Parental Substance Abuse Research Articles

Increased Cardiovascular Disease Risk in Adult Offspring with Prenatal Opioid Exposure Is Associated with Endogenous Opioid Peptide Dysregulation

Parental drug abuse and dysfunctional households during childhood increase the risk for cardiovascular disease (CVD) later in life. Chronic opioid exposure and opioid use disorder (OUD) are associated with a 2-fold increased risk of CVD and a 16% increase in coronary artery disease. OUD among pregnant women is an understudied area related to the opioid epidemic, causing a 5-fold increase in neonatal opioid withdrawal syndrome (NOWS) incidence. In former studies, we subjected female rats to two models of maternal opioid exposure: 1) morphine sulfate during gestation or 2) fentanyl citrate during preconception and gestation. At birth, female and male opioid-exposed offspring showed normal birth weight compared with vehicle-exposed offspring while displaying NOWS-like somatic withdrawal signs after parturition. As adults, in utero opioid-exposed offspring displayed increased mean arterial pressure, sympathetic activation, and CVD risk factors. Prenatal exposure to opioids has been shown to dysregulate the endogenous opioid peptides (EOPs) and alter behavioral outcomes later in life, but the transplacental effects of opioids on blood pressure regulation remain understudied. Therefore, this study aimed to assess whether adult offspring with prenatal opioid exposure display changes in 1) the expression of the EOP proenkephalin (PENK) in brain regions known to control the sympathetic outflow (Paraventricular nucleus (PVN) and rostral ventrolateral medulla (RVLM)), heart, kidneys, and liver; 2) the plasma levels of EOPs (PENK, enkephalin, prodynorphin and dynorphin); and 3) the fentanyl plasma clearance (pharmacokinetics). Protein was extracted from tissues for western blot analysis using the primary antibody for PENK (1:1000, Invitrogen). In opioid-exposed offspring, PENK protein expression was reduced in RVLM (0.55±0.06 vs. 0.36±0.01, AU) and PVN (1.56±0.09 vs. 1.08±0.08, AU), showing a ~35% and ~31% reduction, respectively (n=4-5, p<0.05). In the heart, PENK protein expression was not statistically different in opioid-exposed offspring compared with vehicle-exposed offspring. However, in the kidneys (0.72±0.09 vs. 1.16±0.10, AU) and liver (0.40±0.06 vs. 0.60±0.05, AU), PENK protein expression showed a 61% and 50% increase only in male opioid-exposed offspring compared to vehicle-exposed offspring (n=6-8, p<0.05). None of the plasma circulating EOP levels measured by ELISA were affected by prenatal opioid exposure. Fentanyl clearance in plasma (0, 15, 30, 60, 120, 360,1440 mins) following a fentanyl injection (20ug/kg, sc.) was not different between adult vehicle and opioid-exposed offspring, indicating potential pharmacodynamic alterations secondary to prenatal opioid exposure. As EOPs exert inhibitory effects on adrenergic signaling, our data indicate that prenatal exposure to opioids may induce a permanent downregulation of EOPs in the central nervous system and thus contributing to increasing the sympathetic tone and desensitize the acute depressor responses to opioid peptides, suggesting that EOPs may be critical for blood pressure regulation. However, peripheral expression of PENK seems to reflect pathophysiological alterations in different tissues since elevated PENK level is used in clinical settings as a marker to assess the severity of tissue damage in the liver and kidneys. This study was funded by 1013177615 (NRPA-UK), 1013400001 (SUGAR-UK) and 1013171360 (DPNS-UK). This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Effects of Therapy at a Community Based Trauma Therapy Service Treating Child Abuse and Neglect: A Pre-Post Study Using Administrative Data

This repeated-measures study examined the effects of a hybrid of Trauma-Focused Cognitive Behavioural Therapy (TF-CBT) with other therapeutic approaches at a community-based clinic in Perth Western Australia among a sample of children and young people overwhelmingly experiencing multiple forms of maltreatment and with complex family situations (i.e., family and domestic violence, parental mental health, parental substance abuse). Drawing on 1713 individual client records from between 2017 and 2020, the researchers identified 113 children and young people with viable pre-post treatment assessments including 78 on the TSCC, 36 on the TSCYC, and 12 on the CBCL. Significant improvements on most clinical scales were identified on the TSCC and TSCYC. Sub-analysis of the TSCC results found no differences across gender, age, care status, therapy funding source, and the presence of sexual abuse in the rate of improvement on trauma symptoms. Overall, the study highlights that integrating different therapy approaches for populations with multiple and complex trauma symptoms accessing community-based services can be useful for supporting the delivery of TF-CBT for difficult to treat populations.

How do socioeconomic factors affect the development of adolescent-onset drug use disorders?

Illicit drug use has been a significant issue among adolescents (aged 10 to 19 years). This review investigates the intricate relationship between socioeconomic factors and adolescent-onset illicit drug use in both the United States and Brazil. These socioeconomic factors were categorized into three primary domains: home life, community, and school. At the home level, households grappling with issues such as parental substance abuse, mental health challenges, or financial hardships are notably associated with adolescent drug use. Parental education levels emerge as a critical determinant, with lower education linked to an increased risk of drug use among adolescents. Furthermore, family dysfunction and exposure to adverse childhood experiences (ACEs) , also escalate the likelihood of early drug experimentation. At the community level, poverty and neighborhood disorganization play a pivotal role in adolescent drug use. Adolescents residing in economically disadvantaged communities face heightened vulnerability due to elevated stress and crime, often resorting to illicit drugs as a coping mechanism. The school environment also plays a crucial role in shaping drug use through peer influence. In dysfunctional homes, adolescents seek support outside the family, forming vulnerable connections with peers engaged in substance use. Understanding the intricate association of these socioeconomic factors is imperative for policymakers, healthcare professionals, and educators. Targeted interventions should be developed to curtail the prevalence of adolescent substance use and foster the overall well-being of young individuals in society.

Post-traumatic Stress Disorder in School-age Children: A Nationwide Prospective Birth Cohort Study

Traumatic childhood events are some of the few identifiable and to some extent preventable causes of psychiatric illness. Children exposed to severely stressful events may react with post-traumatic stress disorder (PTSD) and this may impact their level of function in daily life, their future development and mental health. The traumatic stress model suggests that traumatic stress in the family, community violence, and other traumas are regarded as additive environmental factors that can outweigh protective compensatory factors and thus interact with individual vulnerabilities. This study is based on prospective panel data including the whole population of children born in Denmark from 1984 to 1994, who are followed from age 7 to age 18 (N = 679,000) in the window between 2001 and 2012. Risk factors for first-time diagnose with PTSD are analyzed by the discrete time log-odd model. We found a lifetime prevalence of 2.3% PTSD in school-age children (n = 15,636). In accordance with the model, indicators of traumatic stress in the family, family disintegration, community violence, and individual vulnerabilities predicted later diagnose with PTSD. Individual neurodevelopmental disorder – especially autism (adjusted Odds Ratio (OR 7.1) and ADHD (OR 10.7) – were predicative of PTSD. The results cooperated the traumatic stress model. Some results were inconsistent with the traumatic stress model e.g., parental substance abuse were associated with less than expected PTSD in school-age children when adjusted for other risk factors. This indicates that PTSD may be underestimated in these groups. PTSD diagnoses in administrative records underestimate the prevalence, systematically. Efforts to increase PTSD screening may allow for better management.

Paternal cocaine-seeking motivation defines offspring’s vulnerability to addiction by down-regulating GABAergic GABRG3 in the ventral tegmental area

Epidemiological investigations indicate that parental drug abuse experiences significantly influenced the addiction vulnerability of offspring. Studies using animal models have shown that paternal cocaine use and highly motivated drug-seeking behavior are important determinants of offspring addiction susceptibility. However, the key molecules contributing to offspring addiction susceptibility are currently unclear. The motivation for cocaine-seeking behavior in offspring of male rats was compared between those whose fathers self-administered cocaine (SA) and those who were yoked with them and received non-contingent cocaine administrations (Yoke). We found that paternal experience with cocaine-seeking behavior, but not direct cocaine exposure, could lead to increased lever-pressing behavior in male F1 offspring. This effect was observed without significant changes to the dose-response relationship. The transcriptomes of ventral tegmental area (VTA) in offspring were analyzed under both naive state and after self-administration training. Specific transcriptomic changes in response to paternal cocaine-seeking experiences were found, which mainly affected biological processes such as synaptic connections and receptor signaling pathways. Through joint analysis of these candidate genes and parental drug-seeking motivation scores, we found that gamma-aminobutyric acid receptor subunit gamma-3 (Gabrg3) was in the hub position of the drug-seeking motivation-related module network and highly correlated with parental drug-seeking motivation scores. The downregulation of Gabrg3 expression, caused by paternal motivational cocaine-seeking, mainly occurred in GABAergic neurons in the VTA. Furthermore, down-regulating GABAergic Gabrg3 in VTA resulted in an increase in cocaine-seeking behavior in the Yoke F1 group. This down-regulation also reduced transcriptome differences between the Yoke and SA groups, affecting processes related to synaptic formation and neurotransmitter transmission. Taken together, we propose that paternal cocaine-seeking behavior, rather than direct drug exposure, significantly influences offspring addiction susceptibility through the downregulation of Gabrg3 in GABAergic neurons of the VTA, highlighting the importance of understanding specific molecular pathways in the intergenerational inheritance of addiction vulnerability.

Early Childhood Teachers’ Relationships with Families When Children Experience Adversity

ABSTRACT Quality relationships among families and teachers in early care and education (ECE) hold promise to nurture resilience among children impacted by adversity. However, little is known about how adverse childhood experiences (ACEs) may affect the interactions between families and teachers. This study uses quantitative survey data from families (N = 235) and qualitative interview data from teachers (N = 13) to examine the link between children’s adversity and family-teacher relationship quality (knowledge, attitudes, practices) in ECE. Quantitative results indicate that when a child has experienced more of the ACEs conventionally studied (e.g. maltreatment, parent substance abuse or mental illness), parents are more likely to perceive lower quality practices with teachers, but when a child has experienced more ACEs on an extended measure (e.g., bullying, discrimination), parents are more likely to perceive higher quality practices with teachers. Qualitative results indicate that teachers report challenges in relationships with families when children experience trauma or adversity, but that ACEs also can present an opportunity to strengthen family-teacher relationships. Findings can inform professional development for teachers focused on strategies to work with families facing adversity, as well as policies related to program standards (e.g., family engagement) and interventions to improve family-teacher relationships quality.

Re-Examining the Association Between Parental Monitoring, Parental Rearing Behaviors, and Family Risk Factors in Influencing Juvenile Delinquency Among Boys and Girls

This study aimed to investigate the relationship between parenting practices, parental misbehavior, sociodemographic factors, and juvenile delinquency behavior. The sample consisted of 178 adolescents, aged between 14 and 18 years. Self-reported questionnaires were used to collect data, and multiple regression analysis was conducted to analyze the results. The findings revealed significant gender differences in the predictors of delinquent behavior. The predictors of delinquent behavior for boys were lack of parental monitoring, parental rejection, overprotection, father’s alcohol abuse, and mother’s drug abuse, while none of the predictors were significant for girls. These results underscore the importance of considering gender differences when exploring the factors associated with juvenile delinquency. By addressing parental misbehavior and substance abuse in a dysfunctional parental environment, psychological interventions can help prevent and reduce delinquent behavior in adolescents.

Children of parents with substance abuse: assessing impacts and available support

Parental substance misuse and abuse pose significant public health challenges, potentially impacting minors across all developmental stages from pregnancy to adolescence. Such issues can result in medical, psychiatric, and behavioral disorders, along with an elevated risk of child abuse. In Switzerland, around 100 000 children and adolescents live with a parent facing substance abuse. This article aims to succinctly outline the effects of parental substance abuse on children and propose effective intervention strategies and relevant resources for professionals. The goal is to enable the detection of such situations, offer appropriate support, and prevent adverse consequences on the development and health of children and adolescents.

Substance abuse among mothers in Taiwan: Investigating its prevalence and testing the trauma model

Substance abuse is a serious problem in our society. In particular, household or parental substance abuse could lead to adverse childhood experiences for the affected children. However, little is known about the prevalence of substance abuse among parents, especially in Asian societies. Moreover, although the trauma model of addiction has significant implications for the prevention and treatment of substance abuse, most evidence comes from Western samples. To address these knowledge gaps, we examined the prevalence of substance abuse in a sample of mothers in Taiwan and tested the trauma model of substance abuse. A total of 867 Taiwanese mothers completed standardized self-report assessments in 2023. The screening results indicated that the 12-month prevalence of drug abuse and alcohol abuse was 12.3% and 7.3%, respectively; 15.5% had either or both drug and alcohol abuse. Most types of trauma exposure were associated with drug abuse severity, while interpersonal stress and dissociative symptoms were associated with alcohol abuse severity, even after controlling for a variety of demographic and health variables as well as general psychopathology (i.e., depressive symptoms). The relatively high prevalence of substance abuse among Taiwanese mothers in our sample is concerning, particularly when compared to the rates reported in other Asian samples. We also provide preliminary cross-cultural evidence supporting the self-medication theory and the trauma model of substance abuse in the Asian context. We discuss the potential importance of addressing trauma and stress to prevent substance abuse and call for follow-up studies.

Behavioural health problems among Keralite youth: Relationship with family risk factors and adverse childhood experiences

Preventing adverse childhood experiences (ACEs) is very critical for assuring the healthy development of children. Substantial research shows a robust, dose–response relationship between ACEs and subsequent adverse outcomes. The current study examines the prevalence of ACEs, family risk factors, and Behavioural Health Problems (BHPs) and, the risk of BHPs in relation to family risk factors while considering the influential role of ACEs. A Demographic proforma and Childhood Experiences of Care and Abuse Questionnaire-2 were used to gather data from 613 youth, selected through multi-stage stratified sampling from selected educational institutions in Kerala, South India. Descriptive and inferential statistics (Chi-square test and Binary Logistic regression) were used for analysis. Keralite youth have exposure to multiple ACEs and family risk factors. Various ACEs were highly prevalent (14%-69%) and a quarter of youth had four or more ACEs, with more exposure in males. Neglect, antipathy, and psychological abuse were the common types. Family risk factors, domestic violence (8%), and parental substance abuse (10%) were significant predictors for loss, antipathy and sexual abuse, and the ACEs score. Youth with family risk factors were more likely to have ACEs and those with ACEs exposure were more likely to have BHPs. Parental substance abuse increased the likelihood of depression irrespective of ACEs exposure. This evidence suggests that the exposure to family risk factors and ACEs increases the likelihood of the risk of BHPs in youth and their interrelatedness needs to be addressed in preventing the negative outcomes in later life.

Relationship between caregiver adverse childhood events and age of autism spectrum diagnosis

BackgroundThe age at which children are diagnosed with autism spectrum disorder (ASD) has not significantly decreased in the past 20 years. Adverse childhood events (ACEs) experienced by caregivers of autistic children may predict delays in caregivers attending ASD diagnostic evaluations, negatively impacting the age at which the child is diagnosed with ASD. The purpose of this study was to further explore the caregiver delay response by analyzing recurring events common in caregivers of children at risk for ASD. MethodsWe used a quantitative research design with convenience sampling to categorize caregivers of children referred for an ASD diagnostic evaluation into three groups based on their ACEs score and medical history. FindingsA higher percentage of caregivers with four or more ACEs compared to the national average was noted. Parental separation or divorce, verbal aggression, emotional abuse, and parental alcohol or substance abuse occurred most frequently, and the latter predicted a prolonged time in attending the diagnostic evaluation. DiscussionACEs experienced by caregivers of children with ASD may delay the age of ASD diagnosis. Further investigation into the effect of ACEs on caregivers' mental health status and executive functioning is warranted to develop best practice for assisting caregivers in ASD recognition, diagnosis, and care management. Application to practiceClinicians should consider caregiver ACEs score when referring a child for a diagnostic developmental evaluation. Resources to address caregiver mental health needs should be provided at the onset of the referral process to increase the likelihood of caregiver adherence.

Abstract 030: Perinatal Paradigms Of Opioid Use To Investigate Cardiovascular Disease (CVD) Risk In Adult Offspring

Adversity and dysfunctional households during childhood have been shown to increase systolic blood pressure and overall CVD risk in the long term. A common contributor to dysfunctional households is the parental drug abuse, which transplacental effects acts as a stressor to the developing offspring. Opioid use disorder (OUD) among pregnant women is an understudied area related to the opioid epidemic, causing a 5-fold increase in neonatal opioid withdrawal syndrome (NOWS) incidence. In former studies, we subjected female rats to two models of maternal opioid exposure 1) daily escalating doses of morphine from gestational day 1-19, or 2) fentanyl self-administration during preconception and gestation. Female and male opioid-exposed offspring are smaller throughout the lifespan than vehicle (VEH)-exposed counterparts, displaying NOWS-like somatic withdrawal signs and catch-up growth. Also, in utero opioid-exposed adult offspring displayed sympathetic activation and increased CVD risk factors. Perinatal exposure to opioids has been shown to dysregulate the endogenous opioid peptides (EOP) and alter behavioral outcomes later in life, but the effects on blood pressure regulation remain understudied. Therefore, this study aimed to investigate the expression of proenkephalin (PENK) in brain regions known to control the sympathetic outflow (PVN, RVLM, NTS) and the pressor response to Leu-Enkephalin (100 ug/kg i.p) in adult offspring exposed to VEH or opioids in utero. PENK protein expression in RVLM showed a ~50% reduction in opioid-exposed offspring vs. VEH (p<0.05). As expected, the pressor response to Leu-ENK in conscious VEH-exposed rats showed a ~30% increase in mean arterial pressure from baseline, while the pressor response was blunted in opioid-exposed offspring (12.2±3.7 vs. -4.5±2.1 delta mmHg, n=4-5, p<0.05). As EOP exert inhibitory effects on adrenergic signaling, our data indicate that perinatal exposure to opioids may induce a permanent downregulation of EOP in the central nervous system. Similar to what we reported in vasculature and heart, reduced PENK may contribute to increasing the sympathetic tone and desensitize acute pressor responses to EOP, suggesting that optimal EOP levels may be critical for blood pressure regulation.

Time-lagged associations between two adverse childhood experiences and later-life cognitive function through educational attainment and stroke.

Adverse childhood experiences (ACEs) have been associated with worse cognitive health in older adulthood. This study aimed to extend findings on the specificity, persistence, and pathways of associations between two ACEs and cognition by using a comprehensive neuropsychological battery and a time-lagged mediation design. Participants were 3304 older adults in the Health and Retirement Study Harmonized Cognitive Assessment Protocol. Participants retrospectively reported whether they were exposed to parental substance abuse or experienced parental physical abuse before age 18. Factor scores derived from a battery of 13 neuropsychological tests indexed cognitive domains of episodic memory, executive functioning, processing speed, language, and visuospatial function. Structural equation models examined self-reported years of education and stroke as mediators, controlling for sociodemographics and childhood socioeconomic status. Parental substance abuse in childhood was associated with worse later-life cognitive function across all domains, in part via pathways involving educational attainment and stroke. Parental physical abuse was associated with worse cognitive outcomes via stroke independent of education. This national longitudinal study in the United States provides evidence for broad and persistent indirect associations between two ACEs and cognitive aging via differential pathways involving educational attainment and stroke. Future research should examine additional ACEs and mechanisms as well as moderators of these associations to better understand points of intervention.

Enhanced heroin analgesic effect in male offspring of sires who self-administered heroin.

Introduction: A growing body of evidence suggests that parental substance abuse, even prior to conception, may induce phenotypic changes in offspring. Parental opioid exposure has been shown to affect developmental processes, induce memory deficits, and lead to psycho-emotional disorders in offspring. However, how parental, especially paternal, chronic drug exposure affects offspring remains unexplored. Methods: Adult male rats were subjected to 31days of heroin self-administration followed by mating with naïve females. Litter size and body weight of F1 offspring were recorded. Object-based attention tests, cocaine self-administration tests, and hot plate tests were used to test for potential effects of chronic paternal heroin seeking on cognition, reward, or analgesic sensitivity in the offspring. Results: Body weight and litter size of the heroin F1 generation were not altered compared to the saline F1 generation. Furthermore, paternal chronic heroin self-administration experience had no significant effect on object-based attention tests or cocaine self-administration behavior in either sex. However, in the hot plate test, although no difference in basal latency was found between the two groups in either sex, a significant increase in the analgesic effect of heroin was observed in the male heroin F1 generation. Conclusions: Taken together, these data provide evidence that paternal chronic heroin self-administration experience could sex-dimorphically increase the analgesic effect of heroin in male offspring, but had no significant effect on response to cocaine reinforcement or attentional behavior.

Adverse childhood experiences and adolescent cannabis use trajectories: findings from a longitudinal UK birth cohort

Adverse childhood experiences (ACEs) are classically defined as physical abuse, sexual abuse, emotional abuse, emotional neglect, bullying, parental substance use or abuse, violence between parents, parental mental health problems or suicide, parental separation, or a parent convicted of criminal offence. Exposure to ACEs can be associated with cannabis use, but no comparisons across all adversities have been made while also considering timing and frequency of cannabis use. We aimed to explore the association between ACEs and cannabis use timing and frequency in adolescence, considering the cumulative number of ACEs and individual ACEs. We used data from the Avon Longitudinal Study of Parents and Children, a longitudinal UK birth cohort study. Longitudinal latent classes of cannabis use frequency were derived from self-reported data at multiple timepoints in participants aged 13-24 years. ACEs between ages 0 years and 12 years were derived from prospective and retrospective reports at multiple timepoints by parents and the participant. Multinomial regression was used to analyse the effect of both cumulative exposure to all ACEs and the ten individual ACEs on cannabis use outcomes. 5212 participants (3132 [60·0%] were female and 2080 [40·0%] were male; 5044 [96·0%] were White and 168 [4·0%] were Black, Asian, or minority ethnic) were included in this study. After adjustment for polygenic risk and environmental risk factors, participants who had 4 or more ACEs at age 0-12 years were at increased risk of early persisting regular cannabis use (relative risk ratio [RRR] 3·15 [95% CI 1·81-5·50]), later onset regular use (1·99 [1·14-3·74]), and early persisting occasional use (2·55 [1·74-3·73]) compared with low or no cannabis use. After adjustment, early persisting regular use was associated with parental substance use or abuse (RRR 3·90 [95% CI 2·10-7·24]), parental mental health problems (2·02 [1·26-3·24]), physical abuse (2·27 [1·31-3·98]), emotional abuse (2·44 [1·49-3·99]), and parental separation (1·88 [1·08-3·27]) compared with low or no cannabis use. Risks for problematic adolescent cannabis use are highest for individuals reporting 4 or more ACEs, and were particularly raised for those with parental substance use or abuse. Public health measures to address ACEs might reduce adolescent cannabis use. The Wellcome Trust, UK Medical Research Council, Alcohol Research UK.

Event history analysis on racial disparities in the path to adoption for Black and White children

BackgroundBlack children are significantly overrepresented in many phases of the U.S. child welfare system. ObjectiveThe purpose of this study is to investigate racial disproportionality and disparities in the adoption process and factors that predict the length of time to adoption. Participants and settingThis study utilized administrative data from the 2014 year of the Adoption and Foster Care Analysis and Reporting System (AFCARS) collected in 50 States, the District of Columbia, and Puerto Rico. MethodsThe disproportionality metric (DM) and disparity index (DI) were constructed for Black and White children, and event history analyses were conducted to calculate the probability of adoption while considering the time to adoption finalization. ResultsDM indicated that Black children (0.81) were underrepresented in adoption, and DI indicated that the likelihood of adoption for Black children (0.73) was one third lower than that for White children. The event history analyses revealed that White children were 1.27 times more likely to be adopted than Black children. White children had considerably fewer days from termination of parental rights to adoption finalization with a median time of 273.5 days compared to 328 days for Black children. Factors that extended adoption time included child intellectual, physical, and emotional/behavioral disabilities, visual and hearing impairments, parental alcohol abuse and disability, and child maltreatment histories, while parental drug abuse and longer stays in out-of-home care shortened the adoption process. We also found a significant interaction effect of race and neglect on adoption. Neglected Black children had a longer time to adoption than neglected White children. ConclusionsMore dedicated outreach programs and resources must be developed to ensure the effectiveness of adoption services and cultural continuity for Black children.

Adverse childhood experiences as a risk factor for non-suicidal self-injury and suicide attempts in forensic psychiatric patients

BackgroundExposure to adverse childhood experiences (ACE) have been found to have profound negative consequences on an individuals’ health. Non-suicidal self-injury (NSSI) is a clinically complex and serious global health issue and is closely related to suicide attempts. Previous research has found associations between ACE and NSSI and suicide attempts in clinical samples. However, this association has to our knowledge not been studied to this extent in a sample of forensic psychiatric patients. The aim of this study was therefore to describe the prevalence of adverse childhood experiences (ACE) and their associations with non-suicidal self-injury (NSSI) and/or suicide attempts in forensic psychiatric patients.MethodsThe current study is a cross-sectional study of a consecutive cohort of 98 forensic psychiatric patients (86.7% male) in Sweden. We invited 184 patients with a predicted stay of > 8 weeks who had been cleared for participation by their treating psychiatrist. Of these, 83 declined and 98 eligible patients provided informed consent. Information on ACE, NSSI, and suicide attempts derived from files, self-reports (Childhood Trauma Questionnaire-Short Form; CTQ-SF), and interviews were compared separately among participants with and without NSSI or suicide attempts using t-tests. The dose–response association between ACE and NSSI/suicide attempts was analysed using binary logistic regression.ResultsIn file reviews, 57.2% of participants reported physical abuse, 20% sexual abuse, and 43% repeated bullying by peers during childhood. NSSI and suicide attempts were associated significantly with CTQ-SF total scores, with medium effect sizes (d = .60 to .63, p < .01), and strongly with several CTQ-SF subscales. Parental substance abuse was also associated with NSSI (p = .006, OR = 3.23; 95% confidence interval [CI] = 1.36 to 7.66) and suicide attempts (p = .018, OR = 2.75; 95% CI = 1.18 to 6.42). Each additional ACE factor predicted an increased probability of NSSI (p = .016, OR = 1.29; CI = 1.04 to 1.59) but not of suicide attempts. When anxiety and depressive disorders were included in the model, ACE remained a significant predictor of NSSI.ConclusionsWe report extensive ACE, from both files and self-reports. When comparing groups, correlations were found between ACE and NSSI, and ACE and suicide attempts among forensic psychiatric patients. ACE seem to predict NSSI but not suicide attempts in this group, even when controlling for affective and anxiety disorders. Early ACE among forensic psychiatric patients, especially physical and emotional abuse and parental substance abuse, have important impacts on self-harming behaviours that must be acknowledged both by the institutions that meet them as children and in their later assessment and treatment.

The association between suicidal behaviour and violence, sexual abuse, and parental substance abuse among Sami and Greenlandic adolescents: the WBYG study and the NAAHS.

For young Indigenous people, suicide is one of the leading causes of death, and high rates in Arctic areas indicate serious health and societal concerns. More knowledge is needed, as suicidal behaviour predicts later death by suicide. The aim of this study was to investigate associations between suicidal thoughts and suicide attempts and negative life events, including violence, sexual abuse, and parental substance abuse, in Sami and Greenlandic adolescents, within and between groups and gender. Working samples included 442 Sami and 399 Greenlandic Inuit (15-16-year-olds), in The Norwegian Arctic Adolescent Health Study (NAAHS) and the Well-Being among Youth in Greenland (WBYG) study. Multivariable logistic regression explored associations between suicidal behaviour and violence, sexual abuse, and parental substance abuse. Across Indigenous groups, suicidal thoughts and attempts were significantly associated with violence and sexual abuse. The association between suicidal behaviour; especially suicidal thoughts, and sexual abuse was significant and strong among Sami females. Sami and Inuit adolescents with a history of childhood violence reported significantly more suicide attempts; the strongest association was found among Sami males. To Sami and Greenlandic Inuit, the experiences of negative life events, such as violence or sexual abuse are significant risk factors for suicidal behaviour. Public health programmes and prevention strategies targeting youth mental health and suicide should be culturally sensitive and sensitive to gender differences in the association between negative life events and suicidal behaviour.

Supportive Relationships with Trusted Adults for Children and Young People Who Have Experienced Adversities: Implications for Social Work Service Provision

Abstract Adverse childhood experiences encompass both direct harm, such as abuse and neglect, and indirect harm via family issues, including parental substance abuse and mental illness. They create significant risks for problems in later life, including mental health problems, substance abuse, interpersonal violence and self-harm. Due to these enduring and damaging consequences, interventions are essential to prevent or mitigate impact. One form of support is the role played by trusted adults in the lives of vulnerable children and young people. Employing a scoping study methodology, this article examines the role of the trusted adult and explores implications for social work agencies and practitioners. Whilst the idea of a supportive relationship may reflect the social work value base, there can be legal, procedural and bureaucratic barriers to directly providing such relationships in the child and family social work workforce. However, other adults associated with formal services such as teachers and youth workers, as well as extended family and community members may potentially be able to do so. Social workers can assist by becoming recruiters and facilitators of supportive adults for children and young people from their wider family or community and by partnering with organisations to stimulate provision of such services.

Non-compliance with Outpatient Follow-up in Child Abuse Cases - A Single Centre Study

Introduction: To study the characteristics of child abuse cases and determine the risk factors associated with non-compliance to follow-up. Methods: A retrospective review of Suspected Child Abuse and Neglect (SCAN) cases attending an outpatient clinic at Hospital Universiti Sains Malaysia was performed. This was done using a standardized proforma to capture the demographic and clinical data from 2014 until 2020. Variables collected were gender, age at the time of the abuse, religion, education, school attendance, history of previous abuse, parental employment, parental relationship, domestic violence, parental criminal history, substance abuse, and household number. Children under the age of 18 years who were seen by the SCAN team in the emergency department (ED) or during hospital admission within the time frame were included. Results: Compliance rates are defined as the follow-up within the first recommended date given after hospital admission or encounter at the ED. The investigation comprised 311 cases and sexual abuse was reported in 261 cases (83.9%). During the study period, 191 (61.3%) children who were non-compliant with follow-up. Simple binary logistic regression revealed that the significant factors associated with non-compliance to follow-up after the SCAN team review was the patients’ age only. Multiple logistic regression revealed that there were no significant factors associated with failure to comply with outpatient clinic follow-up. Conclusion: This study provides a descriptive study of local child abuse cases. We could not identify any specific factors associated with non-compliance to follow-up.