Types Of Adverse Childhood Experiences Research Articles

Abstract 26: Types of Adverse Childhood Experiences and Association With Sleep Duration in Children: Analysis of 2020-2021 National Survey of Children’s Health

Background: The number of adverse childhood experiences (ACEs) is associated with suboptimal sleep duration in children; however, the differential association of types of ACEs with sleep duration in youth is unknown. Given the known associations of both ACEs and sleep duration with cardiovascular health, such an investigation will provide insights for targeted clinical intervention. Objective: We investigated the most frequently reported ACE types and the association between each type of ACE and sleep duration among U.S. children aged 6-17 years. Methods: We used data from the 2020-2021 National Survey of Children’s Health, the most recent publicly available dataset. Parents or guardians were asked whether their child had ever experienced ten different types of ACEs. Multinomial logistic regression was used to assess the association of sleep duration with each of ACEs. We used the American Heart Association (AHA) Life Essential 8 scoring algorithm to calculate scores for sleep duration (range 0 [lowest] to 100 [highest]). Participants were categorized into three subgroups: (1) meeting age-appropriate optimal sleep duration; (2) ≥1-<2 hour below or ≥ 1 hour above optimal sleep duration; and (3) ≥ 2 hours below optimal sleep duration. Analyses controlled for child’s sex, age, race/ethnicity, household poverty level, regular bedtime, physical activity, and caregiver’s level of education. Results: Parental divorce was the most frequently reported ACE (28.1%) followed by financial hardship (12.9%) and drug abuse (10.1%) among U.S. children aged 6 to 17 years. Adjusting for covariates, 5 of 10 ACEs (parental divorce, parental imprisonment, domestic violence, living with someone who had a problem with alcohol or drugs, unfair treatment because of their sexual orientation or gender identity) were significantly associated with suboptimal sleep category 2. All 10 ACEs were significantly associated with suboptimal sleep category 3. Conclusions: These findings support that ACE type is differentially associated with suboptimal childhood sleep duration and suggests that certain traumatic events experienced during childhood could amplify the adverse effects of poor sleep on cardiovascular health. Healthcare providers should consider screening for ACE type concurrent with sleep duration to better understand aspects contributing to cardiovascular health in childhood.

Adverse Childhood Experiences Among U.S. Adults: National and State Estimates by Adversity Type, 2019–2020

Although adverse childhood experiences (ACEs) are associated with lifelong health harms, current surveillance data on exposures to childhood adversity among adults are either unavailable or incomplete for many states. In this study, recent data from a nationally representative survey were used to obtain the current and complete estimates of ACEs at the national and state levels. Current, complete, by-state estimates of adverse childhood experiences were obtained by applying small area estimation technique to individual-level data on adults aged ≥18 years from 2019-2020 Behavioral Risk Factor Surveillance System survey. The standardized questions about childhood adversity included in the 2019-2020 survey allowed for obtaining estimates of ACE consistent across states. All missing responses to childhood adversity questions (states did not offer such questions or offered them to only some respondents; respondents skipped questions) were predicted through multilevel mixed-effects logistic small area estimation regressions. The analyses were conducted between October 2022 and May 2023. An estimated 62.8% of U.S. adults had past exposure to ACEs (range: 54.9% in Connecticut; 72.5% in Maine). Emotional abuse (34.5%) was the most common; household member incarceration (10.6%) was the least common. Sexual abuse varied markedly between females (22.2%) and males (5.4%). Exposure to most types of adverse childhood experiences was lowest for adults who were non-Hispanic White, had the highest level of education (college degree) or income (annual income ≥$50,000), or had access to a personal healthcare provider. Current complete estimates of ACEs demonstrate high countrywide exposures and stark sociodemographic inequalities in the burden, highlighting opportunities to prevent adverse childhood experiences by focusing social, educational, medical, and public health interventions on populations disproportionately impacted.

The AIP model as a theoretical framework for the treatment of personality disorders with EMDR therapy.

Research has shown that the impact of traumatic events and circumstances on individuals is cumulative and potentially has a wide range of harmful consequences, including negative consequences on mental health. One such consequence is the development of a personality disorder, a persistent mental condition characterized by a pronounced pattern of difficulties in impulse control, emotional regulation, cognitive functions, self-esteem, and interpersonal relationships. A wide array of studies indicates that the personal history of individuals with a personality disorder is often marked by exposure to traumatic events or other types of adverse childhood experiences (ACEs). Because existing treatments for personality disorders are usually long and costly, it is essential to continue exploring alternative and complementary interventions. Nowadays, knowledge and clinical experience in regard to personality disorders have been gained in addressing ACEs by processing memories of these events through eye movement desensitization and reprocessing (EMDR) therapy. In this paper, we present a theoretical framework for this treatment approach, based on Shapiro's Adaptive Information Processing (AIP) model, describe its current empirical basis, and provide guidance on how to formulate a useful case conceptualization that can serve as a basis for the treatment of personality disorders with EMDR therapy. This approach is illustrated with a case example.

Abstract B121: Racial disparities in the association between adverse childhood experiences and history of self-reported depression among cancer survivors

Abstract Introduction. Depression is experienced by 25% of cancer survivors in the United States, and there are racial differences in how adverse childhood experiences (ACEs) affect depression. While previous studies have examined association between ACEs and depression in general population, studies focusing on cancer survivors are lacking. The purpose of this study was to assess the association between ACEs and history of self-reported depression among cancer survivors in different race groups. Methods. This study was a cross-sectional analysis of the 2020 Behavioral Risk Factor Surveillance System among 19,241 cancer survivors. The ACE category (zero, one, two-three, ≥four) included questions assessing exposure to eight types of adverse childhood experiences: three types of abuse (physical, emotional, and sexual) and five types of household challenges (household member substance misuse, incarceration, mental illness, parental divorce, or witnessing intimate partner violence) before age 18 years. The outcome is self-reported history of depression (yes/no). Three weighted multivariable logistic regression models were used to examine the association between ACE and depression for each race group: Non-Hispanic White (NHW), Non-Hispanic Black (NHB) and Hispanics, adjusting for age, sex, smoking status, income, education, marital status, body mass index, health status. Results. In this sample of cancer survivors, 41%, 22%, 21% and 16% reported having experienced zero, one, two-three, and >=4 ACEs respectively. Majority of survivors were NHW (82.5%) while 6.2%, 6.4% and 4.9% were NHB, Hispanics, and Others respectively. Personal history of depression was reported by 21% of survey respondents. Among survivors experiencing >=4 ACEs, depression was reported by 46.9 % of NHW, 55.2% of NHB and 50.6% of Hispanics. In the adjusted models, among NHW survivors with 1 ACE (aOR: 1.7, 95% CI. 1.3– 2.2), 2-3 ACEs (aOR: 1.9, 95% CI. 1.5– 2.4), or >=4 ACES (aOR: 4.2, 95% CI. 3.3– 5.5) had higher odds of depression compared with those with zero ACEs. Among NHB, survivors with >=4 ACEs had higher odds of depression (aOR: 2.5, 95% CI. 1.2– 5.0) compared with those with zero ACEs; no significant difference was observed for survivors with 1 or 2-3 ACEs. Similarly, among Hispanics, survivors with >=4 ACEs had higher odds of depression (aOR: 11.3, 95% CI. 5.4– 23.8) compared with those with zero ACEs whiles no significant difference was observed for survivors with 1 or 2-3 ACEs. Conclusion. Persons with ACEs may represent an important targeted prevention group to reduce risk of depression among cancer survivors. While there is a relationship between all categories of ACE and depression among NHW cancer survivors, only those with >=4 ACEs had association with depression among NHB and Hispanics. Potential variation by race warrants additional studies regarding potential for selective prevention and identification of resilient, cultural, and healthcare access factors. Citation Format: Oluwole A. Babatunde, Melanie S. Jefferson, Swann A. Adams, Chanita Hughes Halbert, Frank Clark, Anusuiya Nagar, Nosayaba Osazuwa-Peters, Eric A. Boakye. Racial disparities in the association between adverse childhood experiences and history of self-reported depression among cancer survivors [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr B121.

Polytraumatization, defense mechanisms, PTSD and complex PTSD in Indian adolescents: a mediation model

BackgroundAdolescence is recognized as a particularly susceptible developmental period for experiencing multiple types of Adverse Childhood Experiences (ACE), increasing the vulnerability to higher levels of Post-Traumatic Stress Disorder (PTSD) and Complex PTSD symptoms. Some studies found that defense mechanisms play an important role on the association between ACE and psychological symptoms.MethodsWe analyzed the associations between direct and indirect exposure to ACE and PTSD and Complex PTSD (affective dysregulation, negative self-concept and disturbances in relationships) through the mediation role of mature defense mechanisms: mature, neurotic, and immature defense mechanisms in Indian adolescents. A sample of 411 Indian adolescents (M = 14.2 years old; S.D. = 0.5) completed validated self-report questionnaires. Serial multiple mediation models were tested by conducting a structural equation modelling employing Preacher and Hayes’ procedures (2008).ResultsImmature and neurotic defense mechanisms mediated the association between direct exposure to ACE with PTSD symptoms. Immature defense mechanisms were mediators of the relationship between direct exposure to ACE and Complex PTSD symptoms clusters.ConclusionsMaladaptive defense mechanisms can disturb the process of self-regulation and emotion regulation capabilities in coping with traumatic experiences, leading to higher PTSD and Complex PTSD symptoms severity.

Longitudinal Associations Between Multiple Types of Adverse Childhood Experiences and Depression Trajectories in Middle-Aged and Older Chinese Adults: a Growth Mixture Model

Longitudinal Associations Between Multiple Types of Adverse Childhood Experiences and Depression Trajectories in Middle-Aged and Older Chinese Adults: a Growth Mixture Model

Comparing relationships between single types of adverse childhood experiences and health-related outcomes: a combined primary data study of eight cross-sectional surveys in England and Wales

ObjectivesAdverse childhood experiences (ACEs) show strong cumulative associations with ill-health across the life course. Harms can arise even in those exposed to a single ACE type but few studies examine...

Gender-specific association of adverse childhood experiences with frailty index level and trajectory in China

BackgroundThe determinants of gender differences in frailty remain unknown but may include social factors. International attention is increasingly focusing on the adverse childhood experiences of women. This study therefore examined the gender-specific association of adverse childhood experiences with frailty index level and trajectory. MethodsThis population-based study used data from the China Health and Retirement Longitudinal Study, with a nationally representative sample of people aged 45 years or more. The frailty index was based on 41 health measurements, and 18 types of adverse childhood experiences were examined. Weighted ordered logistic models were used with additive interaction. ResultsCompared with those exposed to one or no adverse events, exposure to two or three childhood adverse experiences was associated with a 44 % (95%CI: 1.16–1.80) increase in the likelihood of frail status for women, but not significantly associated with the likelihood of frail status for men. Additionally, for men and women, experiencing four or more adversities was associated with a 69 % (95%CI: 1.36–2.09) and a 138 % (95%CI: 1.93–2.94) increase in the likelihood of frail status, respectively. A similar association was found between accumulative scores for adverse childhood experiences and trajectory of the frailty index (men vs. women: OR of exposure to two or three adversities: 1.17 (95%CI: 0.84–1.64) vs. 1.26 (95%CI: 1.02–1.56); OR of exposure to four or more adversities: 1.70 (95%CI: 1.24–2.34) vs. 2.12 (95%CI: 1.70–2.63)). The greatest increase in risk of frailty was observed among men and women experiencing a high level of adversity, followed by socioeconomic deprivation and intrafamilial aggression. There was a significant additive interaction between women and childhood socioeconomic deprivation or a high level of adversity. The risk of being frail or having a rapidly increasing frailty index trajectory for women with a high level of adversity was approximately 4.34 (95%CI: 3.36–5.59) and 4·07 (95%CI: 3·34–4.96) times higher than that for men with a low level of adversity. However, gender differences were not found in the effects of childhood intrafamilial aggression. ConclusionsMen and women routinely experienced adult frailty as a result of adverse childhood events. The biological interaction between women and adverse childhood experiences was evident, with women's frailty being more sensitive to childhood socioeconomic deprivation and a high level of adversity. The findings have important implications for reducing the risk of frailty by mitigating early life stress, especially among women.

Adverse Child Events (ACES) and their Negative, Long-Term

Exposure to adverse childhood experiences (ACEs) is violent, stressful, or traumatic experiences undergone in childhood. It is estimated that about 16 % of adults in the U.S. have had four or more types of adverse childhood experiences, which are significantly associated with poorer health outcomes, health risk behaviors, and socioeconomic challenges. Research has found a relationship between exposure to ACEs and morbidity and mortality later in life. The high prevalence of ACES, along with their effect on health, social, and medical costs has led this issue to be a matter of public health globally. This paper discusses the impact of ACES, how ACES are measured, and the linkages ACES have to different health outcomes. Future research is needed to better understand adverse childhood events, specifically how to assess, address and prevent these experiences in children.

Impact of Adverse Childhood Experiences in the Manifestation of Intimate Partner Violence Victimization and Perpetration among College Students: Gendered Perspective

ABSTRACT Purpose This study examined the effect of five types of adverse childhood experiences (ACEs) on Intimate Partner Violence (IPV) perpetration and IPV victimization for male and female students (N = 3,682). Method The data came from seven universities in the U.S. and Canada using multivariate logistic regression models. Results For female students, peer victimization (PV), childhood maltreatment (CM), exposure to domestic violence (EDV), drug use, and depression were significantly associated with higher odds of IPV perpetration. For male students, IPV perpetration was significantly associated with PV, CM, other physical and sexual violence (PSV), and alcohol use. IPV victimization was significantly associated with CM, EDV, PSV, drug use, and depression for female students. For male students, CM, PSV, alcohol use, and depression were associated with higher odds of IPV victimization. Discussion Because gender-specificity exists in the transmission process of ACEs and other risk factors for IPV, developing gender-specific approaches to IPV prevention and intervention on college campuses is necessary.

TRẢI NGHIỆM BẤT LỢI THỜI THƠ ẤU VÀ SỰ THẤU CẢM Ở HỌC SINH TRUNG HỌC PHỔ THÔNG

This study was conducted on 1070 high school students in Hanoi to find out the current situation of adverse childhood experiences, empathy, and the relationship between these two variables. The study also looked into the impact of the demographic characteristics such as gender, age, parent’s occupation, parents’ educational level, and living area on the level of empathy and adverse childhood experiences in high school students. By using two instruments including the Adverse Childhood Experiences International Questionnaire, the World Health Organization, 2020, and the Basic Empathy scale (Jolliffe và Farrington, 2006), results revealed that high school students experienced adverse childhood experiences at a low level. The most common types of adverse childhood experiences were emotional neglect, having family members being treated violently, having one or no parents, parental separation, or divorce. Most of the adverse childhood experiences happened in the family. Demographic factors also influence the extent to which some types of adverse experiences are experienced. In general, 4 groups of adverse childhood experiences positively correlated together. High school students had an average level of empathy, in which the score of cognitive empathy was higher than that of affective empathy. Girls have higher scores of overall empathy than boys did. There was a positive correlation between empathy and cognitive empathy with the number of adverse childhood experiences in high school students. Explanation of results and limitations of the current studies were also discussed.

Adverse Childhood Experiences (ACE) Among Prolific Young Robbery Offenders in London: Targeting Treatment for Desistance?

Research QuestionHow prevalent are various types of adverse childhood experiences among prolific young robbery offenders in London, with what implications for treatment and desistance of these people from serious offending?DataOf the 1249 suspects under 26 years of age who were arrested for robberies in London in 2019, 81 (6.5%) of them had been arrested for four or more robberies, totalling 24% of all robbery arrests of that age group (465 out of 1936). Of those 81 arrestees, 65 of them (80%) percent had used a knife or threatened with a knife to commit their crime. In total, the 81 had criminal histories as suspects in 939 offences covering 34 offence types, most commonly theft from person (201), possession of drugs (164) and violence with injury (89).MethodsThis study gathered extensive life history data for the 81, with a special emphasis on adverse childhood experiences (ACE) including criminal victimisation by parents or other adults. The analysis compares the prevalence of ACE in the most prolific young robbery suspects to prevalence in general population samples.FindingsThe 81 prolific robbery offenders had extremely high prevalence of ACEs: 80% had previously been victims of crime themselves (highest offence categories assault with bodily harm, robbery and domestic violence). Reported to police as missing is 63%, school exclusions 49%, incarceration of a family member 35% and known to social services 91%. The prevalence of 4 or more ACEs among the 81 prolific robbery offenders is two to five times higher than it is in other estimates for London (random sample) or England (children in need).ConclusionsA substantial proportion of all London arrests for robbery identify young people with disproportionately high levels of adverse childhood experiences. Most of the ACEs are to some extent treatable by cognitive behavioural therapies and related treatments aimed at post-traumatic stress disorder (PTSD). One possible pathway to promote desistance from high-harm crime in this population may be the development and testing of a police role in helping to ensure that these few most chronic, high-harm arrestees received effective treatment for the consequences of ACEs.

Assessing the Victimizaton-Offending Hypothesis of Sexual and Non-Sexual Violence in a Nationally Representative Sample of Incarcerated Men in the United States: Implications for Trauma-Informed Practice in Correctional Settings.

Rates of exposure to sexual and non-sexual physical violence and other adverse childhood events are greater among people who are incarcerated with convictions for offenses related to sexual and non-sexual violence compared to other incarcerated populations and the general community. Few studies have differentiated which types of prior adverse experiences are greatest predictors of sexual and non-sexual violent offenses. The following study investigated associations between experiencing sexual abuse as a child or adult; experiencing non-sexual physical violence during childhood, adulthood, or both; having a caretaker who uses drugs; being in foster care; growing up in socioeconomically marginalized conditions; and the likelihood of reporting a prior physical or sexual conviction. The sample consisted of 13,604 men incarcerated in state and federal prisons in the United States. Multinomial regression models compared convictions for sexual offenses and non-sexual violent offenses to all other crimes. A model also compared sexual offenses to non-sexual violent offenses to differentiate between types of adverse childhood experiences associated with sexual versus non-sexual violent offending. Models adjusted for race/ethnicity, education, and age. Results suggest that exposure to violence during childhood was significantly and violence during adulthood was insignificantly associated with increased risk of conviction for a non-sexual physical offense. Sexual violence victimization as a child only was associated with increased risk of conviction for sexual violence perpetration during adulthood. Foster care involvement was associated with increased risk of being convicted for a non-sexual violent offense. Findings suggest that different traumatic pathways may differentiate types of aggression in adulthood. Future research must evaluate if trauma-informed approaches should be catered to address the unique effects of sexual and non-sexual victimization and the perpetration of different types of aggression in adulthood.

An Exploration of Factors that Mediate the Relationship Between Adverse Childhood Experiences and Sexual Assault Victimization Among LGBTQ+ College Students.

Despite alarming rates of sexual assault on college campuses, little research has examined risk factors for sexual victimization among LGBTQ+ college students. This exploratory study aims to examine adolescent sexual assault, internalized homonegativity, and problematic alcohol use as mediators linking several types of adverse childhood experiences (ACEs; i.e., childhood sexual abuse, parental abuse, and household disorder) to collegiate sexual assault. Utilizing data from 241 LGBTQ+ college students, path analysis findings demonstrated that these proposed mediators increased risk for sexual assault and that various types of ACEs exerted differential impacts on sexual re-victimization, internalized homonegativity, and problematic alcohol use. Practice-based implications are offered, including the need for affirming programming that includes problem drinking prevention components and considers the role of ACEs and internalized homonegativity in increasing risk for sexual assault during college as well as the need for LGBTQ+ resource centers on campus.

Adverse Childhood Experiences among Thai Patients with Depressive Disorders: A University/Tertiary Care Hospital Experiences

Background: Childhood trauma and adverse experiences are common in patients with depressive disorders, and yet, there is a lack of research in this area in Thailand. Objective: To determine the prevalence and types of adverse childhood experiences (ACEs) among patients with depressive disorders and the association between ACEs and some characteristics of depressive patients. Materials and Methods: A cross-sectional descriptive study was conducted in patients with depressive disorders at a university hospital in northeastern Thailand. The patients were interviewed using the ACEs questionnaire, investigating the 10 most common types of childhood trauma. Statistical analyses included descriptive statistics and association analyses. Results: Among the 119 patients who completed the questionnaire, 98 (82.4%) had major depressive disorder (MDD) and 21 (17.6%) had persistent depressive disorder (PDD). Most (62.2%) had at least one type of ACEs with 60.2% in MDD and 71.4% in PDD. The three most common traumatic events were emotional neglect (37.8%), verbal abuse (27.7%), and having family members with alcohol or substance abuse (21%). Only emotional neglect was related to further suicidal risk. A total score of 4 or more significantly increased the risk of admission (OR 23.42, 95% CI 5.73 to 95.78) and suicide attempts (OR 3.68, 95% CI 1.14 to 11.9). Conclusion: About two-thirds of patients with a depressive disorder had at least one type of childhood trauma, and the most common type was emotional neglect. In patients with depression, a history of ACEs should be evaluated before formulating the psychological trauma treatment plan. The authors recommend pro-active strategies for educating and counseling parents regarding appropriate parenting to reduce the incidence of ACEs for their children. Keywords: Adverse Childhood Experiences (ACEs), Depression, Childhood trauma

Triangulating evidence on the role of perceived versus objective experiences of childhood adversity in psychopathology

Triangulating evidence on the role of perceived versus objective experiences of childhood adversity in psychopathology

The influence of early adversity on self-regulation and student-teacher relationships in preschool

Nearly half of young children nationally have some sort of preschool experience by the time they enter kindergarten. Many of these children have experienced one or more types of adverse childhood experiences (ACEs), such as child maltreatment or exposure to violence. Exploring how adversity impacts children in the preschool context may highlight potential opportunities for trauma-informed interventions as well as ways to reduce racial disparities seen in preschool outcomes, such as school readiness and suspension/expulsion rates. This study explores the relationship between children’s exposure to cumulative adversity, their self-regulation, and their relationship with their teachers in a sample of predominantly Black (29%) and Latino(71%) children. Data were collected from caregivers of preschool children (n = 126) ontheir child’s lifetime exposure to twelve childhood adversities, including traditionalACEs (e.g., domestic violence exposure and parental substance use) and environmental ACEs (e.g., community violence exposure and food insecurity). Data was also collected from teachers at the middle and end of the preschool year on the child’s self-regulation and on the student-teacher relationship. Children in the sample experienced an average of 3 adversities, with a range of 0–10 ACEs. In a series of path analyses, children’s mid-year self-regulation problems mediated the relationship between children’s ACEs and their end-of-year student-teacher conflict. Above and beyond the contribution of cumulative adversity, teachers reported higher self-regulation problems and student-teacher conflict for Black preschoolers in the study than for other children. The findings in this study highlight the potential negative impact of cumulative adversity on children in the preschool context and supports the need for the development of trauma-informed preschool models that attend to racial disparities and implicit bias to best support the well-being of adversity-exposed young children.

Adverse childhood experience and adult persistent pain and disability: protocol for a systematic review and meta-analysis

BackgroundA growing body of research highlights the pervasive harms of adverse childhood experiences (ACEs) on health throughout the life-course. However, findings from prior reviews and recent longitudinal studies investigating the association between types of ACEs and persistent pain have yielded inconsistent findings in the strength and direction of associations. The purpose of this review is to appraise and summarize evidence on the relationship between ACEs and persistent pain and disability outcomes in adulthood. The specific aims are (1) to determine whether there is a relationship between exposure to ACE and persistent pain and disability in adults and (2) to determine whether unique and cumulative ACEs exposures (number and type) increase the risk of developing persistent pain and disability in adulthood.MethodA systematic review and meta-analysis of observational studies will be conducted. Our eligibility criteria are defined following a PECOS approach: population, adults with persistent (≥ 3 months) musculoskeletal and somatoform painful disorders exposed to single or cumulative direct ACEs alone (i.e., physical, sexual, emotional abuse or neglect) or in combination to indirect types of ACE (e.g., parental death, exposure to domestic violence) in the first 18 years of life; comparators, unexposed individuals; outcomes, measurements for persistent pain (≥ 3 months) and disability using discrete and/or continuous measures; and settings, general population, primary care. A comprehensive search of MEDLINE (Ovid) and nine other pertinent databases was conducted from inception to 29 August 2019 using a combination of key words and MeSh terms (the search will be updated prior to conducting the analyses). Pairs of reviewers will independently screen records and full text articles, and a third reviewer will be consulted in cases of disagreement. Data will be extracted using Endnote and Covidence and a meta-analysis will be conducted using Review Manager (RevMan) Version 5.3. The Scottish Intercollegiate Guidelines Network (SIGN) and the Joanna Briggs Institute (JBI) checklists will be used to assess the quality of the included studies. If heterogeneity is high, the findings will be presented in narrative form.DiscussionThe present review will help consolidate knowledge on persistent pain and disability by evaluating whether frequency and type of adverse childhood experiences produces the most harm. Findings may help inform practitioners and policy-makers who endeavor to prevent and/or mitigate the consequences of ACEs and promote healthy development and well-being of children, youth, and families.Systematic review registrationPROSPERO CRD42020150230

Adverse Childhood Experiences and Decreased Renal Function: Impact on All-Cause Mortality in U.S. Adults

Evidence suggests that individuals with a history of adverse childhood experiences have higher odds of developing kidney disease than individuals with no adverse childhood experiences. However, no study has examined the influence of coexisting adverse childhood experiences and kidney disease on mortality risk. This study uses a longitudinal survey of adults to examine the influence of coexisting adverse childhood experiences and decreased renal function on all-cause mortality in a sample of U.S. adults. A total of 1,205 adults participating in the Midlife Development in the United States series between 1995 and 2014 were used for this analysis performed in 2019. A total of 6 types of adverse childhood experiences were available in the data set, which were combined to create a dichotomous variable with any adverse experience counted as yes. Decreased renal function was defined as an estimated glomerular filtration rate <60 milliliter/minute/1.73 m2. The main outcome was all-cause mortality. Cox proportional hazards models were performed to examine 4 combinations of adverse childhood experiences and decreased renal function associated with overall survival (neither, adverse childhood experiences only, decreased renal function only, or both) controlling for covariables. In fully adjusted models, adverse childhood experiences and decreased renal function were associated with increased all-cause mortality relative to neither (hazard ratio=2.85, 95% CI=1.30, 6.25). Decreased renal function only and adverse childhood experiences only were not significantly associated with all-cause mortality (hazard ratio=1.14, 95% CI=0.64, 2.04 and hazard ratio=1.55, 95% CI=0.44, 5.41, respectively). When using decreased renal function as the reference group, coexisting adverse childhood experiences and decreased renal function was associated with a 64% increased risk of all-cause mortality, though this relationship was not statistically significant. Coexistence of adverse childhood experiences and decreased renal function is associated with higher all-cause mortality than seen in individuals with neither adverse childhood experiences nor decreased renal function and may be associated with higher all-cause mortality than seen in individuals with decreased renal function alone. Future research is needed to better understand this potential association.

Outpatient Psychiatric Care for Youth with Suicide Risk: Who is Offered Dialectical Behavioural Therapy?

Dialectical behaviour therapy for adolescents (DBT-A) has recently been adapted and tested as an intervention for suicidal youth in randomized trials. Although studies have demonstrated the efficacy of this intervention for suicidal behaviours, research examining which youth get offered DBT-A in clinical practice is lacking. This study aimed to determine the proportion of suicidal youth that were offered DBT-A in a child and youth psychiatric outpatient clinic, and how selected clinical features differ between youth offered and not offered DBT-A. Medical records of 44 youth were reviewed based on: (1) initial mental health intake assessment between January and June 2015, (2) age 13–16 years, and (3) active suicidal ideation (SI) with or without recent non-suicidal self-injury (NSSI)-or suicide attempt (SA). Twenty-four consecutive months of demographic, diagnostic, and treatment data were reviewed retrospectively. 79.5% (n = 35) of the sample endorsed SI, 63.6% (n = 28) endorsed NSSI, and 47.7% (n = 21) reported a past SA. 47.7% (n = 21) were offered DBT-A. There was a significant relationship between offering of DBT-A and endorsement of multiple suicidal risk symptoms at baseline. Youth offered DBT-A reported significantly more types of adverse childhood experiences than those not offered DBT-A. Youth mental health clinicians appear to preferentially offer DBT-A to youth who report multiple suicidal risk symptoms and adverse childhood experiences. This profile is consistent with populations of youth enrolled in randomized trials of DBT-A. A large proportion of suicidal youth are not offered DBT-A, suggesting that clinicians consider multiple factors in treatment decision-making.