Validación de un instrumento para medir experiencias infantiles adversas en estudiantes universitarios colombianos / Validation of an instrument to measure adverse child experiences in Colombian university students / Validação de um instrumento para medir as experiências adversas de crianças em universitários colombianos

El objetivo del presente estudio fue adaptar culturalmente y desarrollar la versión colombiana del test Adverse Childhood Experiences y explorar sus propiedades psicométricas. Metodología: participaron cinco jueces expertos para validar el contenido de la versión adaptada y 100 estudiantes universitarios para realizar la confiabilidad y validez del constructo. Resultados: El instrumento Adverse Childhood Experiences versión Colombia es autoaplicable de 16 ítems y mide cuatro factores o Subsescalas: violencia sociopolítica y desastres naturales, abusos, desafíos domésticos, y negligencia física y emocional. Esta versión mostro una muy buena validez de contenido (k=0,83-1,00), una consistencia interna fuerte y perfecta (0,95) y una validez de constructo que muestra un contenido discriminante importante de las cuatro Subsescalas o factores con el 57% de la varianza. Conclusiones: el Adverse Childhood Experiences versión colombiana es confiable para medir experiencias traumáticas en la infancia y eventos traumáticos por violencia sociopolítica y desastres naturales en población universitaria colombiana.

Objective: The objective of the present study was to culturally adapt and develop the colombi-an version of the Adverse Childhood Experiences test and explore its psychometric properties. Methodology: five expert judges participated to validate the content of the adapted version and 100 university students to perform the reliability and validity of the construct. Results: The Adverse Childhood Experiences instrument, colombia version, is self-applied with 16 items and measures four factors or Subscales: sociopolitical violence and natural disasters, abuse, domestic challenges, and physical and emotional neglect. This version showed a very good content validity (k = 0.83-1.00), a strong and perfect internal consistency (0.95) and a construct validity that shows an important discriminant content of the four subscales or factors with 57% of the variance. Conclusions: The Adverse Childhood Experiences Colombian version is reli-able to measure traumatic experiences in childhood and traumatic events due to socio-political violence and natural disasters in Colombian university population

Objetivo: O objetivo deste estudo foi adaptar culturalmente e desenvolver a versão colombiana do teste Adverse Childhood Experiences e explorar suas propriedades psicométricas. Metodolo-gia: participaram cinco juízes especialistas para validar o conteúdo da versão adaptada e 100 uni-versitários para realizar a confiabilidade e validade do construto. Resultados: A versão colombi-ana do instrumento Adverse Childhood Experiences é autoaplicável com 16 itens e mede quatro fatores ou subescalas: violência sociopolítica e desastres naturais, abuso, desafios domésticos e negligência física e emocional. Esta versão apresentou uma validade de conteúdo muito boa (k=0,83-1,00), uma consistência interna forte e perfeita (0,95) e uma validade de construto que mostra um conteúdo discriminante importante das quatro subescalas ou fatores com 57% da variância. Conclusões: a versão colombiana das Experiências Adversas da Infância é confiável para medir experiências traumáticas na infância e eventos traumáticos devido à violência socio-política e desastres naturais na população universitária colombiana

Toxic stress, epigenetics and child development

Abstract Objectives: To describe the concept of toxic stress, present the basics of epigenetics and discuss their relationship with child development. Data source: Narrative literature review through a search in the SciELO, Lilacs, Medline databases using the terms Adverse Childhood Experience OR Early Life Stress, Epigenomic OR Epigenetic, Child Development OR Infant Development. Data synthesis: Continuing stress response, known as toxic stress, can occur when a child experiences intense, frequent, and/or prolonged adversity-such as physical or emotional abuse, chronic neglect, for example-without adequate adult support. This toxic stress can have harmful effects on learning, behavior, and health throughout life. Epigenetics, an emerging scientific research area, shows how environmental influences affect gene expressions and explains how early experiences can impact throughout life. Conclusions: Toxic stress causes changes in the human body response systems that can be explained in part by epigenetic changes, which can be temporary or long-lasting. Pediatricians must be aware of these mechanisms and their consequences, seeking to prevent them and thus promote the health, well-being, and quality of life of children, contributing to their full development.

Early adversity and adult delinquency: the mediational role of mental health in youth offenders / Adversidade precoce e delinquência na idade adulta: o papel mediador da saúde mental em jovens ofensores

Abstract This research explores the mediational role of mental health in the relationship between early adverse experiences and current self-reported delinquency in young adults with past juvenile justice involvement. Seventy-five young adults with official records of juvenile delinquency in 2010/2011 filled out our protocol in 2014/2015 including the Adverse Childhood Experiences (ACE) questionnaire, the Brief Symptom Inventory, and the D-CRIM questionnaire (evaluating delinquency). The global level of adverse experiences during childhood and adolescence was related to mental health problems and self-reported delinquency in young adulthood, while psychopathological symptoms were also related to current self-reported delinquency. The mental health indicator partially mediated the link between early adversity and current self-reported offending in individuals with past juvenile justice involvement. Our results are in line with previous psychological and neurobiological approaches and highlight the importance of mental health services in youth offender rehabilitation. Future directions for research are provided.

Resumo Esta pesquisa explora o papel mediador da saúde mental na relação entre experiências adversas precoces e delinquência autorreportada em jovens adultos com historia de envolvimento no sistema de justiça juvenil. Setenta e cinco jovens adultos com registros de delinquência juvenil em 2010/2011 preencheram o protocolo em 2014/2015, incluindo o Questionário de Experiências Adversas na Infância, o Inventário de Sintomas Psicopatológicos e o D-CRIM (que avalia a delinquência). O nível global de experiências adversas na infância e adolescência associou-se tanto a problemas de saúde mental como à delinquência autorreportada em jovens adultos, os sintomas psicopatológicos estiveram também associados à delinquência juvenil no presente. O indicador de saúde mental parcialmente mediou a relação entre adversidade precoce e o nível atual de delinquência em indivíduos com história de envolvimento no sistema de justiça juvenil. Os nossos resultados estão em linha com abordagens psicológicas e neurológicas prévias e salientam a importância dos serviços de saúde mental na reabilitação de jovens ofensores. Direções futuras são apresentadas.

Monoamine Oxidase-A Genetic Variants and Childhood Abuse Predict Impulsiveness in Borderline Personality Disorder

OBJECTIVE: Impulsivity is a core feature of borderline personality disorder (BPD) and antisocial personality disorder (ASPD) that likely arises from combined genetic and environmental influences. The interaction of the low activity variant of the monoamine oxidase-A (MAOA-L) gene and early childhood adversity has been shown to predict aggression in clinical and non-clinical populations. Although impulsivity is a risk factor for aggression in BPD and ASPD, little research has investigated potential gene-environment (G×E) influences impacting its expression in these conditions. Moreover, G×E interactions may differ by diagnosis. METHODS: Full factorial analysis of variance was employed to investigate the influence of monoamine oxidase-A (MAO-A) genotype, childhood abuse, and diagnosis on Barratt Impulsiveness Scale-11 (BIS-11) scores in 61 individuals: 20 subjects with BPD, 18 subjects with ASPD, and 23 healthy controls. RESULTS: A group×genotype×abuse interaction was present (F(2,49)=4.4, p=0.018), such that the interaction of MAOA-L and childhood abuse predicted greater BIS-11 motor impulsiveness in BPD. Additionally, BPD subjects reported higher BIS-11 attentional impulsiveness versus ASPD participants (t(1,36)=2.3, p=0.025). CONCLUSION: These preliminary results suggest that MAOA-L may modulate the impact of childhood abuse on impulsivity in BPD. Results additionally indicate that impulsiveness may be expressed differently in BPD and ASPD.

Adversidade na infância prediz sintomas depressivos e tentativas de suicídio em mulheres adultas portuguesas / Adversity in childhood predicts depressive symptoms and suicide attempts in adult portuguese women

Este estudo examinou a prevalência de 10 categorias de experiências adversas na infância autorrelatadas em mulheres adultas portuguesas, e avaliou se essas experiências eram preditoras do índice de sintomatologia depressiva e de tentativas de suicídio. Um total de 225 mulheres completou o Adverse Childhood Experiences Study Questionnairee a subescala de depressão do Inventário de Sintomas Psicopatológicos. Quase 96,0% das mulheres relatou ter sido exposta a pelo menos uma experiência adversa na infância e adolescência. Os resultados da regressão linear indicam que a adversidade total explica 6,6% da variância dos sintomas de depressão, enquanto a regressão logística mostra que o incremento de um ponto na adversidade total aumenta o risco de tentativas de suicídio em 1,818 vezes. Os resultados deste estudo mostram que a exposição a experiências adversas na infância é frequente e o seu grau é preditor de sintomatologia depressiva e tentativas de suicídio.

This study examined the prevalence of 10 categories of self-reported childhood adverse experiences in adult Portuguese women and assessed whether these factors were predictive of depressive symptoms and suicide attempts. A total of 225 women completed the Adverse Childhood Experiences Study Questionnaire and evaluated the depression subscale of the Brief Symptoms Inventory. Almost 96.0% of the participant women reported being exposed to at least one adverse experience in childhood and adolescence. Linear regression indicated that the total adversity explains 6.6% of the variance in symptoms of depression, whereas logistic regression indicated that the increase in adversity by one point increased the risk of suicide attempts 1,818 times. The results obtained show that exposure to adverse childhood experiences is frequent and that the degree of exposure is a predictor of depressive symptoms and suicide attempts.

Estudio de casos y controles en un grupo de mujeres embarazadas con experiencias adversas en la infancia y/o adolescencia e infecciones de transmisión sexual / Case studies and controls in a group of pregnant with adverse experience in childhood and/or adolescence and sexually transmitted infections

Introduction Psychic traumas, also called adverse experiences, are events from the subject's life characterized by its intensity, the subject's inability to respond to them properly and the pathogenic lasting effects they cause in the psychic organization. The violence effects against women and girls are usually devastating for their reproductive health and other aspects of their physical and mental well-being. Besides injuries, violence causes an increase in the long-term risk of women developing other health problems. Women with a history of psychic mistreat or sexual abuse face also a bigger risk of non-expected or involuntary pregnancies, sexual transmitted infections and adverse results from pregnancy. High rates of childhood abuse were found: 42.2% had suffered physical mistreat, 21.4% had been insulted, 16.5% was victim of humiliation and 7.6% had been a victim of sexual abuse before fifteen years of age. The main aggressors were male relatives, the stepfather or the father. A study done in the United States found that women exposed to this form of violence suffered STI in adult age in a bigger proportion (10.7%) than the ones that were never exposed (5.7%). An investigation was made in the National Perinatolgy Institute called «STD/HIV-AIDS and Personality Disorders (PD) in pregnant women and their couples. Detection and prevention from high risk practices¼ with the objective -among others- to resolve the existing association between adverse experiences in childhood and the presence of sexually transmitted infections in gestation. Material and method The investigation design was of cases and controls; the characteristics of the study in relation to temporality was prospective with respect to the presence or absence of the pathogenic agent in gestation and retrospective (investigating adverse experiences in childhood), analytical referring to the analysis type and transverse with respect to the capture of the sample. The evaluation of the STIs was made through the Laboratory of the Sexually Transmitted Infections Clinic of the INPer and from the pertinent clinic exams. The diagnostic evaluation was made on the basis of the structured clinic interviews for the diagnostic psychiatric evaluation of I and II axes of DSM-IV. To investigate adverse childhood experiences, a psychodynamic interview was made and answers were transcribed then to the questionnaire made by Whitfields, Dube, Felitti and Anda, who developed the instrument Adverse Experiences in Childhood and/or Adolescence (ACE) with the aim to measure the amplitude of the exposition to emotional, physical and sexual abuse, as well as family dysfunction in these stages of life. It includes seven categories of adverse experiences, three relative to active abuse and five to passive abuse: 1. psychological abuse; 2. physical abuse; 3. sexual abuse; 4. conjugal violence against the mother; 5. living with parent or adults with alcohol problems and/or substance abusers; 6. living with parents or adults with mental disorders or suicidal; 7. living with parents that had been in jail. Results One hundred seventy-eight pregnant women were divided in two groups, the first one with 89 participants, in which a virus that caused the STI was identified, and the second group was the control group with also 89 pregnant women without STI. Significant differences were obtained in the socioeconomic level. There was also a significant association between fathers of the women with STI that had some legal problem and had being sent to jail for a period of time (RM 3.311); they also show small alcoholic problems (RM 2.073). There was a significant association with the different types of passive abuse (carelessness, negligence and indifference) physical, emotional and sexual, emphasizing that the relation between these categories and having an STI by a virus is highly significant; this is, being exposed in childhood to adverse events, more probability to get a viral STI in adulthood. The cases group accumulated three or more in bigger proportion (20.2%) than the control group (9%). The STI pregnant group presented a bigger number of traumatic events (69.9%) in comparison to the group with no STI that was 48.3%. It is appraised the bigger prevalence of mental disorders in the STI pregnant group, having a disorder increased the potential risk of infection by 2.45 times (C:I to 95% that oscillates between 1.303 and 4.61). Conclusions The STI viral group and the control group are different concerning socioeconomic level and schooling, finding in the STI group a bigger proportion of women whose monthly family income is lower, the poverty as a risk factor and/or social vulnerability for the HIV infection, the interaction between living in poverty conditions and the difficulty to access and to stay in the national educative system are closely related. In addition, this case group was integrated in a bigger proportion with pregnant who were not united in the study period. It is important to mention that half of the pregnant that formed the HIV/ AIDS group suffered the pain of seeing their couple die. From the adverse experiences in childhood and/or adolescence that could have been in the start or been a beginning factor for getting afterwards a viral STI in adulthood, the significant ones were having lived with a alcohol abuser adult, thus being victim of carelessness, negligence or indifference, same as being hit, pushed, pushed or hit so hard to leave marks, humiliations, coarses, insults, feelings of being less and victim of being touched or having a sexual experience. These traumatic events happened simultaneously, mainly in the cases group where 40 pregnant declared being exposed to two or more categories in contrast with 22 of the control group. Alcohol abuse is a generalized health problem and common in all societies; pregnant women with STI were in bigger proportion more exposed to familiar alcohol than the control group and approximately half of them were at the same time victims of some forms of abuse or violence by their fathers or stepfathers. Studies made in 21 countries show that between 7% and the 36% of the women had accepted being victims of sexual aggressions during their childhood and, according to most of these studies, the rate of abuses suffered by girls is 1.5 to 3 times bigger than men. The same report makes evident the fact that between 133 and 275 millions of children from all over the world are witnesses of domestic violence each year; this is, witness violent scenes at their home, generally through fights between their parents or between their mother and couple, which can also seriously affect their well-being, development and their social interaction in childhood and adult age. It has also been found that suffering an active abuse in childhood is a risk factor for structuring a borderline personality disorder.

Resumen Introducción Los traumas psíquicos, también denominados experiencias adversas, son acontecimientos de la vida del sujeto caracterizados por su intensidad, la incapacidad del sujeto para responder a ellos adecuadamente y los efectos patógenos duraderos que provocan en la organización psíquica. Los efectos de la violencia contra las mujeres y las niñas suelen ser devastadores para la salud reproductiva de la mujer y otros aspectos de su bienestar físico y mental. Además de causar lesiones, la violencia lleva a que aumente el riesgo a largo plazo de que las mujeres desarrollen otros problemas de salud. Las mujeres con una historia de maltrato físico o abuso sexual también enfrentan un riesgo mayor de embarazos no previstos o involuntarios, infecciones de transmisión sexual (ITS) y resultados adversos del embarazo. En el Instituto Nacional de Perinatología se realizó una investigación titulada «ETS/VIH-SIDA y trastornos de la personalidad en mujeres embarazadas y sus parejas. Detección y prevención de prácticas de alto riesgo¼ con el objetivo -entre otros- de determinar la asociación existente entre experiencias adversas en la infancia y la presencia de infecciones de transmisión sexual en la gestación. Material y método El diseño de la investigación fue de casos y controles; el estudio fue prospectivo respecto de la presencia o ausencia del agente patógeno en la gestación y retrospectivo (indagación de experiencias adversas en la infancia). La evaluación de las ITS se efectuó por medio del laboratorio; la evaluación diagnóstica se efectuó con base en las Entrevistas Clínicas Estructuradas para la evaluación diagnóstica psiquiátrica de los Ejes I y II del DSM-IV. Se aplicó el instrumento Experiencias Adversas en la Infancia y/o Adolescencia (ACE, por sus siglas en inglés), con el fin de medir la amplitud de la exposición al abuso emocional, físico y sexual, así como la disfunción familiar en estas etapas de la vida. El instrumento comprende siete categorías: 1. abuso psicológico; 2. abuso físico; 3. abuso sexual; 4. violencia conyugal contra la madre; 5. vivir con padres o adultos con problemas de alcoholismo y/o que eran abusadores de sustancias; 6. vivir con padres o adultos con trastornos mentales o suicidas; 7. vivir con padres que fueron encarcelados. Resultado Se estudiaron dos grupos, el primero de casos integrado con 89 embarazadas con ITS viral y el segundo fue el grupo control integrado también con 89 gestantes, sin ITS. Se obtuvieron diferencias significativas en el nivel socioeconómico. Así mismo hubo una asociación significativa entre los padres de las mujeres con ITS que tuvieron algún problema con la ley por lo que habían sido encarcelados por un determinado periodo de tiempo (la razón de momios fue 3.311); y los que manifestaron leves problemas de alcoholismo (RM 2.073). Hubo una asociación significativa en: abuso pasivo, físico, emocional y sexual, donde destaca que la relación entre estas categorías y padecer una ITS por virus es altamente significativa. El grupo de las gestantes con ITS presentó un mayor número de problemas traumáticos (69.9%) en comparación con el grupo sin ITS que fue de 48.3%. Conclusiones De las experiencias adversas en la infancia y/o adolescencia, que pudieron estar en el origen o haber sido un factor iniciador para adquirir posteriormente una ITS de origen viral en la edad adulta, fueron significativas haber convivido con un adulto cercano con problema de abuso del alcohol y haber sido víctima de descuido, abuso físico, emocional o sexual.