Predictors and (in-)stability of ICD-11 complex posttraumatic stress disorder in older adults: findings from a longitudinal study in Switzerland.

Objective: There is a lack of research on complex post-traumatic stress disorder (CPTSD) in older individuals, with little known about the temporal course of CPTSD. Therefore, this study assessed and compared the demographic characteristics, adverse childhood experiences (ACE), and well-being of Swiss older adults with and without probable CPTSD. The (in-)stability of probable CPTSD was also examined in relation to the predictive value of various emotion-related factors.Methods: A longitudinal study was conducted in Switzerland with N = 213 participants (Mage = 69.98 years, SD = 10.61; 45.5% female). Data was collected via face-to-face assessments at baseline and follow-up, 21 months apart. The German version of the International Trauma Questionnaire was used to screen for (C)PTSD. Standardized instruments were used to assess ACE as well as the predictors anger, embitterment, emotion regulation, and meaning in life.Results: From the total sample, n = 16 participants (7.5%) were identified as having probable CPTSD, with only five of these (31.25%) having probable CPTSD at both baseline and follow-up. Individuals with and without probable CPTSD differed significantly regarding age and employment status. Significant predictors of probable CPTSD were anger (ß = 0.16), embitterment (ß = 0.06), cognitive reappraisal (ß = -0.41), and the presence of meaning in life (ß = -0.10).Conclusions: Probable CPTSD appears to be relatively unstable over the course of a 21-month period in older individuals. The links between CPTSD and emotion-related predictors highlight potential targets for intervention.

KEY FINDINGS: Older adults with and without probable CPTSD differ in terms of age, employment status, adverse childhood experiences, psychiatric comorbidities, well-being, and life satisfaction.Temporal (in-)stability: In older adults, probable CPTSD appears to be unstable over a 21-month period with around one-third of the participants showing a stable course.Treatment targets: The identified significant predictors anger, embitterment, cognitive reappraisal, and the presence of meaning in life beliefs are potential treatment targets.

[Psychotherapy for elderly patients]. / Psychische Störungen im Alter und ihre psychotherapeutische Behandlung.

A particular feature of the demographic change is the growing proportion of elderly and very elderly people. In Western countries, this is largely due to improved medical care for age-associated diseases. There is still comparatively little knowledge about mental health disorders in old age, their age-typical clinical presentation and specific psychotherapeutic treatment.

Differential Pathways from Child Maltreatment Types to Insecure Adult Attachment Styles via Psychological and Social Resources: A Bayesian Network Analysis.

Child maltreatment has been linked to insecure adult attachment. However, it is not yet clear how different child maltreatment types are associated with attachment-related anxiety and avoidance in adulthood; and whether resilience against these insecure attachment styles is dependent on risk-specific resources. Therefore, this study explored differential pathways from child maltreatment types to attachment-related anxiety and avoidance in adulthood and examined whether psychological resources (self-esteem) and social resources (perceived social support) show risk-specific effects. An online survey retrospectively assessed experiences of child maltreatment, the level of attachment-related anxiety and avoidance in adulthood, self-esteem, and perceived social support in N = 604 former members of fundamentalist Christian faith communities (mean age = 41.27 years, SD = 12.50; 65.90% female). Cross-sectional data was analyzed using Bayesian network analysis. Only emotional child maltreatment showed direct relationships to insecure adult attachment. Specifically, emotional abuse and emotional neglect were associated with anxious and avoidant adult attachment, respectively. The effects of other child abuse types on adult attachment were mediated through emotional abuse, which indicated patterns of complex traumatization. Self-esteem mediated the effect of emotional abuse on anxious attachment, while perceived social support mediated the effect of emotional neglect on avoidant attachment. Social support was also linked to self-esteem and was therefore also important for individuals with experiences of emotional abuse. This study showed that child maltreatment types and their interactions are meaningfully linked to attachment-related anxiety and avoidance in adulthood. Interventions for survivors of child maltreatment should focus on risk-specific resources to support their resilience.

Childhood adversity and later life prosocial behavior: A qualitative comparative study of Irish older adult survivors.

Objective: Although childhood adversity can have lasting effects into later life, positive adaptations have also been observed, including an increased tendency toward prosocial behavior. However, little is known about the link between childhood adversity and later life prosocial behavior, with a particular scarcity of research on intrafamilial childhood adversity. Therefore, this study aimed to examine older adult's experiences of childhood adversity and identify mechanisms linked to prosocial behavior. Two adversity contexts (intrafamilial and extrafamilial) were compared to explore individual, as well as broader cultural and contextual mechanisms linking childhood adversity and later life prosocial behavior. Method: Semi-structured interviews (60-120 min) were conducted with N = 29 Irish (older) adult survivors of childhood adversity: n = 12 intrafamilial survivors (mean age: 58 years, range: 51-72), n = 17 institutional survivors (mean age: 61 years, range: 50-77). Interviews were analyzed using the framework analysis method, with reference to the conceptual model of altruism born of suffering. Results: Five themes were identified on prosocial mechanisms, with three themes in both survivor groups (enhanced empathy, self-identity, amelioration), and two group-specific themes (compassion fatigue in intrafamilial survivors; denouncing detrimental social values in institutional survivors). Conclusion: Results identified motivational processes and volitional factors linked to later life prosocial behavior. Connections to caring roles, (lack of) support, and social norms in childhood, as well as the need for a sense of purpose and meaning from the adversities in adulthood, highlight potential targets for psychotherapeutic intervention to promote prosocial responding and positive adaptation for childhood adversity survivors.

Associations Between Complex Trauma Exposure in Childhood/Adolescence and Psychopathology in Older Age: The Role of Stress Coping and Coping Self-Perception.

Complex trauma exposure in childhood and/or adolescence is common and has repeatedly been linked to mental ill-health across the lifespan. While the correlates of complex trauma and mental health are well-studied in individuals up to middle adulthood, correlates in older adulthood, as well as potential mediators of this relationship, such as stress coping, are insufficiently studied. Therefore, this study aimed to (a) examine the mental health of Swiss older adults affected by complex trauma exposure in childhood and/or adolescence, in comparison to non-affected individuals; and (b) to examine the potential mediating role of coping strategies and coping self-perception. Data from N = 257 participants (complex trauma [CT] group: n = 161; M age = 69.66 years, 48.4% female; non-complex trauma [nCT] group: n = 96; M age = 72.49 years, 42.7% female) were assessed using self-report questionnaires and a clinical interview. The CT group presented with significantly more current and lifetime mental health disorders, more disadvantageous coping strategies, and significantly lower coping self-perception, compared to the nCT group. Mediation analyses revealed that maladaptive coping and coping self-perception were relevant mediators of the relationship between complex trauma exposure and psychopathology. Results suggest that complex trauma exposure in childhood and/or adolescence can have a lasting impact on mental health in later life and can be negatively associated with stress coping. Findings emphasize the relevance of a lifespan perspective in research and clinical practice for addressing consequences of complex trauma exposure.

Internalizing Mental Health Disorders and Emotion Regulation: A Comparative and Mediational Study of Older Adults With and Without a History of Complex Trauma Exposure.

Individuals with complex trauma exposure (CTE) in early life (i.e., childhood/adolescence) are at heightened risk for developing problems in various domains of functioning. As such, CTE has repeatedly been linked to internalizing mental health disorders, such as depression and anxiety, as well as emotion dysregulation across the lifespan. While these correlates of CTE are comparatively well studied up to middle adulthood, they are insufficiently studied in older adulthood. Therefore, this study aimed to (a) compare Swiss older adults with and without a CTE history regarding current and lifetime internalizing mental health disorders and emotion regulation strategies; and (b) to examine the potential mediating role of emotion regulation in the mental health disparities between these groups. A total of N = 257 participants (age = 49-95 years; 46.3% female) were assessed in a retrospective, cross-sectional study, using two face-to-face interviews. The CTE group (n = 161; M age = 69.66 years, 48.4% female) presented with significantly more current and lifetime internalizing mental health disorders than the non-affected (nCTE) group (n = 96; M age = 72.49 years, 42.7% female). The CTE group showed significantly higher emotion suppression and lower emotion reappraisal compared to the nCTE group. Mediation analysis revealed that the two emotion regulation strategies were significant mediators between CTE history and internalizing mental health disorders. Findings emphasize the relevance of emotion (dys-)regulation in understanding mental health disparities in older age and deciding about treatment strategies. Research and practice should pay more attention to the needs of this high-risk group of older individuals.

Identifying well-being profiles and resilience characteristics in ex-members of fundamentalist Christian faith communities.

There is a lack of empirical research on the heterogeneity in well-being of individuals who disaffiliated (i.e., left or were expelled) from an exclusionary and demanding faith community. Thus, little quantitative knowledge exists on factors related to resilience in these individuals. Therefore, the study aims were twofold: (1) to identify profiles of well-being in ex-members; and (2) to examine the characteristics of the identified profiles. A cross-sectional online survey assessed ex-members of various fundamentalist Christian faith communities. Latent profile analysis identified latent heterogeneity within the sample. Well-being profile indicators included perceived stress, psychopathological symptoms, affect, and satisfaction with life. Profile-related characteristics included socio-demographics (i.e., gender, age), membership (i.e., reason for joining, duration, extent of involvement, reasons for exit, social support during exit, and time since the exit), and resilience-supporting resources (i.e., social support, self-esteem, sense of coherence, personality, socio-economic status). In the final sample (N = 622, Mage = 41.34 years; 65.60% female), four distinct profiles were identified: resilient (25.70%), normative (36.40%), vulnerable (27.20%), and adverse (10.70%). The resilient profile was characterised by higher age, lower reporting of abuse or maltreatment as exit reason, and highest levels of resilience-supporting resources. Ex-members of fundamentalist Christian faith communities differ substantially in their well-being. Membership aspects were only weakly related to current well-being, with the exception of the exit reason of abuse or maltreatment. This study provided novel quantitative insights into the well-being profiles of individuals who disaffiliated from a fundamentalist Christian faith community in German-speaking countries.

Salutary mechanisms in the relationship between stress and health: The mediating and moderating roles of Sense of Coherence-Revised.

While chronic and acute stress are often associated with negative health, the sense of coherence-revised (SOC-R) is proposed to facilitate coping with stress and promote health. However, research is lacking on the specific mechanisms. Therefore, the current study aimed to investigate potential mediating and moderating mechanisms of SOC-R in the relationship between stress and health. Using a cross-sectional design, standardized questionnaires assessed SOC-R, acute (perceived) stress, early-life adversity (ELA; indicator for early-life chronic stress), mental and physical health, and satisfaction with life. Mediation and moderation analyses were conducted with N = 531 Irish adults (mean age: 59.5 years; 58.4% female). Regarding acute (perceived) stress, results showed that SOC-R and its Manageability subscale significantly mediated the association between perceived stress and mental health, and satisfaction with life. SOC-R and its Manageability subscale also significantly moderated the association between perceived stress and mental health. Regarding ELA, the Manageability subscale significantly mediated the association between ELA and mental health, and satisfaction with life; and the Balance subscale significantly mediated the association between ELA and physical health. SOC-R may provide a useful focus for stress-related research, with future longitudinal studies needed to examine SOC-R as a long-term modulating pathway between stress and health.

An exploratory comparison of resilience profiles of Swiss older adult survivors of child welfare-related maltreatment and controls.

Child welfare practices in the last century have been linked to a high risk for child maltreatment and the subsequent development of mental ill-health. However, not all affected individuals develop clinically relevant psychopathology, which can be considered as a form of resilience. Such resilience is insufficiently understood in survivors of an advanced age. Therefore, this exploratory study aimed to depict a resilience profile of Swiss older adult survivors of child welfare-related maltreatment (n = 132; Mage = 71 years) and to contrast it with age-matched controls (n = 125). Approximately 30% of survivors did not meet the diagnostic criteria for any of the assessed current or lifetime DSM-5 disorders. These survivors were older, experienced less physical abuse, and had higher trait resilience, self-esteem, income, and satisfaction with their socio-economic status. They had lower levels of neuroticism and some empathy characteristics. Group differences in the resilience profiles suggest that resilience-related aspects may vary as a function of past adversity.

A cascade model of complex posttraumatic stress disorder centered on childhood trauma and maltreatment, attachment, and socio-interpersonal factors.

The present study proposes and tests a cascade model of complex posttraumatic stress disorder (CPTSD) focusing on childhood trauma and maltreatment, attachment, and socio-interpersonal factors. Multigroup path analysis was used to examine data from 126 individuals formerly affected by compulsory social measures and placements (CSMP) in their childhood and/or adolescence (i.e., risk group [RG]; M age = 70.8 years) and an age-matched control group (CG; n = 125; M age = 70.6 years). The final model confirmed the cascade structure, with stronger associations emerging in the RG. Childhood trauma and maltreatment were associated with attachment anxiety, ß = |.20|-.30, which was related to all socio-interpersonal factors (i.e., disclosure of trauma, social acknowledgment, and social support), ß = .27-|.54|; the latter were associated with substantial aspects of the CPTSD symptoms as well as life satisfaction, ß = |.21|-.42. Among participants in the CG, we observed more direct, rather than mediated, paths to CPTSD symptoms. Adulthood trauma exposure did not follow the full cascade pattern but was associated with the socio-interpersonal factors. Nevertheless, more in-depth clinical knowledge of CPTSD and potential targets for psychological treatment may be gained from the confirmation of this newly proposed cascade model of CPTSD.

Associations and correlates of general versus specific successful ageing components.

The heterogeneity in the operationalisation of successful ageing (SA) hinders a straightforward examination of SA associations and correlates, and in turn, the identification of potentially modifiable predictors of SA. It is unclear which SA associations and correlates influence all facets of the SA construct, and whether psychosocial reserve models developed in neuropathological ageing research can also be linked to SA. It was therefore the aim of this study to disentangle the effect of various previously identified SA associations and correlates on (1) a general SA factor, which represents the shared underpinnings of three SA facets, and (2) more confined, specific factors, using bifactor modelling. The associations and correlates of three recently validated SA operationalisations were compared in 2478 participants from the German AgeCoDe study, aged 75 years and above. Based on participants' main occupation, cognitive reserve (CR) and motivational reserve (MR) models were built. Younger age, male gender, more education, higher socio-economic status, being married or widowed, as well as more physical exercise and cognitive activities in old age were found to correlate positively with the general SA factor, indicating a simultaneous effect on all aspects of SA. Smoking and ApoE-ε4 were related only to the physiological facet of SA. CR models were significantly related to the general SA factor. Among all SA associations and correlates, proxy indicators of lifelong cognitive activity and physical exercise showed the strongest effects on SA. Future intervention studies should assess the influence of the preservation of active lifestyle across the life span on SA.

Clinical Ecopsychology: The Mental Health Impacts and Underlying Pathways of the Climate and Environmental Crisis.

Humankind is confronted with progressing climate change, pollution, environmental degradation, and/or destruction of the air, soil, water, and ecosystems. The climate and environmental crisis is probably one of the greatest challenges in the history of humankind. It not only poses a serious current and continuing threat to physical health, but is also an existing and growing hazard to the mental health of millions of people worldwide. This synergy of literature provides a current summary of the adverse mental health impacts of the climate and environmental crisis from the perspective of Clinical Psychology. Furthermore, it presents potential underlying processes, including biological, emotional, cognitive, behavioral, and social pathways. The existing data suggest that the climate and environmental crisis not only acts as a direct stressor, but can also exert a detrimental impact on the various pathways, with the potential to amplify an individual's biopsychosocial vulnerability to develop mental ill-health. This is a call for an increased investigation into this emerging research field of Clinical Ecopsychology by clinical psychologists and other researchers.

Lifetime post-traumatic stress disorder in older individuals with a history of institutional upbringing in childhood: the role of social acknowledgement and stressful life events.

Background: Child maltreatment (CM), particularly in institutional contexts, can affect the development of post-traumatic stress disorder (PTSD). Research suggests that factors during CM (e.g. severity, variety, duration) and in the aftermath of CM (e.g. stressful life events, and social acknowledgement, i.e. the degree to which an individual feels validated and supported following a traumatic event) can explain some of the heterogeneity in PTSD development. However, there is a lack of research on long-term correlates of CM and mitigating factors, with only a few studies having been conducted with older survivors of institutional upbringing. Such research is relevant, given the long-term associations between CM and the older age status of many survivors. Objective: The current study examined the link between CM and PTSD in older individuals with a history of institutional upbringing (risk group; RG) and a matched control group (CG). Differences in stressful life events and social acknowledgement were also investigated. Method: Participants were n = 116 RG (Mage = 70.25 years, 41% female) and n = 122 CG (Mage = 70.71 years, 51% female). Data was assessed using self-report questionnaires and a clinical interview. Results: The RG reported higher levels of exposure to CM. Lifetime PTSD showed a bigger association with the level of exposure to CM, compared to having an institutional upbringing. Participants with higher CM levels reported more stressful life events. High levels of social acknowledgement mediated the relationship between CM and PTSD in the CG. Conclusions: Exposure to CM had a stronger association with PTSD than a history of institutional upbringing. In the CG, the survivors' perception of social acknowledgement ameliorated lifetime PTSD to a small extent. A critical issue for policy makers should be to enhance safeguarding measures against CM exposure, not only in institutional contexts, but also more generally, given the link to PTSD.

Antecedentes: El maltrato infantil (MI), particularmente en contextos institucionales, puede incidir en el desarrollo del trastorno de estrés postraumático (TEPT). La investigación sugiere que los factores durante el MI (ej. gravedad, variedad, duración) y en el periodo posterior al MI (ej. eventos estresantes de la vida y reconocimiento social, es decir, el grado en que un individuo se siente validado y apoyado después de un evento traumático) pueden explicar en parte la heterogeneidad en el desarrollo del TEPT. Sin embargo, hay una falta de investigación sobre los correlatos a largo plazo del MI y los factores atenuantes, y solo se han realizado unos pocos estudios con personas mayores que han sobrevivido a la crianza institucional. Dicha investigación es relevante, dadas las asociaciones a largo plazo entre MI y el estado a mayor edad de muchos sobrevivientes.Objetivo: El presente estudio examinó el vínculo entre MI y TEPT en personas mayores con antecedentes de crianza institucional (grupo de riesgo; GR) y un grupo de control emparejado (GC). También se investigaron las diferencias en los eventos vitales estresantes y el reconocimiento social.Método: Los participantes fueron N = 116 en GR (edad promedio = 70,25 años, 41% mujeres) y N = 122 en GC (edad promedio = 70,71 años, 51% mujeres). Los datos se evaluaron mediante cuestionarios de auto-reporte y una entrevista clínica.Resultados: El GR reportó niveles más altos de exposición a MI. El TEPT durante la vida mostró una mayor asociación con el nivel de exposición a MI, en comparación con la crianza institucional. Los participantes con niveles más altos de MI reportaron más eventos vitales estresantes. Altos niveles de reconocimiento social mediaron la relación entre MI y TEPT en el GC.Conclusiones: La exposición a MI tuvo una asociación más fuerte con el TEPT que el historial de crianza institucional. En el GC, la percepción de reconocimiento social de los sobrevivientes mejoró en pequeña medida el TEPT durante la vida. Una cuestión fundamental para los responsables de la formulación de políticas debería ser mejorar las medidas de protección contra la exposición a MI, no solo en contextos institucionales, sino también de manera más general, dado el vínculo con el trastorno de estrés postraumático.

Child maltreatment, lifetime trauma, and mental health in Swiss older survivors of enforced child welfare practices: Investigating the mediating role of self-esteem and self-compassion.

BACKGROUND: Child maltreatment is a common occurrence and has frequently been shown to adversely impact mental health over the lifespan. Minors affected by welfare practices have a higher risk of exposure to child maltreatment. However, the long-term correlates of child maltreatment in welfare practices and mental health, in addition to potential mediators, are insufficiently examined in later life. OBJECTIVE: This study aims to a) examine the experiences of child maltreatment, lifetime traumata, and mental health of Swiss older adults affected by enforced child welfare practices, in comparison to an age-matched control group; and b) to examine the potentially protective roles of self-esteem and self-compassion. PARTICIPANTS AND SETTING: A total of N = 257 participants (risk group: n = 132, MAGE = 70.8 years, 58 % male; control group: n = 125, MAGE = 70.6 years, 49 % male) were assessed in a retrospective, cross-sectional study involving two face-to-face interviews. METHODS: A structured clinical interview for DSM-5 assessed current and lifetime mental health disorders; self-esteem and self-compassion were assessed with psychometric instruments. RESULTS: Affected individuals (risk group) had higher rates of child maltreatment and lifetime traumata compared to non-affected individuals (control group). Affected individuals also presented with a higher mental health burden over the lifespan. Across both groups, self-esteem, but not self-compassion, acted as a significant mediator between emotional abuse and neglect and mental health. CONCLUSIONS: Findings suggest that child maltreatment has a lifetime impact and influences mental health into later life, and that self-esteem can mitigate the detrimental impact of emotional abuse and neglect on mental health.

Steeling in Later Life: Exploring Age-Specific Effects of Varying Levels of Stress on Psychological Resilience.

The steeling effect suggests that "optimal" stress positively affects well-being by enhancing resilience. However, there is lack of longitudinal investigations in diverse age groups. The aim was to explore steeling in later life and potential predictors. The sample consisted of N = 195 participants. A 1-year longitudinal survey study was conducted. Sociodemographics, experienced stress, resilience resources, and satisfaction with life were assessed. Latent profile analysis was used to identify profiles that differ in the change of resilience resources over time and to examine differences between the profiles across the other study variables. Three profiles emerged: decreased resources (Decrease), stability of resources (Maintenance), and increased resources (Increase). "Decrease" was characterized by low, Maintenance by moderate, and Increase by high stress. Age influenced profile membership. While the results failed to support the classic steeling effect, with high stress associated with increased resilience resources, optimal stress was associated with the maintenance of resilience resources.

Health, stress, and well-being in Swiss adult survivors of child welfare practices and child labor: Investigating the mediating role of socio-economic factors.

BACKGROUND: With widespread deprivation in the education of minors affected by child welfare practices (CWP) in the last century, affected individuals often continued a life dominated by socio-economic disadvantage. According to life course theories, the impact of socio-economic disadvantage can accumulate across the life span, leading to worse health in later life. However, the scientific examination of health correlates of CWP in later life and the mediating role of socio-economic factors (SEF) has previously been neglected. OBJECTIVE: This study examined whether Swiss survivors of CWP, including former Verdingkinder, have poorer health in later life compared to controls, and whether this association is mediated by socio-economic factors: education, income, satisfaction with financial situation, socio-economic status. PARTICIPANTS AND SETTING: Two face-to-face interviews were conducted with N = 257 participants (risk group, RG, n = 132, MAGE = 70.83 years, 58 % male; control group, CG, n = 125, MAGE = 70.6 years, 49 % male). METHODS: A broad set of physical health outcomes, stress, well-being, and SEF were assessed with psychometric instruments. RESULTS: The RG reported more physical illnesses, vascular risk factors, health symptoms, stress, and lower well-being, compared to the CG. Mediation analyses revealed that SEF were relevant mediators for the significant health and stress disparities between groups. CONCLUSIONS: Results suggest that SEF can play a crucial role in mitigating the negative effects and health impairments in individuals formerly affected by CWP. Public health services and policies that target these SEF could improve current welfare practices by providing opportunities to overcome early-life disadvantage and facilitating healthier life trajectories.

Resilience and Stress in Later Life: A Network Analysis Approach Depicting Complex Interactions of Resilience Resources and Stress-Related Risk Factors in Older Adults.

BACKGROUND: Emerging systemic approaches on resilience propose that a person's or group's adaptability to significant stress relies on a network of interdependent resources. However, little knowledge exists on systemic resilience in older survivors of early-life adversity (ELA) and how ELA affects their resource network in later life. OBJECTIVE: This study investigated how ELA may be linked to the interplay of resources and stress-related risk factors in later life. RESEARCH DESIGN AND METHODS: Data from N = 235 older adults (M age = 70.43 years; 46.40% female) were assessed. Half the participants were affected by ELA through compulsory social measures and placements in childhood, and/or adolescence ("risk group"). The other half were age-matched, non-affected participants ("control group"). Using psychometric instruments, a set of resilience-supporting resources in later life and current stress indices were assessed. Regularized partial correlation networks examined the interplay of resources in both groups, whilst also considering the impact of stress. RESULTS: Both groups demonstrated only positive resource interrelations. Although the control group showed more possible resource connections, the groups did not significantly differ in the overall strength of connections. While group-specific resource interrelations were identified, self-esteem was observed to be the most important resource for the network interconnectedness of both groups. The risk group network showed a higher vulnerability to current stress. DISCUSSION AND IMPLICATIONS: Network analysis is a useful approach in the examination of the complex interrelationships between resilience resources and stress-related risk factors in older adulthood.

Childhood Physical Neglect Is Associated With Exaggerated Systemic and Intracellular Inflammatory Responses to Repeated Psychosocial Stress in Adulthood.

Experiences of child maltreatment are associated with a host of adverse mental and physical health outcomes in adulthood. Altered reactivity to psychosocial stress exposure may partially explain known associations between early experiences of maltreatment and later life health. The present study focuses on examining whether experiences of child maltreatment are associated with physiological reactions to initial and repeated psychosocial stress in adulthood. To this end, 44 healthy adults (52% male, aged 18-65) completed the Childhood Trauma Questionnaire to provide information about exposure to child maltreatment and completed the Trier Social Stress Test (TSST) on 2 consecutive days. Peripheral blood was collected prior to as well as 30 and 120 min following the TSST on each day. Plasma Interleukin-6 (IL-6) and gene expression of IL-6, IL-1ß, nuclear factor-kB (NF-kB), and inhibitor of kB (IkB) were measured from each blood sample. Total CTQ scores were unrelated to plasma IL-6 and gene expression (ps > .10) but a history of childhood physical neglect was associated with increased interleukin-1ß (ß =.35; p =.02; R2 =.19) and nuclear factor-kB (ß =.30; p =.046; R2 =.13) expression following initial stress. Following repeated exposure to the TSST, childhood physical neglect was associated with increased plasma IL-6 reactivity (ß =.34; p =.02; R2 =.16) and increased expression of nuclear factor-kB (ß =.31; p =.04; R2 =.08). Finally, childhood physical neglect was associated with decreased habituation following repeated exposure to the TSST. Other CTQ subscales were not related to plasma IL-6 and gene expression when considered individually. Results from this study are suggestive of a unique effect of childhood physical neglect on the physiological stress response following initial and repeated exposure to a common psychosocial stressor. This provides important directions for future research because the effect of childhood physical neglect on long-term neglect are not well understood and in need of further investigation.

"Some call it resilience": A profile of dynamic resilience-related factors in older adult survivors of childhood institutional adversity and maltreatment.

BACKGROUND: Childhood adversity and maltreatment can have lasting negative effects into later life. However, emerging research suggests that certain factors may facilitate resilience in adults with experiences of childhood adversity and maltreatment. OBJECTIVE: Using conceptual models of resilience, this qualitative study investigated factors associated with resilience in older adult survivors of childhood institutional adversity and maltreatment. PARTICIPANTS AND SETTING: Participants consisted of 17 adults, 10 females and 7 males, aged between 50-77 years (mean age = 60 years). All participants had experienced childhood adversity and maltreatment within institutional care settings during childhood and/or adolescence. METHODS: In-depth, semi-structured interviews were conducted, lasting between 60-120 min. Transcribed interviews were analysed using the Framework Analysis method. RESULTS: Nine themes were derived from the data, including core, internal, and external resilience factors: Individual characteristics, personality characteristics, support systems, goal attainment, adaptive belief systems, processing, influential events and experiences, recognition and collective identity, and access to services. CONCLUSIONS: Results support a dynamic concept of resilience that can be understood not only as an inherent trait, but also as a learnable set of behaviours, thoughts, and attitudes, which can be supported by external resources in an older adults' environment. These findings add a novel contribution to the literature in the identification of a distinct cluster of personal and contextual factors underpinning resilience in this sample of survivors of childhood institutional adversity and maltreatment, which may inform the psychological treatment of this population and provide a focus for further research.