indicators of resilience and healthcare outcomes: findings from the 2010 health and retirement survey.

To test the hypothesis that higher levels of resilience indicators are associated with lower overall healthcare utilization (HCU) as well as improvements in self-rated health (SRH), we analyzed a representative sample of 4562 adults 50-70 years old enrolled in the US 2010 health and retirement survey. Multivariable logistic regression models estimated odds ratios (ORs) and 95 % confidence intervals (CIs) for high versus low resilience in relation to HCU and SRH improvements over 2 years. Resilience indicators included: cumulative lifetime adversity, social support, global mastery and domain-specific mastery. Cumulative lifetime adversity was defined as 0, 1-2, 3-4 or 5+ events. HCU included hospitalization (any vs. none) and physician visits (< 20 vs. ≥ 20) over 2 years. Hospitalization odds declined by 25 % (OR 0.75, 95 %CI 0.64-0.86), odds of ≥ 20 physician visits declined by 47 % (OR 0.53, 95 % CI 0.45-0.63) and the odds of SRH improvement increased by 49 % (OR 1.49, 95 % CI 1.17-1.88) for respondents with high versus low health mastery. Cumulative lifetime adversity manifested a dose-dependent positive relationship with HCU. Specifically, hospitalization odds was, respectively, 25, 80 and 142 % elevated for participants that reported 1-2, 3-4 and 5+ versus 0 lifetime adversities. High versus low global, financial and health mastery, respectively, predicted improved SRH, lower physician's visits and hospitalizations. In this sample of adults near or in retirement, resilience predicted lower HCU and improved SRH. Resilience is a dynamic state that can be enhanced in adults with positive impacts on subjective well-being and HCU.

Cumulative burden of lifetime adversities: Trauma and mental health in low-SES African Americans and Latino/as.

This study examined the utility of a lifetime cumulative adversities and trauma model in predicting the severity of mental health symptoms of depression, anxiety, and posttraumatic stress disorder. We also tested whether ethnicity and gender moderate the effects of this stress exposure construct on mental health using multigroup structural equation modeling. A sample of 500 low-socioeconomic status African American and Latino men and women with histories of adversities and trauma were recruited and assessed with a standard battery of self-report measures of stress and mental health. Multiple-group structural equation models indicated good overall model fit. As hypothesized, experiences of discrimination, childhood family adversities, childhood sexual abuse, other childhood trauma, and chronic stresses all loaded on the latent cumulative burden of adversities and trauma construct (CBAT). The CBAT stress exposure index in turn predicted the mental health status latent variable. Although there were several significant univariate ethnic and gender differences, and ethnic and gender differences were observed on several paths, there were no significant ethnic differences in the final model fit of the data. These findings highlight the deleterious consequences of cumulative stress and trauma for mental health and underscore a need to assess these constructs in selecting appropriate clinical interventions for reducing mental health disparities and improving human health.

Long-Term Mental Health Among Low-Income, Minority Women Following Exposure to Multiple Natural Disasters in Early and Late Adolescence Compared to Adulthood

High impact experiences following a natural disaster have been shown to influence later psychopathology. Individual-level factors such as age may also contribute to a disaster's impact on mental health, though it is unclear whether young age confers a protective effect or represents a period of increased risk as compared to adulthood. The present study evaluated the influence of adolescent age and hurricane experiences on mental health in the years following multiple hurricanes in the New Orleans region. 794 women, currently aged 18-45, participating in a cohort study of lifetime adversity and reproductive health completed a survey about hurricane experience and current mental health. Joint associations between disaster experience and age at the time of disaster on depression and post-traumatic stress disorder (PTSD) were evaluated. Compared to women who were adults at the time of the disaster, being in early adolescence resulted in reduced depression and PTSD up to 9-years post-disaster, controlling for hurricane experiences, time since disaster, and income. A similar effect was not observed among older adolescents. Increased endorsement of feeling one's life was in danger and experiencing illness or injury resulted in increased odds of depression, while danger was associated with increased odds of PTSD. Younger age at the time of a natural disaster may confer a protective effect on mental health outcomes post-disaster, even when disaster experiences are considered, potentially representing the importance of parental support and cognitive development on disaster effects.

Risk factors for alcoholism in the Oklahoma Family Health Patterns project: Impact of early life adversity and family history on affect regulation and personality

AimThis study examined the impact of early lifetime adversity (ELA) on affect regulation and personality in persons with family history (FH+) and without (FH−) a family history of alcoholism. We examined the impact of early life adversity in healthy young adults, 18–30 years of age enrolled in a long-term study on risk for alcohol and other substance abuse. MethodsELA was assessed by a composite score of low socioeconomic status and personal experience of physical or sexual abuse and/or separation from parents before age 16, resulting in a score of 0, 1–2, or >3 adverse events. Unstable affect regulation and personality variables were obtained via self-report measures. ResultsHigher ELA scores were seen in FH+ (χ2=109.2, p<0.0001) and in women (χ2=17.82, p=0.0019). Although higher ELA predicted less emotional stability and more behavioral undercontrol, further analysis including both FH and ELA showed that FH+ persons are prone to poor affect regulation, negative moods, and have risky drinking and drug abuse tendencies independent of ELA level. ELA predicts reduced stress reactivity and poorer cognitive control over impulsive behaviors as shown elsewhere. ConclusionsThe present work shows that FH+ have poor mood regulation and antisocial characteristics. The greater prevalence of ELA in FH+ persons indicates that life experience and FH+ work in tandem to result in risky patterns of alcohol and drug experimentation to elevate risk for alcoholism. Further studies of genetic and environmental contributions to alcoholism are called for.

Bisexuality and Mental Health: Future Research Directions

Studies have indicated that bisexual individuals may report worse mental health than their heterosexual and gay/lesbian counterparts. This article reviews research related to bisexuality and mental health. Further, the main theories relevant to why bisexual individuals may face mental health disparities—namely, minority stress and lifetime adversity—are discussed. Based on a review of the literature, the second part of the article outlines directions for future research on bisexuality and mental health. It is suggested that studies explore how sexual orientation disclosure; lesbian, gay, bisexual, and transgender community support; and sexual behavior may help to explain the association between bisexuality and mental health.

The effect of lifetime adversities on resistance to antipsychotic treatment in schizophrenia patients

AimThe aim of this study is to examine whether there is an association between cumulative life adversities and treatment-resistant schizophrenia. MethodsWe recruited 186 participants diagnosed with schizophrenia spectrum disorders. Adverse life-events were assessed using the Stressful Life Events Screening Questionnaire (SLESQ) and the Childhood Trauma Questionnaire (CTQ). Treatment resistant status was identified using the criteria of the American Psychiatric Association for refractory schizophrenia. We performed a multiple logistic regression model, including life adversities, to predict the treatment resistant status controlling for confounding variables. ResultsForty two percent of the patients were found to be treatment resistant (n=78) and 58% were non-treatment resistant (n=108). The treatment resistant group had higher score on both SLESQ and CTQ (4.5±3.3 and 54.7±19.7) than the non-treatment resistant group (2.5±2.3 and 47.7±17.5) and the difference between the two groups was significant for both SLESQ (p<0.001) and CTQ (p=0.011). After adjustment for demographic variables and previously reported risk factors of treatment resistance, the association remained significant for SLESQ (OR=1.20, 95% CI 1.05–1.38; p=0.009) but not for CTQ (p=0.13). DiscussionThe results suggest that cumulative lifetime adversities could have an independent effect on the resistance to treatment in schizophrenia spectrum disorders. Routine assessment of trauma exposures and an individualized bio-psycho-social formulation is necessary for a personalized treatment.

The effect of lifetime cumulative adversity and depressive symptoms on functional status.

The study aimed to examine whether lifetime cumulative adversity (LCA) and depressive symptoms moderate time-related trajectories of functional status. A total of 15,073 older adults (mean age = 63.91 at Wave 1) who participated in the first four waves of the Survey of Health, Ageing and Retirement in Europe reported on exposure to negative life events, depressive symptoms and three measures of functional status-difficulty in performing daily and instrumental activities, and functional limitation. Growth-curve models showed that time-related increase in disability and functional limitation was steeper among those exposed to higher levels of lifetime adversity. Moreover, a three-way interaction between time, lifetime adversity, and depressive symptoms emerged across measures of functional status, so that when exposure to lifetime adversity was accompanied by high level of depressive symptoms, the time-related increase in disability and functional limitation was the steepest. LCA is associated with a hastening of the disablement process, especially under conditions of high distress. Although the overall modest effects imply that resilience to lifetime adversity is widespread among older adults, prevention and intervention programs should consider that distressed older adults previously exposed to high levels of lifetime adversity are at risk for more rapid impairment in functional status.

The 16-year course of shame and its risk factors in patients with borderline personality disorder

The current study had two aims. The first was to examine the course of shame over 16 years of prospective follow-up among borderline patients and axis II comparison subjects. The second was to determine risk factors associated with feelings of shame among borderline patients. A total of 290 borderline inpatients and 72 axis II comparison subjects were assessed using a series of semi-structured interviews and self-report measures at baseline, and 87% of surviving patients were reassessed at eight waves of follow-up. Borderline patients reported significantly higher levels (2.6 times) of shame (assessed with one item) across 16 years of follow-up than axis II comparison subjects. However, the severity of shame decreased (78% relative decline) significantly over time for both groups. Regarding risk factors, four lifetime adversity risk factors were found to be significantly associated with feelings of shame. Two of these factors (severity of childhood sexual abuse and severity of childhood neglect) remained significant in multivariate analyses. Taken together, the results of this study suggest that borderline patients struggle with intense but decreasing feelings of shame. They also suggest that childhood adversities are significant risk factors for this dysphoric affective state.

Research Facts about Resilience

Resilience is a dynamic process, through which, a person succeed to adapt to various lifetime adversities. Resilience perception and conceptualization have been changed through time. The resilience significance, broadening and components knew continuous changes, its complexity making difficult to develop thorough and standardized studies. The study of resilience went through several stages, trying to identify the factors involved in resilience, its explanatory processes and mechanisms and to develop interventions that enhance resilience. The lack of consensus on definition of the construct, the existence of multiple, various elements of resilience, the numerous measures meant to quantify resilience cause confusion within the field and ignite criticism of resilience theory. There is a need in the scientific realm for construct clarification for practical application and evaluation.

Greater age-related decline in markers of physical, mental and cognitive health among Israeli older adults exposed to lifetime cumulative adversity

Objectives: This longitudinal investigation addressed whether and how lifetime cumulative adversity and depressive symptoms moderated age-related decline in markers of physical, mental, and cognitive health.Method: 1248 older adults (mean age = 62 at Wave 1) who completed the first two waves of the Israeli component of the Survey of Health, Ageing and Retirement in Europe (SHARE-Israel) reported on exposure to potentially traumatic life events, depressive symptoms, and three outcomes – disability, quality of life, and cognitive markers.Results: Age was related to greater functional decline in outcome measures across the two waves (i.e., increase in disability and decrease in quality of life and cognitive functioning). This age-related decline became stronger as lifetime adversity increased. A three-way interaction showed that the greatest age-related functional decline in outcome measures was especially salient among those with high level of lifetime adversity and high level of depressive symptoms.Conclusion: Lifetime cumulative adversity is associated with a more noticeable process of age-related dysfunction across various markers of health. Although the majority of older adults are resilient to lifetime adversity, prevention and intervention programs should be aimed at mitigating the pronounced senescence observed when adversity accumulated to a large degree, and especially when it is accompanied with high level of distress.

Discursive Resilience

Discursive Resilience

An Upside to Adversity?

Despite common findings suggesting that lack of negative life events should be optimal, recent work has revealed a curvilinear pattern, such that some cumulative lifetime adversity is instead associated with optimal well-being. This work, however, is limited in that responses to specific stressors as they occurred were not assessed, thereby precluding investigation of resilience. The current research addressed this critical gap by directly testing the relationship between adversity history and resilience to stressors. Specifically, we used a multimethod approach across two studies to assess responses to controlled laboratory stressors (respectively requiring passive endurance and active instrumental performance). Results revealed hypothesized U-shaped relationships: Relative to a history of either no adversity or nonextreme high adversity, a moderate number of adverse life events was associated with less negative responses to pain and more positive psychophysiological responses while taking a test. These results provide novel evidence in support of adversity-derived propensity for resilience that generalizes across stressors.

Adverse experiences and suicidal ideation in adolescence: Exploring the link using the LONGSCAN samples.

Although widely studied in adults, the link between lifetime adversities and suicidal ideation in youth is poorly understood. The purpose of this study was to explore this link in adolescents. The analyses used a sample of 740 16-year-old youth in the LONGSCAN sample, and distinguished between childhood (before the age of 12) and adolescent (between age 12 and age 16) adversities. There was a significant link between cumulative lifetime adversities and suicidal ideation. There was no evidence that this link was moderated by gender. Childhood adversities moderated the effects of adolescent adversities on suicidal ideation; effects of adolescent adversities were strongest at low levels of childhood adversities. There was also some evidence supporting a specific cumulative model of the effects of adversities on suicidal ideation; the most predictive model included the sum of the following adversities: childhood physical abuse, childhood neglect, childhood family violence, childhood residential instability, adolescent physical abuse, adolescent sexual abuse, adolescent psychological maltreatment, and adolescent community violence. The timing and nature of adversities are important in understanding youth suicidal ideation risk; in particular, adolescent maltreatment and community violence appear to be strong predictors. Preventing and appropriately responding to the abuse of adolescents has the potential to reduce the risk of suicidal ideation.

Resilience

When adverse life events occur, people often suffer negative consequences for their mental health and well-being. More adversity has been associated with worse outcomes, implying that the absence of life adversity should be optimal. However, some theory and empirical evidence suggest that the experience of facing difficulties can also promote benefits in the form of greater propensity for resilience when dealing with subsequent stressful situations. I review research that demonstrates U-shaped relationships between lifetime adversity exposure and mental health and well-being, functional impairment and health care utilization in chronic back pain, and responses to experimentally induced pain. Specifically, a history of some lifetime adversity predicts better outcomes than not only a history of high adversity but also a history of no adversity. This has important implications for understanding resilience, suggesting that adversity can have benefits.