The Role of ACEs and Discrimination on Mental Health: A Longitudinal Analysis Among College Students

Both adverse childhood experiences (ACEs) and perceived discrimination have been found to impact mental health in adults, but less is understood about the ways they interact to affect anxiety and depression symptoms. In the spring and summer of 2020, there were large societal changes stemming from the COVID-19 pandemic and social and racial justice movements in the United States. The current study aimed to characterize the interactive associations of ACE history and perceived discrimination with mental health in a sample of college students assessed prior to the pandemic in the fall of 2019 and then again in the fall of 2020. Results showed that in 2019, greater discrimination and more ACEs were associated with greater anxiety/depression symptoms. In 2020, a negative interactive effect of ACE history and discrimination on mental health was found, such that for individuals with low ACEs, greater discrimination was associated with significantly greater anxiety/depression symptoms. We also found that increases in perceived discrimination from 2019 to 2020 were significantly positively associated with increases in anxiety/depression symptoms over that same time period. The findings highlight the significant impacts that both ACEs history and perceived discrimination have on mental health and suggest that experiences of discrimination should be thought of as a critical, dynamic factor impacting college students' mental health. [ FROM AUTHOR] Copyright of Journal of Aggression, Maltreatment & Trauma is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Depression and suicidal behavior in adolescents. (Special Issue: Clinical psychiatry.)

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Testing an integrated dimensional model of adverse childhood experiences: Associations with COVID-19 outcomes.

BACKGROUND: Adverse childhood experiences (ACEs) are a salient risk factor for a myriad of negative outcomes. Extant theoretical and empirical models traditionally quantify the impact of ACEs using cumulative representations. Recent conceptualizations challenge this framework and theorize that the types of ACEs children are exposed to differentially impacts their future functioning. OBJECTIVE: The current study tested an integrated ACEs model using parent-report of child ACEs across four aims: (1) characterize heterogeneity in child ACEs using a latent class analysis (LCA); (2) examine mean level class differences in COVID specific and COVID non-specific environmental factors (i.e., COVID impact, ineffective parenting, effective parenting) and internalizing and externalizing problems during the COVID pandemic; (3) test interactions between COVID impact and ACEs classes in predicting outcomes, and (4) compare a cumulative risk approach to a class membership approach. PARTICIPANTS AND SETTING: A nationally representative sample of U.S. parents (N = 796; 51.8 % fathers, M age = 38.87 years, 60.3 % Non-Hispanic White) completed a cross-sectional survey about themselves and one child (5-16 years old) between February-April 2021. METHOD: Measures of child's ACEs history, COVID impact, effective and ineffective parenting, and children's internalizing and externalizing problems were completed by parents. RESULTS: A LCA demonstrated three distinct classes of ACEs reflecting low-risk, trauma-risk, and environmental-risk classes. In general, the trauma-risk class had more negative COVID-19 outcomes than the other classes (small to large effect sizes). CONCLUSIONS: The classes differentially related to outcomes, providing support for dimensions of ACEs and emphasizing the distinct types of ACEs.

Trauma-Informed Care for Hospitalized Adolescents.

Purpose of Review: Exposure to trauma accelerates during the adolescence, and due to increased behavioral and psychiatric vulnerability during this developmental period, traumatic events during this time are more likely to cause a lasting impact. In this article, we use three case studies of hospitalized adolescents to illustrate the application of trauma-informed principles of care with this unique population. Recent Findings: Adolescents today are caught in the crosshairs of two syndemics-racism and other structural inequities and the COVID-19 pandemic. Increased hospitalizations and mental health diagnoses during the past two years signal toxic levels of stress affecting this group. Trauma-informed care promotes health, healing, and equity. Summary: This concept of the "trauma-informed approach" is still novel; through examples and practice, providers can learn to universally apply the trauma-informed care framework to every patient encounter to address the harmful effects of trauma and promote recovery and resilience.

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)

Predicted posttraumatic growth based on event centrality and contingencies of self-worth

This study was designed to test a regression model of event centrality and contingencies of self-worth as predictors of posttraumatic growth (PTG), drawing from Constructivist Self Development Theory (CSDT;Saakvitne et al., 1998). In order to participate in the study, participants had to experience at least one adverse childhood experience (ACE) and had to be 18 years or older. Individuals who experienced sexual abuse before 18 years old were excluded from the study to prevent significant discomfort to these individuals (Mersky et al., 2019). Due to conducting the study during a global pandemic, COVID-19 questions were included in the study and used in the correlations, regression model, and post-hoc analyses. Significant results included event centrality and God's love were positively correlated with PTG. Other contingencies of self-worth were not significantly correlated with PTG. Two demographic variables (marital status and education level) were significantly correlated with PTG and used as covariates in the regression model. One result indicated COVID-19 impacting participant's answers was significantly correlated with PTG, and thus, this also was used as a covariate in the regression model. Event centrality and God's love were found to significantly predict PTG in a sequential multiple regression. Post-hoc analyses suggested ACEs affected participants' coping skills during the COVID-19 pandemic, changes in self-worth occurred as a result of the pandemic, and participants made meaning of their traumatic experiences. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

The school nurse's experience of secondary exposure to trauma

The school nurse (SN) is often the sole health care expert in the school setting, providing for the physical and socio-emotional needs of others. SN may be exposed to reports of trauma, a widespread and costly public health issue. This study sought to explore the experience of the SN when exposed to reports of trauma from those in their care. Seven N.J. certified school nurses participated in two online interviews via Microsoft Teams, spaced one to two weeks apart between June 2021 and September 2021. Interviews were recorded & transcribed verbatim and thematic analysis applied. This study found that SN receive reports of trauma to varying degrees, with those in high-poverty urban settings relaying more frequent exposure than those in suburban settings. The SN identified the health office as a safe haven where students are welcome, accepted as they are, can share concerns, and seek comfort from their ailments. SN reported challenges working within the school model, and experienced obstacles to receiving reports of trauma including a lack of school-based collaboration, a lack of understanding of the SN role, and SN workload. In the eye of the storm, while receiving traumatic reports, SN focus on immediate needs. Later, while mitigating the aftermath, they process the experience and apply coping strategies, such as self-care and social support, to restore and replenish. While weathering the storm, they share concern and frustration, but acknowledge that they can only do so much. The SN in this study did not demonstrate secondary trauma but instead shared stories of resilience. Effects of the COVID-19 pandemic on the SN receipt of reports of trauma were explored. Further research is needed regarding the role of the SN, SN workload, and their experience in receiving reports of trauma. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Trauma responsive approaches in education: A review of the current literature to address the pandemic

The COVID-19 pandemic has been a traumatic experience that has impacted children for almost 2 years. As schools return to face-to-face settings, it will be vital to consider how schools can manage the transition and address the issues of trauma in students and educators. The purpose of this extended literature review is to evaluate how teachers and children alike are suffering through stress, Complex-PTSD, and PTSD as they navigate the new complexities faced within education. This extended literature review is centered on the topic of trauma in children as well as trauma-informed approaches to education. The designs, implementations, outcomes, and associated challenges and barriers of existing trauma-informed approaches in schools are discussed to provide an overview of the current state of trauma-informed education. This literature review will yield a product in training that will entail solutions for the research questions, including an appraisal of the school system and a holistic perspective applied to the entire school system. After completing this extended literature review, the researcher recommends the implementation of the whole school approach in online education, a collaborative approach with a team specifically dedicated towards trauma-informed education, a synchronous class design with fewer students, as well as more outdoor classes and activities. Studies on trauma-informed care have been researched heavily over the past decade. More research is needed with a focus on the educators and staff attending to the children. There has been more research on secondary or vicarious trauma among front-line workers and much less for educators. Therefore, whole school trauma-informed pilot programs are imperative for the health and wellness of staff and students to assess their safety and efficacy to convince the government to mandate all schools to be trauma-informed. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Mental health providers' perspectives: The link between childhood trauma, juvenile delinquency and long-term effects

Juvenile delinquency is an ongoing problem in society and is detrimental as many delinquents have mental and behavioral health issues. Delinquency is costly to society, and it was found that many delinquents have a traumatic past or adverse childhood experiences. They include child abuse and neglect, loss, separation/divorce of parents, witnessing domestic violence, parents who struggle with mental health and/or drug and substance abuse, parents who have their own trauma, death of a loved one, natural disaster, or other tragedies that are linked to an increase in the likelihood of juvenile delinquency. In this study, the relationship between juvenile delinquency and trauma by the lived experiences of professionals who have worked with delinquents and at-risk youth was examined. The biopsychosocial model provided a theoretical framework for the study. Data were collected by interviewing 20 mental health professionals. The data were analyzed to determine common themes and patterns about professionals who work with at-risk youth. The 6 themes found during analysis were professionals' caseloads consisted of clients who have lived through trauma, vicarious trauma was common, professionals must adapt to the barriers that stem from working with the population, they faced many barriers working with at-risk youth, they wanted to be effective for their clients, they were interested in trainings to increase their effectiveness with clients, they found it was necessary for caregivers to be involved in treatment, and COVID-19 has impacted traumatized youth. This study can contribute to positive social change as professionals may be able to identify ways to intervene with at-risk youth to encourage normal social functioning. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Challenges and burden of the Coronavirus 2019 (COVID-19) pandemic for child and adolescent mental health: a narrative review to highlight clinical and research needs in the acute phase and the long return to normality

BACKGROUND: The coronavirus disease 2019 (COVID-19) is profoundly affecting life around the globe. Isolation, contact restrictions and economic shutdown impose a complete change to the psychosocial environment in affected countries. These measures have the potential to threaten the mental health of children and adolescents significantly. Even though the current crisis can bring with it opportunities for personal growth and family cohesion, disadvantages may outweigh these benefits. Anxiety, lack of peer contact and reduced opportunities for stress regulation are main concerns. Another main threat is an increased risk for parental mental illness, domestic violence and child maltreatment. Especially for children and adolescents with special needs or disadvantages, such as disabilities, trauma experiences, already existing mental health problems, migrant background and low socioeconomic status, this may be a particularly challenging time. To maintain regular and emergency child and adolescent psychiatric treatment during the pandemic is a major challenge but is necessary for limiting long-term consequences for the mental health of children and adolescents. Urgent research questions comprise understanding the mental health effects of social distancing and economic pressure, identifying risk and resilience factors, and preventing long-term consequences, including-but not restricted to-child maltreatment. The efficacy of telepsychiatry is another highly relevant issue is to evaluate the efficacy of telehealth and perfect its applications to child and adolescent psychiatry. CONCLUSION: There are numerous mental health threats associated with the current pandemic and subsequent restrictions. Child and adolescent psychiatrists must ensure continuity of care during all phases of the pandemic. COVID-19-associated mental health risks will disproportionately hit children and adolescents who are already disadvantaged and marginalized. Research is needed to assess the implications of policies enacted to contain the pandemic on mental health of children and adolescents, and to estimate the risk/benefit ratio of measures such as home schooling, in order to be better prepared for future developments.

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.

Adverse childhood experiences and depressive symptoms among adolescents during the COVID-19 pandemic: mediating roles of poor sleep quality and psychological inflexibility.

Previous studies have found that adverse childhood experiences can lead to depressive symptoms. But the underlying mechanisms have not been determined. Guided by the 3-P model of insomnia and acceptance and commitment therapy, this study examined the mediating role of poor sleep quality and psychological inflexibility in the relationship between adverse childhood experiences and depressive symptoms during the COVID-19 pandemic. A total of 996 senior high school students in China (Mage = 16.57 years; SD = 1.03) completed the self-report measures of adverse childhood experiences, depressive symptoms, poor sleep quality, and psychological inflexibility. Multiple mediation analysis revealed that adverse childhood experiences were related to depressive symptoms through poor sleep quality and psychological inflexibility, serially. These findings point to potential targets in the prevention of and intervention in adolescent depressive symptoms.

Parental stress and physical violence against children during the second year of the COVID-19 pandemic: results of a population-based survey in Germany.

BACKGROUND: Parents and caregivers belonged to those with the highest burdens during the COVID-pandemic. Considering the close link between parental stress and child maltreatment, identifying families with high parental stress is of utmost importance to prevent violence against children. Within this study, we thus aimed to investigate the interplay of parental stress, changes in parental stress, and physical violence against children during the second year of the COVID-pandemic on an exploratory level. METHODS: We conducted a cross-sectional, observational study in Germany from July to October 2021. By using different sampling steps, a representative probability sample of the German population was generated. A subsample of these participants with children under the age of 18 was included for analysis within this study (N = 453, 60.3% females, Mage = 40.08; SD = 8.53). RESULTS: Higher parental stress levels were associated with more physical violence against children, higher levels of own experiences of child maltreatment, and mental health symptoms. An increase in parental stress during the pandemic was associated with female sex, the use of physical violence against children, and parental experience of child maltreatment. Parents who have ever used physical violence against their children have been characterized by higher parental stress levels, a stronger increase in parental stress during the pandemic, own experience of child maltreatment, mental health symptoms and sociodemographic characteristics. Higher parental stress levels, a stronger increase of parental stress during the pandemic, having pre-existing psychiatric disorders, and parental experience of child maltreatment predicted an increased use of physical violence against children during the pandemic. CONCLUSIONS: Our results underscore the importance of parental stress for the risk of physical violence against children, more so in times of overall increased stress due to the pandemic and underline the need for low threshold support for families at risk in times of crises.

Adverse Childhood Experiences and Health Risk Behaviours among the Undergraduate Health Campus Students.

Background: Adverse childhood experiences (ACEs) are linked with health risk behaviours (HRBs). The study aimed to evaluate ACEs in the undergraduate health campus of a public university located in the northeast of Malaysia and determine their association with HRBs. Methods: A cross-sectional study was performed by recruiting 973 undergraduate students at the health campus of a public university from December 2019 to June 2021. The World Health Organization (WHO) ACE-International Questionnaire and the Youth Risk Behaviour Surveillance System questionnaire were distributed using simple random sampling according to year of study and the selected batch of students. Descriptive statistics were used for demographic findings and logistic regression analyses were performed to determine the association between ACE and HRB. Results: The 973 participants (male [n = 245] and female [n = 728]) had a median age of 22 years old. The prevalence of child maltreatment among the study population was 30.2%, 29.2%, 28.7%, 9.1% and 6.1% for emotional abuse, emotional neglect, physical abuse, physical neglect and sexual abuse, respectively, among both sexes. The most commonly reported household dysfunctions were parental divorce/separation (5.5%). Community violence was 39.3% among the surveyed participants. The highest prevalence of HRBs among respondents was 54.5% from physical inactivity. The findings confirmed that those exposed to ACEs were at risk of HRBs and that a higher number of ACEs was associated with a higher number of HRBs. Conclusion: ACEs were highly prevalent among participating university students, ranging from 2.6%-39.3%. Hence, child maltreatment is an important public health problem in Malaysia.

Effect of COVID-19 Pandemic Response and Parental Adverse Childhood Experiences on Child Health and Well-Being.

Family responses to crises such as COVID-19 are driven by parents' experiences. Parental history of adverse childhood experiences (ACEs) might play an important role in predicting resilience, coping capacity, and parenting practices during the COVID-19 pandemic response. The purpose of this review is to examine the impact of COVID-19 pandemic disruption on child health and well-being as influenced by the previous history of ACEs in the parents. Scopus, Google Scholar, PubMed, and PsychInfo were searched for peer-reviewed articles using the keywords "COVID-19", "Parents or Maternal Adverse Childhood Experiences", and "child health" or "child well-being". Data were extracted using a literature review matrix template. Title, abstract, and full article-level reviews were conducted by two reviewers. The association between COVID-19 disruption, negative parenting, and child behavioral and emotional problems was stronger for parents with younger children with a history of high ACE scores. Parents with high ACE scores were more likely to cope poorly with childcare duties and engage in child neglect, verbal abuse, and reduced feeding frequency, specifically during the COVID-19 pandemic. The review findings support the framework of inadequate resilience and coping skills of adults with a history of ACEs during periods of stress and unpredictability such as the COVID-19 pandemic. The negative effects of these parental stressors on a child's health and well-being are modifiable and could be mitigated by targeted interventions. Trauma-informed care should be adopted to contribute to optimum child health.

Addressing Social Context in Adverse Childhood Experience Screening Policy: Implications for Children With Special Health Care Needs.

Adverse childhood experiences (ACEs) disproportionately affect children with special health care needs, especially racial and ethnic minority children whose ACEs may be less likely to be identified. As awareness and understanding of the health impacts of ACEs have increased, heightened by the COVID-19 pandemic, several areas of the United States have initiated policy efforts to screen for and address ACEs. However, these policies do not always include mechanisms to account for context-specific adversity or contemporary stressors in the lives of children. Stressors most significant in a child's life may include adversities beyond those included in common ACE screening instruments. ACE policy in California will be discussed relative to addressing the social context in ACEs screening. By taking a holistic view of ACEs and thinking beyond deriving ACE scores alone, clinicians can ensure that ACE-related policies are implemented with maximum benefit to diverse children with special health care needs.

Pandemic calls for more comprehensive approach to ACEs: CDC

The federal Centers for Disease Control and Prevention (CDC) has released a study that showed suicide among adolescents, already on the increase before the March 2020 beginning of the pandemic in the United States, was contributed to by the adversity experienced before and during the pandemic.