Family instability in childhood affects language and memory in adulthood: results from the Pró-Saúde Study, Brazil / Instabilidade familiar na infância afeta a linguagem e memória na vida adulta: resultados do Estudo Pró-Saúde

Abstract The study aims to investigate associations between adverse childhood psychosocial exposures and declarative memory, language, and executive function in adults with secondary schooling or more and without dementia. In 361 participants from the Pró-Saúde Study, we estimated associations between maternal educational attainment, principal source of the family´s income, food insecurity, and childhood family structure and performance in learning, word recall, and semantic and phonemic verbal fluency tests using multiple linear regression models. Individuals whose mother was the family breadwinner (mean difference: -1.97, 95%CI: -3.27; -0.72) and head-of-household (mean difference: -1.62, 95%CI: -2.89; -0.35) or who lived with a non-parental caregiver or in institutions in childhood (mean difference: -2.19, 95%CI: -4.29; -0.09) showed a reduction in the mean number of words in language and memory in adulthood. The results provide further evidence of the effect of adverse exposures in childhood. Without effective interventions, such exposures are likely to have far-reaching impacts on cognition.

Resumo Nosso objetivo é investigar as associações de exposições psicossociais adversas na infância com memória declarativa, linguagem e função executiva em adultos livres de demência com ensino médio completo ou mais. Em 361 participantes do Estudo Pró-Saúde estimamos as associações entre escolaridade materna, principal apoio financeiro familiar, insegurança alimentar e estrutura familiar na infância com o desempenho no teste de aprendizagem e evocação de palavras, e fluência verbal semântica e fonêmica usando modelos de regressão linear múltipla. Ter a mãe como principal suporte financeiro familiar (diferença média: -1,97, IC95%: -3,27; -0,72) e ter morado apenas com ela (diferença média: -1,62, IC95%: -2,89; -0,35) ou outra pessoa/ser institucionalizado (diferença média: -2,19, IC95%: -4,29; -0,09) na infância permaneceu associada à uma redução na média de palavras nos testes de linguagem e memória na vida adulta. Nossos achados adicionam mais evidências sobre o efeito de exposições na infância que, sem intervenções apropriadas, provavelmente terão legados de longo alcance na cognição.

Adversidades na Infância: Associação a Fatores Protetivos e Sintomas Internalizantes na Adultez / Childhood Adversities: Association with Protective Factors and Internalizing Symptoms in Adulthood / Adversidades en la Infancia: Asociación con Factores Protectores y Síntomas Internalizantes en la Adultez

Este estudo teve por objetivo discutir relações entre adversidades na infância e sintomas de depressão, ansiedade e estresse em uma amostra de adultos brasileiros, além dos fatores proximais e distais que poderiam explicar o caminho dessa relação da infância até a idade adulta. 510 participantes com idades entre 18 e 59 anos (MD=30,64; DP=10,47) responderam a uma ficha de dados sociodemográficos, à Maltreatment and Abuse Exposure Scale, à DASS-21 e à Social Readjustment Rating Scale, por coleta online e presencial. Os resultados indicaram que ter vivenciado adversidades na infância estava associado a maiores índices dos sintomas e à ideação suicida e que a violência psicológica e emocional se mostrou mais prevalente e com maior efeito em longo prazo. Percepção de rede de apoio social e psicoterapia são fatores que podem atuar de forma positiva e eventos estressores recentes podem intensificar o prejuízo sobre a saúde mental. São discutidas as implicações na identificação e intervenção sobre as adversidades na infância e no investimento nos fatores protetivos em longo prazo. (AU)

This study aimed to discuss the relationships between childhood adversity and symptoms of depression, anxiety and stress in a sample of Brazilian adults, as well as the proximal and distal factors that could explain the path of this relationship from childhood to adulthood. 510 participants aged 18-59 years (M = 30.64; SD = 10.47) responded to a sociodemographic data sheet, the Maltreatment and Abuse Exposure Scale, the DASS-21 and the Social Readjustment Rating Scale. The results indicated that experiencing childhood adversities is associated with higher indexes of symptoms and suicidal ideation, and that psychological and emotional violence was more prevalent and had a greater long-term effect. Perceptions of social support network and psychotherapy are factors that can act positively and recent stressful events can intensify the damage on mental health. Implications for identifying and intervening on childhood adversities and investing in long-term protective factors are discussed. (AU)

Este estudio tuvo por objetivo discutir relaciones entre adversidades en la infancia y síntomas de depresión, ansiedad y estrés en una muestra de adultos brasileños, además de los factores proximales y distales que podrían explicar el camino de esa relación de la infancia hasta la edad adulta. 510 participantes con edades entre 18 y 59 años (M = 30,64, DE = 10,47) respondieron a una ficha de datos sociodemográficos, a la Maltreatment and Abuse Exposure Scale, a la DASS-21 y a la Social Readjustment Rating Scale, por colecta online y presencial. Los resultados indicaron que haber vivido adversidades en la infancia estaba asociado a mayores índices de los síntomas y a la ideación suicida, y que la violencia psicológica y emocional se mostró más prevalente y con mayor efecto a largo plazo. La percepción de la red de apoyo social y la psicoterapia son factores que pueden actuar de forma positiva y los acontecimientos de estrés recientes pueden intensificar el perjuicio sobre la salud mental. Se discuten las implicaciones en la identificación e intervención sobre las adversidades en la infancia y en la inversión en los factores protectores a largo plazo. (AU)

Gender-related dimensions of childhood adversities in the general population

Objective: Childhood adversities (CAs) comprise a group of negative experiences individuals may suffer in their lifetimes. The goal of the present study was to investigate the cluster discrimination of CAs through psychometric determination of the common attributes of such experiences for men and women. Methods: Parental mental illness, substance misuse, criminality, death, divorce, other parental loss, family violence, physical abuse, sexual abuse, neglect, physical illness, and economic adversity were assessed in a general-population sample (n=5,037). Exploratory and confirmatory factor analysis determined gender-related dimensions of CA. The contribution of each individual adversity was explored through Rasch analysis. Results: Adversities were reported by 53.6% of the sample. A three-factor model of CA dimensions fit the data better for men, and a two-factor model for women. For both genders, the dimension of family maladjustment - encompassing physical abuse, neglect, parental mental disorders, and family violence - was the core cluster of CAs. Women endorsed more CAs than men. Rasch analysis found that sexual abuse, physical illness, parental criminal behavior, parental divorce, and economic adversity were difficult to report in face-to-face interviews. Conclusion: CAs embrace sensitive personal information, clustering of which differed by gender. Acknowledging CAs may have an impact on medical and psychiatric outcomes in adulthood.

Behavioral problems of school children: impact of social vulnerability, chronic adversity, and maternal depression

This study's objective was to identify the predictive effect of indicators concerning social vulnerability, chronic adversity, and maternal depression on behavioral problems among school-aged children, according to the perceptions of mothers and teachers, considering the presence or absence of difficulties in the contexts of family and school. A total of 85 pairs of mothers and school children were distributed into three groups according to the behavioral problems identified. A General Questionnaire, the PHQ-9, the Chronic Adversity Scale, and the (Strengths and Difficulties Questionnaire) SDQ were applied to the mothers; the Raven's Colored Progressive Matrices were applied to the children; and the SDQ was applied to the teachers. Data were analyzed with descriptive, predictive, and comparative statistical procedures (p ≤ 0.05). The results reveal the presence of cumulative risks for children with behavioral problems; mothers more frequently identified behavioral problems than teachers; and maternal depression was a predictor for behavioral problems. Such findings are relevant for devising mental health programs.

Impact of Childhood Exposure to Intimate Partner Violence and Other Adversities

Childhood exposure to intimate partner violence (IPV) and other adversities has been shown to have adverse effects on health and well-being not only in childhood but also throughout the lifespan. This paper focuses on the prevalence of childhood adversities including exposure to IPV. The intersection of adverse childhood experiences and IPV victimization/perpetration in adulthood is also explored. The neurobiology of trauma is discussed and by understanding the impact of trauma on health, it is hoped that enhancement of resilience is possible. Based on the identification of protective factors at the individual, familial, and community level, examples of interventions that encourage safe, stable, and nurturing relationships between parents and children are described.

The Phenomenon Of Dissociation, Depression And Borderline Personality In A Young Woman

Early life adversities like parental loss during childhood, physical abuse, sexual abuse and emotional harassment may have deleterious consequences in an individual’s life, which can manifest under the form of various externalizing or internalizing behaviors. This case study aimed to highlight the impact of unusual early life adversities in a young woman’s mental health and related management issues. Methods: We reported a case of a young lady presenting with anxiety, low mood, disturbed sleep and appetite for more than six months. She also had episodes of dissociative stupor following any stressful event for approximately 13 years. She was hospitalized, evaluated clinically as well as by psychometric assessment. Relevant pharmacological and psychological interventions were performed. Results: She was diagnosed with Major depressive disorder with dissociative disorder and borderline personality disorder. The patient had multiple stressors during childhood like - loss of parents, emotional & physical abuse, which had an impact on her mental wellbeing. Conclusion: Early life adversities are detrimental to the mental health of an individual. The clinical outcome depended upon on the nature of trauma to the mental well-being, mode of intervention done and available psychosocial supports. ASEAN Journal of Psychiatry, Vol. 17 (2): July – December 2016: XX XX.

Psychosocial Morbidities In Children With Medically Unexplained Pain Symptoms: A Study From India

Objective: Medically unexplained pain is a common manifestation of psychological distress in children, though establishing this diagnosis is seldom an easy task. This study aimed to enhance and share clinical insights in the complex interplay of medical and/ or psychological factors in these children as revealed by multidimensional assessment, to help in their effective management. Methods: Researchers assessed 65 consecutive children with unexplained pain for more than a month, referred by pediatrician. Of these, 59 consented and completed the interview. Clinical interview by psychiatrist generated psychiatric diagnosis as per ICD – 10 research criteria. Global functioning of the child (CGAS) and relational functioning of the family (GARF) were assessed before and after treatment. Psychosocial stresses were assessed clinically and treatments given to child and/or parent were recorded. Psychologist assessed intelligence of the child using Raven’s Coloured Progressive Matrices and administered Children’s Apperception Test (CAT). Results: A total of 38 (64.4%) children fulfilled criteria for Persistent Somatoform Pain Disorder. Most of them (89.8 %) were undergoing personal, familial and social stresses, many of which were revealed only after detailed clinical assessment. Major depression (28.8%), intellectual subnormality (11.9%), non-organic enuresis (8.5%) and ADHD (8.5%) were common co-morbid psychiatric diagnoses. Children with varying intellectual levels were proportionately represented, and colored the clinical complexity. Repression and reaction formation were common defenses and fear of loss of love of parent, injury, being overpowered were common fears as revealed on CAT. Conclusion: Unexplained pain was often a somatic expression of emotional needs in these children. Psychosocial adversities were common and often causative. However being subtle, these were routinely unidentified. Precise assessment is the key to effective management of these cases.

Socio-demographic and clinical features of children with intellectual disability and their parents-an Indian study.

Aim: Intellectual disability often referred to as a mental, cognitive or mental retardation is a lifelong condition that affects intellectual functioning and adaptive behaviors. Information about children with intellectual disability attending regular schools is limited in India as there are no mandatory screening procedures used to detect these children while starting their schooling. Hence the purpose of the study was to examine the demographic and clinical features of children in regular schools with intellectual disability and also to explore their parental demographic and clinical features. Study Design: Cross sectional study Sample: The sample (N=382) was collected from regular school going children within the age range of 5 to 16 years who were referred by special educators. Methodology: Clinical diagnosis and psychological assessments were conducted individually for 382 children and their parents. Results: Results of the clinical evaluation and assessment indicate that intellectual disability was associated with male gender (61.3%), poor socio-economic status (78.8%), pre-natal, peri-natal and post-natal complications (74%), family history of intellectual disability (11.2%), mental illness (22.2%) and increased maternal age. High rates of comorbidity with psychiatric disorders (48.17%), especially with externalizing disorders were noticed. Conclusion: Intellectual disability is associated with psychosocial adversities and psychiatric comorbidities.

Social anxiety and negative early life events in university students / Eventos negativos na infância e ansiedade social em estudantes universitários

INTRODUCTION: There is substantial evidence regarding the impact of negative life events during childhood on the aetiology of psychiatric disorders. We examined the association between negative early life events and social anxiety in a sample of 571 Spanish University students. METHODS: In a cross-sectional survey conducted in 2007, we collected data through a semistructured questionnaire of sociodemographic variables, personal and family psychiatric history, and substance abuse. We assessed the five early negative life events: (i) the loss of someone close, (ii) emotional abuse, (iii) physical abuse, (iv) family violence, and (v) sexual abuse. All participants completed the Liebowitz Social Anxiety Scale. RESULTS: Mean (SD) age was 21 (4.5), 75% female, LSAS score was 40 (DP = 22), 14.2% had a psychiatric family history and 50.6% had negative life events during childhood. Linear regression analyses, after controlling for age, gender, and family psychiatric history, showed a positive association between family violence and social score (p = 0.03). None of the remaining stressors produced a significant increase in LSAS score (p > 0.05). CONCLUSION: University students with high levels of social anxiety presented higher prevalence of negative early life events. Thus, childhood family violence could be a risk factor for social anxiety in such a population.

INTRODUÇÃO: Existem evidências substanciais sobre o impacto de eventos negativos da vida durante a infância na etiologia dos transtornos psiquiátricos. Examinamos a associação entre os eventos negativos ocorridos na infância e a ansiedade social em uma amostra de 571 estudantes universitários espanhóis. MÉTODOS: Em um estudo transversal realizado em 2007, foram coletados os dados de variáveis sociodemográficas, história psiquiátrica pessoal e familiar e abuso de substâncias por meio de um questionário semiestruturado e avaliamos cinco eventos negativos ocorridos na infância: (i) a perda de alguém próximo, (ii) abuso emocional, (iii) abuso físico, (iv) violência familiar e (v) abuso sexual. Todos os participantes preencheram a escala de Liebowitz para ansiedade social. RESULTADOS: A média (DP) de idade foi de 21 anos (4,5); 75% eram do sexo feminino; o escore na LSAS foi 40 (DP = 22); 14,2% tinham história psiquiátrica familiar e 50,6% tiveram eventos negativos durante a infância. A análise de regressão linear, após o controle para idade, sexo e história psiquiátrica familiar, mostraram associação positiva entre violência familiar e escore de ansiedade social (p = 0,03). Nenhum dos fatores estressores restantes produziu aumento significativo no escore da LSAS (p > 0,05). CONCLUSÃO: Os estudantes universitários com altos níveis de ansiedade social apresentaram prevalência maior de eventos negativos precoces. Portanto, a violência familiar na infância pode ser um fator de risco para ansiedade social em tal população.