The missed pandemic: Intimate partner violence in female mental-health-care-users during the COVID-19 pandemic.

Adverse childhood experiences (ACEs) and interpersonal violence (IPV) in mentally ill women are often neglected and need to be reviewed in light of the suggested increase in IPV during the COVID-19 pandemic.We investigated the prevalence of ACEs and IPV in women living with severe mental illness (SMI) attending an outpatient psychiatry service at a public hospital in KwaZulu-Natal, South Africa, during the COVID-19 pandemic. We also described the association of ACEs with later IPV.A written survey comprising socio-demographic and clinical questionnaire, WHO Adverse Childhood Experiences International Questionnaire (ACE-IQ) for ACEs and the Women abuse screening tool (WAST) for IPV, was completed by the 154 women with SMI.141 (91.6%) participants scored positive for ACEs and 104 (67.5%) had experienced three or more ACEs. The most prevalent forms of ACEs were emotional neglect 72 (46.8%), one or no parents, parental separation, or divorce 104 (67.5%), contact sexual abuse 67 (43.5%) and witnessing a household member treated violently 67 (43.5%). Sixty-one (46.6%) participants reported IPV with scores  13 (indicative of abuse). On logistic regression, experience of three or more ACEs was significantly associated with IPV in adulthood (aOR 3.3, 95% CI: 1.2-9.6).The high prevalence of IPV and association of IPV with cumulative ACEs reflect firstly the hidden epidemic of domestic violence and secondly the vulnerability of those with ACEs to become victims of abuse later which is often  missed in the care of women with SMI.

The impact of child and adult stressors on multiple sclerosis biopsychosocial disease features

Background: Multiple Sclerosis (MS) is a neuroinflammatory demyelinating autoimmune disease of the central nervous system that disproportionately affects people in North America. Although the etiology and cure remain unknown, interactions among genetic, environmental (e.g., latitude), and behavioral (e.g., smoking) influences are considered contributing factors. The Social Safety Theory offers a pathway from stress to disease through the physiological responses of the inflammation cascade. Through this cascade, childhood stressors have been implicated in the development of many physical health conditions including heart disease, stroke, Alzheimer's disease, obesity, diabetes, and numerous autoimmune diseases. Childhood stressors are also linked with behavioral and mental health outcomes including perceived stress in adulthood and substance use. Adult stress has been associated with MS onset and relapses. Although traumatic stressors have been associated with the development of autoimmune diseases, remarkably few studies (n=5) have investigated the relationship between childhood stressors and MS disease features. Of these studies, none accounted for adult stressors, and few accounted for MS specific covariates.Purpose: The purpose of this cross-sectional study was to evaluate relationships among childhood adversity, adult stressors, and features of MS while accounting for MS specific confounders. Guided by the Social Safety Theory, this work posits that child and adult stressors are social threats which elicit neuroinflammatory responses contributing to MS symptoms.Methods: An electronic invitation was sent to the National MS Society listserv of 80,000 people with MS, and 924 participants successfully completed the survey. The aims of this dissertation include to examine the associations between: 1) cumulative child stressor characteristics (e.g., severity, duration), and cumulative adult stressor characteristics with individual MS disease outcome features;2) child stressor types, grouped by emotional, physical, and environmental, and MS disease features;and 3) individual lifetime stressor type characteristics (e.g., physical danger severity) and MS disease features. Hierarchical block modeling was used for aims 1 and 2 to assess the shared contribution of similar stressors, while multiple regression was used for aim 3.Results: For aim 1, hierarchical block modeling was used to sequentially assess childhood cumulative and adult cumulative stressors in relation to the six MS outcomes. Both child and adult stressors were associated with three outcomes, pain interference, disability, and mental health comorbidity. Only child stressors were associated with fatigue, while only adult stressors were associated with relapse burden changes since Covid-19. The age at symptom onset was not significantly associated with any stressors. For aim 2, hierarchical block modeling was used to sequentially assess childhood stressors, grouped by emotional, physical, and environmental stressors. At least two types of childhood stressors were significantly associated with all MS feature outcomes, except the relapse burden change since Covid-19 which was unaffected by stressors. For aim 3, multiple regression was used to assess cumulative stressors across the lifespan, grouped into five core social-psychological types, and the same six MS features. Stressors were significantly associated with four features, fatigue, pain interference, age at symptom onset, and mental health comorbidity. Stressors did not impact disability or relapse burden change.Conclusions: Findings across all aims fill gaps and advance knowledge in this field. This dissertation supports relationships between stressors experienced across the lifespan and common clinical features of MS. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

The Intersection and Dynamics between COVID-19, Health Disparities, and Adverse Childhood Experiences: "Intersection/Dynamics between COVID-19, Health Disparities, and ACEs".

The coronavirus disease 2019 (COVID-19) pandemic is shining a spotlight on health disparities that have long been overlooked in our society. The intersection between Adverse Childhood Experiences (ACEs), longstanding health disparities, and COVID-19 cannot be ignored. The accumulation of traumatic events throughout the childhood and adolescent years can cause toxic stress in the absence of supportive adults. This repetitive activation of the stress response system can be a catalyst to long-term, negative effects on both the body and brain. A major factor to appreciate is that ACEs do not affect all populations equally. ACEs disproportionately affect groups that have been historically oppressed. The current COVID-19 pandemic highlights this point when observing both case rates and fatality rates of the virus and has the potential to create a new series of long-term health conditions that will disproportionately affect marginalized communities. A foundational first and critical step of adopting a trauma-informed approach will help lead to system change, advance equity, and create a setting of mutuality and empowerment for our patients.

The Effectiveness of Playful Augmented Reality Media for Teaching Early-Primary Students

Hybrid learning has become the only solution to ensure the learning process still occurs in place of traditional classroom activities during the Covid-19 pandemic. Following this condition, the phenomenon of "Zoom Fatigue" has emerged. Some of the symptoms reported are decreased learning motivation, low attention, and reduced responses. Thus, a refresher process, including the use of new playful and frugal learning media is necessary for varying children's learning activities. A learning intervention was designed to teach anatomy playfully as part of a biology curriculum. The Augmented Reality technology used in this research is a Humanoid 4D+ mobile application with flashcards, developed by Octagon Studio. This media displays information virtually on a smartphone screen when the application uses the camera to scan flashcards containing visual markers. A hybrid learning space is formed as students can see information virtually. But, physically, they are in control because they run applications and choose the type of flashcard they want to scan. The research was undertaken in several learning parks in Solo City, Central Java Province, Indonesia, with a total of 43 volunteer teachers and 132 early primary students participating. Previously, the ACES team (part of a UKRI funded project) had provided online training on the use of this media with teachers. Each teacher would then implement the media for all students in each learning park. The teachers demonstrate the media and each student takes turns running the application to view information virtually, therefore experiencing interactive learning. The qualitative approach was conducted for capturing teachers' perceptions of Augmented Reality media. A survey using the JISC online platform was distributed to capture participants' reflections on the activities and media used. Based on findings, the media appears beneficial, effective, and efficient for teaching anatomy concepts. Its virtual features can attract the children's attention and teachers do not need to bring a lot of physical teaching aids, just one application to explain all organ system concepts. Students can learn playfully on their own and feel new learning experiences. The results indicated that the intervention could create playful and frugal activities which build student engagement as a potential solution to address issues of Zoom Fatigue. The next stage of the project will involve volunteer teachers implementing the technology more widely in their classes. © 2022 Dechema e.V.. All rights reserved.

Latent Classes of Adverse and Benevolent Childhood Experiences in a Multinational Sample of Parents and Their Relation to Parent, Child, and Family Functioning during the COVID-19 Pandemic.

Adverse Childhood Experiences (ACEs) are known to contribute to later mental health. Conversely, Benevolent Childhood Experiences (BCEs) may buffer against mental health difficulties. The importance of ACEs and BCEs for mental health of both parents and children may be most obvious during periods of stress, with potential consequences for functioning of the family. Subgroups of ACEs and BCEs in parents during the COVID-19 pandemic were investigated and validated in relation to indices of parent, child, and family well-being. In May 2020, ACEs/BCEs were assessed in 547 parents of 5-18-year-old children from the U.K., U.S., Canada, and Australia. Subgroups of parents with varying levels of ACEs and BCEs were identified via latent class analysis. The subgroups were validated by examining associations between class membership and indices of parent and child mental health and family well-being. Four latent classes were identified: low-ACEs/high-BCEs, moderate-ACEs/high-BCEs, moderate-ACEs/low-BCEs, and high-ACEs/moderate-BCEs. Regardless of the extent of BCEs, there was an increased risk of parent and child mental health difficulties and family dysfunction among those reporting moderate-to-high levels of ACEs. Parents' history of adversity may influence the mental health of their family. These findings highlight the importance of public health interventions for preventing early-life adversity.

Adverse Childhood Experiences and COVID-19 Stress on Changes in Mental Health among Young Adults.

The COVID-19 pandemic has been linked to poor mental health outcomes and may be particularly damaging for young adults who may be more affected by governmental pandemic responses such as mandatory school and work closures, online schooling, and social isolation. Exposure to Adverse Childhood Experiences (ACEs) has also been shown to have a significant impact on mental health among young adults. This prospective study examined whether young adults with higher ACE profiles were more vulnerable to COVID-19 stressors. Using pre-COVID-19 data from the Niagara Longitudinal Heart Study and a follow-up online survey during COVID-19, we examined 171 young adults and found that high COVID-19-related stress, especially emotional and relationship stress, led to a greater reduction in mental health among young adults with higher levels of ACEs. Findings indicate that young adults with high ACE profiles may benefit from resources and intervention programs directed at mental health in times of crisis, such as the COVID-19 pandemic.

Adverse childhood experiences are associated with a higher risk for increased depressive symptoms during Covid-19 pandemic - a cross-sectional study in Germany.

BACKGROUND: Covid-19 pandemic has been profoundly affecting people around the world. While contact restrictions, school closures and economic shutdown were effective to reduce infection rates, these measures go along with high stress for many individuals. Persons who have experienced adverse childhood experiences (ACEs) have an increased risk for mental health problems already under normal conditions. As ACEs can be associated with a higher vulnerability to stress we aimed to assess the role of ACEs on depressive symptoms during the Covid-19 pandemic. METHODS: In a cross-sectional online survey, 1399 participants above the age of 18 years were included during the first lockdown in Germany. Via two-way repeated measures ANOVA, differences in depressive symptoms before (retrospectively assessed) and during the pandemic were analyzed. Linear regression analyses were performed in order to identify predictors for increase of depressive symptoms. RESULTS: Compared to prior to the Covid-19 pandemic, depressive symptoms increased among all participants. Participants with ACEs and income loss reported about a stronger increase of depressive symptoms. Other predictors for increased depressive symptoms were young age and a lack of social support. CONCLUSIONS: Based on these results, ACEs are a significant predictor for an increase in depressive symptoms during the pandemic, indicating that personss with ACEs may be a risk group for mental health problems during the current and potential later pandemics. These findings underline the relevance of support for persons who have experienced ACEs and may help to provide more targeted support in possible scenarios due to the current or possible other pandemics. Besides, economic stability seems to be of prior importance for mental health.

Contributions to Critical Care from Psychological Science and Practice

In this chapter we highlight findings and practices from Psychology that can be applied to mitigate the impact of critical illness and the ICU environment on patients, families and staff. The substantial accumulating evidence for detrimental health effects of traumatic stress is highly relevant for the care of patients on the ICU, who are potentially traumatized by the experience and who may bring a history of trauma with them. The fields of trauma psychology and rehabilitation psychology share foundational principles to guide patient-centered and systemic changes to ICU care, and these principles guided our selection and presentation of material. Our discussion of how to implement these principles within a healthcare system is informed by selected findings from social, organizational and behavioral psychology, which also are summarized. © Oxford University Press 2022. All rights reserved.

ACE inhibitors on ACE1, ACE2, and TMPRSS2 expression and spheroid attachment on human endometrial Ishikawa cells.

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) enters cells via receptor angiotensin-converting enzyme 2 (ACE2) and co-receptor transmembrane serine protease 2 (TMPRSS2). However, patients with SARS-CoV-2 infection receiving ACE1 inhibitors had higher ACE2 expression and were prone to poorer prognostic outcomes. Until now, information on the expression of ACE1, ACE2, and TMPRSS2 in human endometrial tissues, and the effects of ACE inhibitors on embryo implantation are limited. We found human endometria expressed ACE1, ACE2, and TMPRSS2 transcripts and proteins. Lower ACE1, but higher ACE2 transcripts were found at the secretory than in the proliferative endometria. ACE1 proteins were weakly expressed in endometrial epithelial and stromal cells, whereas ACE2 and TMPRSS2 proteins were highly expressed in luminal and glandular epithelial cells. However, ACE1 and TMPRSS4 were highly expressed in receptive human endometrial epithelial (Ishikawa and RL95-2) cells, but not in non-receptive AN3CA and HEC1-B cells. Treatment of human endometrial epithelial cells with ACE1 (Captopril, Enalaprilat, and Zofenopril) or ACE2 (DX600) inhibitors did not significantly alter the expression of ACE1, ACE2 and TMPRSS2 transcripts and spheroid (blastocyst surrogate) attachment onto Ishikawa cells in vitro. Taken together, our data suggest that higher ACE2 expression was found in mid-secretory endometrium and the use of ACE inhibitors did not alter endometrial receptivity for embryo implantation.

Halal Travel “2.0” and Beyond COVID-19

Halal travel market appears to be at crossroads. On one hand, it is being shaped by the demands of Muslim consumer who is now younger and educated and with a larger disposable income. While on the other, innovative technologies are enabling and redefining the Muslim travel experience, from planning and purchasing to living the experience and sharing the adventures with others. The challenge for service providers is to innovate and integrate these technologies into their offerings, in order to catalyze the next level of growth in halal travel. Just when the stage seems to be perfectly set for a transition from halal travel 1.0 into halal travel 2.0, the world is hit by the COVID-19 pandemic. The present research tries to look into the changes taking place in halal travel market based on the evolution of GMTI over the years and the key trends in halal travel segment. Based on GMTI report 2021, Travel Readiness Report 2020, and some of the recent researches, an attempt is made to systematically look at the crisis precipitated by COVID-19 and outline a road map for recovery. © 2022, The Author(s), under exclusive license to Springer Nature Switzerland AG.

The Influence of Adverse Childhood Experiences in Pain Management: Mechanisms, Processes, and Trauma-Informed Care.

Adverse childhood experiences (ACEs) increase the likelihood of reduced physical and psychological health in adulthood. Though understanding and psychological management of traumatic experiences is growing, the empirical exploration of ACEs and physical clinical outcomes remains under-represented and under-explored. This topical review aimed to highlight the role of ACEs in the experience of chronic pain, pain management services and clinical decision making by: (1) providing an overview of the relationship between ACEs and chronic pain; (2) identifying biopsychosocial mechanisms through which ACEs may increase risk of persistent pain; (3) highlighting the impact of ACEs on patient adherence and completion of pain management treatment; and (4) providing practical clinical implications for pain management. Review findings demonstrated that in chronic pain, ACEs are associated with increased pain complications, pain catastrophizing and depression and the combination of these factors further heightens the risk of early treatment attrition. The pervasive detrimental impacts of the COVID-19 pandemic on ACEs and their cyclical effects on pain are discussed in the context of psychological decline during long treatment waitlists. The review highlights how people with pain can be further supported in pain services by maintaining trauma-informed practices and acknowledging the impact of ACEs on chronic pain and detrimental health outcomes. Clinicians who are ACE-informed have the potential to minimize the negative influence of ACEs on treatment outcomes, ultimately optimizing the impact of pain management services.

Mediation-Moderation Links Between Mothers' ACEs, Mothers' and Children's Psychopathology Symptoms, and Maternal Mentalization During COVID-19.

Research has suggested adverse childhood experiences (ACEs) as a transdiagnostic risk factor for a variety of affective disorders. They are also linked with a parent's tendency toward affect dysregulation and hyperarousal, which may interfere with parenting and children's wellbeing. On the other hand, maternal mentalization can serve as a moderating factor that can help parents regulate their arousal, shielding children during adverse circumstances. We studied the mediated links between ACEs and mothers' and children's psychopathology symptoms during COVID-19 to determine whether maternal mentalization and the child's age moderate these links. Using results from 152 Israeli mothers of children aged 3-12 years recruited during the month-long lockdown in Israel, we documented that the mothers' ACEs were linked with increased risk of depressive and anxiety symptoms and with children's internalizing and externalizing behaviors. Moreover, as hypothesized, the mothers' symptoms of depression and anxiety mediated the links between their ACEs and their children's internalizing behaviors. In addition, the mothers' mentalization skills and, in the case of their depressive symptoms, their child's age, moderated these indirect links. For mothers of young children (3-6 years old) with higher mentalization levels, the link between the mothers' ACEs and the children's behavior problems was weaker compared to mothers with low mentalization levels. For mothers of older children (6-12 years old), and only in the case of maternal depressive symptoms, higher levels of maternal mentalization were linked with more internalizing behaviors. We discuss the potential clinical implications of the findings.

Psychological Flexibility Mediates Wellbeing for People with Adverse Childhood Experiences during COVID-19.

BACKGROUND: The psychological impact of COVID-19 is multifaceted, both acute and chronic, and has not affected everyone equally. METHOD: This longitudinal study compared those with and without Adverse Childhood Experiences (ACEs) on measures of psychological distress and wellbeing over time. RESULTS: All groups (No ACE, Low ACE, and High ACE) had similar levels of distress at Time 1, with significant increases in psychological distress for those with ACEs over time, but not for those without. Psychological Flexibility was strongly and significantly associated with decreases in psychological distress and improved wellbeing. It significantly mediated the relationship between ACE and wellbeing. CONCLUSIONS: Those with ACEs report significantly increased psychological distress over time, compared to those without ACE during the COVID-19 pandemic. Evidence-based interventions using Psychological Flexibility may improve mental health and wellbeing to help further mediate its effects.

The mediating role of COVID-19-related burden in the association between adverse childhood experiences and emotional exhaustion: results of the egePan - VOICE study.

Background: Adverse childhood experiences (ACEs) increase the risk for mental health problems. However, there is a lack of data targeting the role of ACEs for one of the most prevalent mental health problems in health-care professionals: burnout. Objective: We aimed to assess the relationship between ACEs and the core burnout dimension 'emotional exhaustion' (EE). As health-care professionals have been facing particular challenges during the COVID-19 pandemic, we furthermore aimed to assess the role of COVID-19 associated burden in the interplay between ACEs and EE. Methods: During the first lockdown in Germany, a total of 2500 medical healthcare professionals were questioned in a cross-sectional online survey. Questions targeted, among others, sociodemographics, ACEs, COVID-19-associated problems (e.g. increase of workload, worries about relatives and patients) and emotional exhaustion, measured by the respective dimension of the Maslach Burnout Inventory (MBI). Results: In German health-care professionals, ACEs were associated with a higher EE score. The number of experienced ACEs was associated with the majority of assessed COVID-19-associated problems. An increasing number of ACEs predicted higher EE scores, controlling for gender. The association between ACEs and EE was mediated significantly by COVID-19-associated problems. These included maladaptive coping strategies such as increased smoking, drinking and use of antidepressants/tranquilizers, feeling less protected by measures of the employee or the state, a greater feeling of being burdened by COVID-19-associated problems and greater exhaustion and sleep problems. Conclusion: Our findings suggest ACEs as significant risk factor for EE in German health-care professionals. The current pandemic means a significant burden that further pronounces this risk.

Antecedentes: Las experiencias adversas en la niñez (ACEs en sus siglas en inglés) aumentan el riesgo de problemas de salud mental. Sin embargo, faltan datos sobre el papel de las ACEs en uno de los problemas de salud mental más prevalentes en los profesionales de la salud: el agotamiento (burnout).Objetivo: Nuestro objetivo fue evaluar la relación entre las ACEs y la dimensión central del agotamiento 'agotamiento emocional' (AE). Dado que los profesionales de la salud se han enfrentado a desafíos particulares durante la pandemia de COVID-19, además nos propusimos evaluar el papel de la carga asociada a COVID-19 en la interacción entre las ACEs y la AE.Métodos: Durante la primera cuarentena en Alemania, se interrogó a un total de 2500 profesionales de la salud en una encuesta transversal en línea. Las preguntas fueron dirigidas, entre otros, a datos sociodemográficos, ACEs, problemas asociados a COVID-19 (por ejemplo, aumento de la carga de trabajo, preocupaciones sobre familiares y pacientes) y agotamiento emocional, medidos por la dimensión respectiva del Maslach Burnout Inventory (MBI).Resultados: En los profesionales sanitarios alemanes, las ACEs se asociaron con una puntuación de AE más alta. El número de ACEs experimentados se asoció con la mayoría de los problemas asociados a COVID-19 evaluados. Un mayor número de ACEs predijo puntuaciones de AE más altas, controlado por género. La asociación entre ACEs y AE fue mediada significativamente por problemas asociados con COVID-19. Estos incluyeron estrategias de afrontamiento desadaptativas, como fumar, beber y usar antidepresivos/tranquilizantes, sentirse menos protegido por las medidas del empleador o el estado, una mayor sensación de estar agobiado por los problemas asociados con COVID-19 y un mayor agotamiento y problemas de sueño.Conclusión: Nuestros hallazgos sugieren que las ACEs son un factor de riesgo significativo para la AE en los profesionales de la salud alemanes. La pandemia actual implica una carga importante que acentúa aún más este riesgo.

Changes in young adult substance use during COVID-19 as a function of ACEs, depression, prior substance use and resilience.

Background: Given the potential for increased substance use during COVID-19, we examined (1) young adults' changes in cigarette, e-cigarette, marijuana, and alcohol use from pre- to during COVID-19; and (2) related risk/protective factors. These findings could inform intervention efforts aimed at curbing increases in substance use during periods of societal stress. Methods: We analyzed Wave 3 (W3; September-December 2019) and Wave 4 (W4; March-May 2020) from the Vape shop Advertising, Place characteristics and Effects Surveillance (VAPES), a 2-year, five-wave longitudinal study of young adults across six metropolitan areas. We examined risk/protective factors (i.e. adverse childhood experiences [ACEs], depressive symptoms, resilience) in relation to changes in past 30-day substance use frequency. Results: In this sample (N = 1084, Mage=24.76, SD = 4.70; 51.8% female; 73.6% White; 12.5% Hispanic), W3/W4 past 30-day use prevalence was: 29.1% cigarettes (19.4% increased/26.4% decreased), 36.5% e-cigarettes (23.2% increased/28.6% decreased), 49.4% marijuana (27.2% increased/21.2% decreased), and 84.8% alcohol (32.9% increased/20.7% decreased). Multivariate regressions indicated that, greater increases were predicted by: for e-cigarettes, greater ACEs; and for alcohol, greater depression. Among those with low resilience, predictors included: for e-cigarettes, greater depression; and for marijuana, greater ACEs. Conclusions: Interventions to reduce substance use during societal stressors should target both risk and protective factors, particularly resilience.

[Violence in intimate partnerships and mental problems in children and adolescents]. / Gewalt in intimen Partnerschaften und psychische Probleme bei Kindern und Jugendlichen: Online-Survey während der COVID-19-Pandemie.

Background: The coronavirus disease 2019 (COVID-19) pandemic has changed the lives of families in an unprecedented way. During the first lockdown, extrafamilial contact was significantly reduced. Many parents had to look after their children and work from home while the economic pressure increased. Objective: The aim of the present study was to investigate the association between intimate partner violence (IPV) and mental health problems in children and adolescents before and during the COVID-19 pandemic. Material and methods: In a cross-sectional online survey 687 parents of underaged children in Germany were included. Demographic and psychosocial predictors for IPV and associations with mental health problems of children before and during the first lockdown due to the COVID-19 pandemic were assessed. The survey ran from 18 May 2020 to 21 July 2020 and the lockdown in Germany began on 23 March 2020 and ended via a gradual relaxation. The first schools reopened on 22 April and the opening of schools, kindergartens and daycare centers extended to the end of June 2020. Results: Lower household incomes and the experience of own adverse childhood experiences increased the risk of participants reporting violence in their relationship. According to the participating parents, children and adolescents living in families in which violence was reported by intimate partners were more likely to have higher levels of externalizing problems before and during the pandemic. There were no significant differences with respect to emotional problems. Conclusion: Adverse childhood experiences increase the risk of intimate partner violence, which in turn increases the risk of mental health problems in the children. Therefore, in the psychotherapeutic practice questions should also be systematically asked about corresponding experiences and appropriate treatment offers should be recommended.

The disparate impact of COVID-19 on the mental health of female and male caregivers.

Caregiver mental health is crucial to the wellbeing of children. This is most apparent when caregivers face high levels of stress or life adversity. To study this phenomenon in the current global context, this study examined the relation between stress/disruption from the COVID-19 pandemic and the mental health of female and male caregivers. Pre-pandemic childhood adversity was considered as a moderator of this association. A multi-national sample (United Kingdom, 76%; United States, 19%; Canada, 4%, and Australia, 1%) was recruited in May 2020, of whom 348 female and 143 male caregivers of 5-18 year-old children provided data on the constructs of interest. At this time, caregivers reported on their history of adverse childhood experiences (ACEs) and COVID stress/disruption. About two months later (July 2020) caregiver mental health was evaluated. We examined differences between female and male caregivers on ACEs, COVID stress/disruption, and mental health (distress, anxiety, substance use, and posttraumatic stress). Main and interactive effects of ACEs and COVID stress/disruption on each mental health outcome were examined. Female caregivers reported higher COVID stress/disruption, more ACEs, and greater distress, anxiety, and posttraumatic stress symptoms compared to male caregivers. Among female caregivers, higher COVID stress/disruption and more adverse childhood experiences (ACEs) independently predicted all mental health outcomes, consistent with a stress accumulation model. Among male caregivers, a pattern of interactions between COVID stress/disruption and ACEs suggested that the effects of COVID stress/disruption on mental health was stronger for those with higher ACEs, especially for substance use, consistent with a stress sensitization model. Higher levels of stress and mental health difficulties among female caregivers suggests a disproportionate burden due to pandemic-related disruption compared to male caregivers. Findings speak to the disparate effects of COVID-19 on the mental health of female compared to male caregivers, and the role of pre-existing vulnerabilities in shaping current adaptation.

Childhood Adversity and Perceived Distress from the COVID-19 Pandemic.

Childhood exposure to adversity may increase an individual's reactivity to subsequent stressors. In this paper, we examine how adverse childhood experiences (ACEs) are associated with experiencing greater perceived distress during the pandemic. In this volunteer clinical cohort study, 177 pregnant women (ages 16-38) were recruited from two university-affiliated perinatal clinics located in a small metropolitan city between October 2017 and May 2018. Longitudinal data collection is ongoing. The current study includes the 101 women who participated through the eighth and most recent survey conducted in mid-April 2020. OLS regression analyses were used to examine the association between childhood adversity and pandemic-related distress. We found that ACE scores were associated with higher levels of distress (b = .08; se = .03; p < .01) when controlling for demographic characteristics. The addition of loneliness to the model fully mediates the association between ACEs score and distress. Findings suggest that adverse childhood experiences influence COVID-19-related distress due to greater social isolation. Those who had greater adversity during childhood may be less likely to have the social connectedness needed to reduce distress due to the pandemic.

Is the psychological impact of exposure to COVID-19 stronger in adolescents with pre-pandemic maltreatment experiences? A survey of rural Chinese adolescents.

BACKGROUND: Since the COVID-19 outbreak at the end of 2019, it has evolved into a global pandemic with tremendous mental health impact besides the threats to people's physical health. OBJECTIVE: The aims were to examine whether exposure to COVID-19 predicts elevated levels of anxiety and post-traumatic stress symptoms and whether pre-pandemic maltreatment experiences exacerbate this impact on mental health in adolescents. PARTICIPANTS AND SETTING: The survey was conducted online from February 8 st to February 27th, 2020, and the questionnaires were distributed and retrieved through a web-based platform. This study includes a total of 6196 subjects, aged range from 11 to 18 years old. METHODS: Several multivariable linear regressions were used to analyse the data. RESULTS: The largest variance in PTSS and anxiety problems was explained by ACEs, with more pre-pandemic maltreatment experiences predicting more PTSS (effect size beta = 0.16∼0.27), and more anxiety (effect size beta = 0.32∼0.47). Experienced or subjective fear of exposure to COVID-19 predicted statistically significant variance in PTSS and anxiety, and standardized betas ranged from 0.04 to 0.09. Participants who had adverse childhood experiences and had experienced exposure to COVID-19 showed elevated PTSS. CONCLUSIONS: After pre-pandemic maltreatment experiences the impact of exposure to COVID-19 on mental health may be stronger. Scars from the past seem to be vulnerabilities during societal upheaval. We therefore suggest that when exposed to COVID-19 rural adolescents should get prioritized professional family support and mental health counseling in particular when they have experienced family abuse and neglect in childhood, even though such support is more difficult to organize in rural areas.