Childhood Maltreatment and Toxic Stress: What We Have Learned From the COVID-19 Pandemic Era.

Stress is a natural state that emerges due to the dynamics of an individual's life. Children must learn how to effectively manage stress as part of their growth and development. Resolution is possible when children are exposed to stress and receive adequate support from their families. However, when stress is intense, frequent, protracted, or traumatic, as in cases of childhood abuse, it can become toxic and interfere with the development of the child's brain and body. This results in vulnerability, which can have detrimental effects on the child's overall physical, mental, and emotional health. This perspective discusses the impact of childhood maltreatment and toxic stress, drawing on insights gained during the COVID-19 pandemic. We aimed to shed light on the lessons learned from this unique and challenging period and how they inform our understanding of the effects of stress on children's well-being.

Impact of Childhood Maltreatment on Cognitive Function and Its Relationship With Emotion Regulation in Young Adults.

Objectives: Childhood maltreatment can negatively impact cognitive development, including executive function, working memory, and processing speed. This study investigated the impact of childhood maltreatment on cognitive function in young adults using various measurements, including computerized tests, and their relationship with emotional dysregulation. Methods: We recruited 149 healthy individuals with and without maltreatment experiences and used the Wechsler Adult Intelligence Scale IV (WAIS-IV) and a computerized battery to analyze cognitive function. Results: Both the WAIS-IV and computerized tests revealed that individuals with a history of childhood maltreatment had decreased cognitive function, especially in terms of working memory and processing speed. These individuals tended to employ maladaptive emotion regulation strategies. Among cognitive functions, working memory is negatively related to maladaptive emotion regulation strategies such as catastrophizing. Conclusion: This study highlights the effects of childhood maltreatment on cognitive function in young adulthood. Moreover, the study suggests clinical implications of cognitive interventions for improving emotion regulation and cognitive function in individuals with a history of childhood maltreatment.

Impact of emotional abuse on eating disorder psychopathology: A multiple mediation analysis.

INTRODUCTION: Childhood maltreatment, particularly emotional abuse (EA), has been identified as a significant risk factor for the development of eating disorders (EDs). This study investigated the association between EA and ED symptoms while considering multiple potential mediators. METHODS: Participants included 151 individuals with Anorexia Nervosa (AN), 115 with Bulimia Nervosa (BN), and 108 healthy controls. The Childhood trauma questionnaire, the Toronto Alexithymia scale, the Behavioral inhibition System, and the Eating Disorder Inventory 2 scale were completed before treatment. A mediator path model was conducted in each group: EA was set as independent variable, eating symptoms as dependent variables and ineffectiveness, sensitivity to punishment, alexithymia, and impulsivity as mediators. RESULTS: In individuals with AN, impulsivity emerged as a significant mediator between EA and desire for thinness and bulimic behaviors. Conversely, in individuals with BN, sensitivity to punishment was found to mediate the association between EA and dissatisfaction with one's body. Ineffectiveness and difficulty identifying emotions were identified as transdiagnostic mediators in both clinical groups. No mediation effect was found in healthy individuals. DISCUSSION: The simultaneous assessment of multiple mediators in a unique model outlines the complex interplay between childhood EA and ED psychopathology. Improving ineffectiveness, emotion identification, sensitivity to punishment and impulsivity and exploring their relations with early emotional abuse may represent treatment targets in individuals with EDs and childhood trauma.

HIV status affects PTSD symptom severity, psychophysiology, and heart rate variability in women with low but not high exposure to childhood maltreatment.

Objective: People living with HIV (PLWH) experience high rates of childhood trauma exposure, which is a significant risk factor for the development of posttraumatic stress disorder (PTSD). Because Black Americans living in urban environments are exposed to high levels of trauma, suffer from chronic PTSD, and are at increased risk for HIV infection, it is important to understand how HIV status interacts with childhood maltreatment to influence PTSD symptom severity and underlying psychophysiology. Methods: The current cross-sectional study assessed whether HIV status interacts with childhood maltreatment to influence PTSD symptom severity and heart rate variability during a dark-enhanced startle (DES) task in 88 Black women with (n=30) and without HIV (n=58). Results: HIV was associated with greater PTSD symptom severity only in women with low levels of childhood maltreatment (p=.024). Startle potentiation during DES was highest in women living without HIV and with high childhood maltreatment (p=.018). In women who had experienced low levels of childhood maltreatment, respiratory sinus arrhythmia (RSA) was lower during the dark phase of DES in women living without HIV than women living with HIV (WLWH), (p=.046). RSA during the light phase of DES was lower in WLWH than in women living without HIV (p=.042). Conclusion: In the current sample of Black women, HIV status was associated with PTSD symptom severity in a manner dependent on level of childhood maltreatment, suggesting that HIV status may be an important factor to consider for behavioral and pharmacological treatment strategies for PTSD. Additionally, HIV status is associated with lower percent potentiation to darkness and lower RSA during the light phase of DES, suggesting physiological mechanisms by which HIV may contribute to PTSD symptoms in individuals exposed to low levels of childhood maltreatment.

Intergenerational associations between childhood maltreatment, post-traumatic stress symptoms, and chronic pain in young adult offspring and their parents.

Findings have revealed a strong link between exposure to child maltreatment (CM) and later chronic pain. Concurrently, other findings have been grounded in the understanding that CM consequences may not end with the exposed individual, rather, they extend to their offspring. However, little is known regarding the possible intergenerational transmission of chronic pain following CM. This study examines whether chronic pain among parents and their young adult offspring may be associated with parental exposure to CM. Three hundred ninety-three parent-offspring dyads (parents' mean age = 58, SD = 5.91 years; offspring's mean age = 27, SD = 3.91 years) completed self-report questionnaires, assessing CM (CTQ), posttraumatic stress (PTS) and disturbances in self-organisation (DSO) symptoms (ITQ), and chronic pain. CM was associated with chronic pain mediated by DSO symptoms among parents (indirect effect = 0.77; p = 0.007) and PTS symptoms among offspring (indirect effect = 0.285; p = 0.005). Offspring chronic pain was significantly associated with parental CM through two intergenerational paths: the mediation of parents' DSO symptoms and chronic pain (indirect effect = 0.298; p = 0.011), and through parents' PTS symptoms and offspring's PTS symptoms (indirect effect = 0.077; p = 0.004). This study's findings support the relevance of the intergenerational transmission of chronic pain following parental exposure to CM. Furthermore, the findings reveal complex PTS symptoms as a possible underlying mechanism for the intergenerational associations of chronic pain following CM.

Childhood poverty and foster care placement: Implications for practice and policy.

BACKGROUND: About 6 % of US children enter foster care (FC) at some point before age 18. Children living in poverty enter more frequently than non-poor children. Still, it is less clear if specific dimensions of poverty place a child at risk of FC entry. OBJECTIVE: This study aids our understanding of the relationships between poverty and FC entry. PARTICIPANTS AND SETTING: Data were drawn from a large linked administrative data study following low-income and/or children with maltreatment reports at baseline and followed them through 2010 (n = 9382). METHODS: Separate analyses compared low-income children and children reported for maltreatment. Cox regression analyses were used to account for clustering at the tract level. Poverty was measured at birth, receipt of income maintenance (IM) during the study period, and census tract poverty at baseline. RESULTS: The results showed that within a low-income sample, both family poverty and community poverty measures were significant factors in predicting later FC entry. However, when analyses were run comparing children with maltreatment reports with and without baseline AFDC use, the various measures of poverty diminished in impact once the type of maltreatment and report dispositions were controlled. Furthermore, we found that children living in families with more spells on income maintenance were less likely to enter FC. CONCLUSIONS: Results indicate that specific dimensions of poverty during childhood are associated with later FC entry. The lowered risk associated with a number of spells suggests connections between time limits for income assistance and the risk of entering FC.

Identifying inflicted injuries in infants and young children.

Child physical abuse is a common cause of pediatric morbidity and mortality. Up to half of all children presenting with abusive injuries have a history of a prior suspicious injury, suggesting a pattern of repeated physical abuse. Medical providers are responsible for identifying children with suspicious injuries, completing mandated reporting to child protective services for investigation, and screening for occult injuries and underlying medical conditions that can predispose to injuries. Early identification of inflicted injuries appropriate evaluations may serve as an opportunity for life-saving intervention and prevent further escalation of abuse. However, identification of abuse can be challenging. This article will review both physical exam findings and injuries that suggest abuse as well as the evaluation and management of physical abuse.

Trauma-informed care.

In recent years, trauma informed care has become a heavily researched topic; however, it has yet to achieve a universal standard in the field of pediatric medicine. One of the primary tenants of trauma informed care is a clear understanding of the pervasiveness and complexities of childhood trauma, and its intersection with a child and caregiver's physical wellness. A major component of trauma informed care is addressing the way medical providers may be exposed to vicarious trauma, secondary traumatic stress, and compassion fatigue. By taking proactive steps to educate medical providers on the effects of trauma, they are better equipped to assess a family's needs and provide enhanced quality of care for their patients and themselves.

Childhood intra- and extra-familial maltreatment and later-life trajectories of depressive symptoms: evidence from China.

BACKGROUND: Both late-life depression and childhood maltreatment have become major global public health issues, given their prevalence and social-economic and health consequences. However, previous studies have solely focused on the relationship of childhood maltreatment to average levels of depressive symptoms. The current study addresses this gap of knowledge by simultaneously examining the impacts of childhood intra- and extra-familial maltreatment on age trajectories of depressive symptoms in later life in the Chinese context. METHODS: Hierarchical linear models were applied to data from the China Health and Retirement Longitudinal Study (2011-2018, N = 12,669 individuals aged 45 to 80, comprising N = 43,348 person-years). Depressive symptoms were measured by the CES-D-10 scale. Childhood intra-familial maltreatments were measured by physical abuse and emotional neglect, while extra-familial maltreatment was measured by peer bullying. All analyses were conducted separately by gender in Stata 16. RESULTS: Childhood extrafamilial peer bullying (ß = 1.628, p < 0.001), and intrafamilial physical abuse (ß = 0.746, p < 0.001) and emotional neglect (ß = 0.880, p < 0.001) were associated with higher later-life depressive symptoms levels in the whole sample. Peer bullying differences in depressive symptoms widened with age for both men and women. Physical abuse differences in depressive symptoms remained stable over the life course among men but increased among women. Emotional neglect differences in depressive symptoms decreased with age among men, while it increased first and then decreased among women. CONCLUSIONS: Findings in this study suggest that childhood maltreatment is not only associated with later-life poorer mental health but contributes to increasing inequalities in mental health as people age, especially among peer-bullying victims and women.

Linkages between childhood emotional maltreatment and adulthood marital attitudes among rural first-generation college students in China: A latent profile analysis and multigroup comparisons.

BACKGROUND: Although there is a wealth of evidence indicating the enduring consequences of childhood emotional maltreatment (CEM) on social and relational functioning across life stages, little known about how CEM affects marital attitudes in emerging adulthood, particularly among rural first-generation college students (rural FGCS) at the critical stage of developing romantic relationships. OBJECTIVE: To explore whether differential patterns of CEM existed among rural FGCS in China during emerging adulthood. Furthermore, the study aims to examine the potential differences in the chain mediating role of CEM on the pathway to adulthood marital attitudes across different CEM profiles. PARTICIPANTS AND SETTING: Using a cluster sampling approach, a total of 3848 rural first-generation college freshmen (males = 39.2 %, mean age = 18.42 years) were recruited from three universities in China. METHODS: Latent profile analysis was utilized to identify potential patterns of CEM using Mplus version 7.4. Structural equation modeling and multigroup comparisons were then performed to investigate the association between CEM and attitudes towards marriage in emerging adulthood, utilizing AMOS 24.0. RESULTS: Three profiles of CEM was identified among rural FGCS: a low-CEM group (51.87 %), a moderate-CEM group (36.69 %), and a severe-CEM group (11.44 %). The association between CEM and adulthood marital attitudes was mediated by core self-evaluation and meaning in life. However, the mediation effects varied across the three CEM profiles. In the low-CEM group, core self-evaluation and meaning in life were observed to partially mediate the negative association between CEM and adulthood marital attitudes. On the other hand, in the moderate-CEM and severe-CEM groups, the relationship between CEM and adulthood marital attitudes was fully mediated by core self-evaluation. CONCLUSIONS: The study's findings suggest that CEM is a significant predictor of marital attitudes among rural FGCS during emerging adulthood, with the severity of emotional neglect and abuse being the primary distinguishing factor between different CEM profiles. Core self-evaluation plays an important role in this relationship. Future clinical interventions could benefit from focusing on enhancing core self-evaluation and meaning in life, particularly for those with CEM experiences.

Hospital admissions and community health service contacts for mental illness following self-reported child maltreatment: Results from the Childhood Adversity and Lifetime Morbidity (CALM) study.

BACKGROUND: Child maltreatment (CM) includes neglect, and several types of abuse, including physical, emotional, and sexual. CM has been associated with a wide range of mental illnesses. Literature examining these illnesses in mid-life is scarce, and the impact of these illnesses on mental health service use is currently unknown. OBJECTIVE: To examine associations between self-reported CM and subsequent hospital admissions for mental illnesses, and/or community mental health service contacts. SETTING: Birth cohort study data linked to administrative health data, including hospital admissions and community mental health service contacts, up to the age of 40. METHODS: Associations between hospital admissions for mental health and community mental health contacts and CM subtypes (neglect, physical abuse, emotional abuse and sexual abuse) were examined using multivariate logistic regression. RESULTS: Adjusted analyses showed that all subtypes of CM were significantly (p < 0.05) associated with admissions to hospital for any type of mental illness (aOR range 1.87-3.61), non-psychotic mental disorders (aOR range 1.98-3.61), alcohol and/or substance use (aOR range 2.83-5.43), and community mental health service contacts (aOR range 2.44-3.13). Hospital admissions for psychotic mental disorders were significantly associated with physical abuse, emotional abuse, and sexual abuse (aOR range 2.14-3.93). CONCLUSIONS: The results of this study confirm the current knowledge around CM and subsequent mental health illnesses up to the age of 40, and extend this knowledge to hospital and mental health service use.

Impact of family and caregiver factors on development and behaviours in maltreated young children.

Introduction: This study aimed to evaluate the prevalence of developmental and emotional/ behavioural concerns in maltreated children and to examine the impact of adverse family/caregiver risk factors on these outcomes. Method: We analysed family demographic and baseline data of 132 maltreated children and their caregivers from a family support programme in Singapore. We examined the associations of 3 main risk factors (i.e., caregiver mental health, educational attainment, and family socio-economic status [SES]) with developmental/behavioural outcomes using multivariable logistic regression, controlling for caregiver relationship to the child. Caregiver mental health was assessed using the Patient Health Questionnaire 9 (PHQ-9) and General Anxiety Disorder 7 (GAD-7) tools. Developmental/behavioural outcomes were assessed using the Ages and Stages Questionnaires (ASQ-3), ASQ-Social-Emotional (ASQ-SE), and the Child Behaviour Checklist (CBCL). Results: The children ranged in age, from 2 months to 3 years 11 months (median age 1.7 years, interquartile range [IQR] 0.9-2.6). Among caregivers, 86 (65.2%) were biological mothers, 11 (8.3%) were biological fathers, and 35 (26.5%) were foster parents or extended family members. Low family SES was associated with communication concerns on the ASQ-3 (adjusted odds ratio [AOR] 3.04, 95% CI 1.08-8.57, P=0.04). Caregiver mental health concerns were associated with increased behavioural concerns on the CBCL (AOR 6.54, 95% CI 1.83-23.33, P=0.004) and higher scores on the ASQ-SE (AOR 7.78, 95% CI 2.38-25.38, P=0.001). Conclusion: Maltreated children with caregivers experiencing mental health issues are more likely to have heightened emotional and behavioural concerns. Those from low SES families are also at increased risk of language delay, affecting their communication.

"We don't know how to talk": Adolescent meaning making and experiences of participating in research on violence in Romania, South Africa, and the Philippines.

BACKGROUND: Current evidence on adolescent participation in violence research has primarily measured distress, harm or upset using quantitative methods. There are relatively few studies which have employed qualitative methods to understand adolescent emotional experiences, and to articulate the experiences of participation from their own perspective. OBJECTIVE: This study aimed to assess adolescents' experiences of participating in research on violence in different contexts, namely Romania, South Africa, and the Philippines. METHODS: A purposive sample of adolescents (N = 53, 51 % female) were recruited from rural, urban, and peri-urban areas in Romania, the Eastern Cape Province of South Africa, and Metro Manila, Philippines. Semi-structured one-on-one in-depth interviews and drawings sought adolescent perspectives on their experiences of participation, including the emotions they felt, and their perceptions of research on violence. RESULTS: Drawing on analysis of interviews and drawings, adolescents reported a layered emotional experience, ranging from sadness, anger, apprehension, and upset, to joy, relief, and laughter. Their emotional experiences were driven by participation as a relational encounter, both with the researchers involved, as well as with other children and young people they encountered. Adolescents emphasized participation as enabling disclosure of difficult experiences, and the creation of awareness of violence. CONCLUSIONS: Adolescent perspectives of participation in research on violence are nuanced and encompass their lived experience as well as the fundamentally relational nature of participation. Adolescents experienced increased awareness of topics in violence and perceived research participation as enabling disclosure and possible help-seeking. Measures of participation impact developed along with adolescents, which reflect this complexity, are needed.

Trends in child and adolescent assault and maltreatment following the re-introduction of the Banned Drinker Register in the Northern Territory, Australia.

OBJECTIVE: In 2017 the Northern Territory (NT) government re-introduced the Banned Drinker Register (BDR) to address the high rates of alcohol related harm. This paper aims to evaluate whether trends in assault, maltreatment and sentinel injuries in children and adolescents were associated with the re-introduction of the BDR, in the context of other local interventions such as police officers stationed in bottle shops being partially removed, Police Auxiliary Liquor Inspectors, and the introduction of a minimum unit price of alcohol. METHOD: Interrupted time series analysis was used to assess monthly trends in emergency department presentations and inpatient hospital admissions for assault, maltreatment and sentinel injuries between January 2014 and December 2019 in the regions of Greater Darwin, Alice Springs, and Katherine. RESULTS: A significant step increase after the introduction of the BDR in emergency department presentations for assault and maltreatment was present when examining the three regions combined (ß = 7.65, 95 % CI = 2.15, 13.16). However, this was not present at the individual community level. Results across a range of other models pointed towards null effects of the BDR introduction. CONCLUSIONS: The current study found that the re-introduction of the BDR had minimal impact on rates of assault, maltreatment, or sentinel injuries in children and adolescents. To ensure long-term harm mitigation from alcohol use, a combination of evidence informed alcohol policies that address the price and availability of alcohol in a comprehensive framework, along with measures which address the underlying social determinants of unregulated drinking and health more broadly will assist in reducing alcohol related harm in both children and adults.

Self-stigma mediates the relationships between childhood maltreatment and symptom levels of PTSD, depression, and anxiety.

Background: Childhood maltreatment is a risk factor for developing multiple forms of psychopathology, including depression, posttraumatic stress disorder (PTSD), and anxiety. Yet, the mechanisms linking childhood maltreatment and these psychopathologies remain less clear.Objective: Here we examined whether self-stigma, the internalization of negative stereotypes about one's experiences, mediates the relationship between childhood maltreatment and symptom severity of depression, PTSD, and anxiety.Methods: Childhood trauma survivors (N = 685, Mage = 36.8) were assessed for childhood maltreatment, self-stigma, and symptoms of depression, PTSD, and anxiety. We used mediation analyses with childhood maltreatment as the independent variable. We then repeated these mediation models separately for childhood abuse and neglect, as well as the different subtypes of childhood maltreatment.Results: Self-stigma significantly mediated the relationship between childhood maltreatment and depression, PTSD, and anxiety symptoms. For sexual abuse - but not physical or emotional abuse - a significant mediation effect of self-stigma emerged on all symptom types. For childhood neglect, self-stigma significantly mediated the relationship between both emotional and physical neglect and all symptom types.Conclusion: Our cross-sectional study suggests that different types of childhood maltreatment experiences may relate to distinct mental health problems, potentially linked to increased self-stigma. Self-stigma may serve as an important treatment target for survivors of childhood abuse and neglect.

Childhood maltreatment is linked to depression, PTSD, and anxiety symptoms.Self-stigma, or internalizing negative stereotypes, plays a significant role in mediating this relationship.Different types of maltreatment are linked to varying levels of self-stigma and symptom severity.

Metacognition as a transdiagnostic factor across eating disorders: a latent profile analysis study.

Background: Metacognition is a crucial aspect of understanding and attributing mental states, playing a key role in the psychopathology of eating disorders (EDs). This study aims to explore the diverse clinical profiles of metacognition among patients with EDs using latent profile analysis (LPA). Method: A total of 395 patients with a DSM-5 diagnosis of ED (116 AN-R, 30 AN/BP, 100 BN, 149 BED) participated in this study. They completed self-report measures assessing metacognition, eating psychopathology, depression, emotional dysregulation, personality traits, and childhood adversities. LPA and Welch ANOVAs were conducted to identify profiles based on metacognition scores and examine psychological differences between them. Logistic regression models were employed to explore associations between personal characteristics and different profiles. Results: A 3-class solution had a good fit to the data, revealing profiles of high functioning (HF), intermediate functioning (IF), and low functioning (LF) based on levels of metacognitive impairments. Participants in the IF group were older and had a higher BMI than those in the HF and LF groups. Individuals with BN were largely categorized into HF and LF profiles, whereas participants with BED were mainly included in the IF profile. Participants in the LF group reported an impaired psychological profile, with high levels of depression, emotional dysregulation, childhood adversity, and personality dysfunction. Multinomial logistic regression analyses showed significant associations between metacognitive profiles and emotional and neglect abuse, emotion dysregulation, and detachment. Conclusion: This exploratory study unveils distinct metacognitive profiles in EDs, providing a foundation for future research and targeted interventions. In this light, metacognitive interpersonal therapy could be a valid and effective treatment for EDs, as suggested by the initial promising results for these patients.

Medical assessments for abuse and neglect in contacts of maltreated children.

AIM: Identifying abuse or neglect in one child (index) implicates risk to other children residing in the same home (contacts). While child protection investigators may interview and visually examine contacts, there is lack of consensus regarding when contacts should have a medical assessment. Our goal was to describe the prevalence, characteristics and predictors of abuse and neglect among contacts medically assessed by a child maltreatment evaluation centre over a 5-year period. METHODS: Records of 381 maltreated index children and their 588 contacts were reviewed. Abuse or neglect was diagnosed in 15% of contact children. RESULTS: When index children had more than one type of maltreatment or more than three risk factors, their contacts were more likely to be neglected or abused, respectively. Failure to thrive, patterned injuries, and unmet medical needs were the most common findings among maltreated contacts, and most were diagnosed with injuries or conditions that would not be evident to a child protection investigator. CONCLUSIONS: Clinicians should consider evaluating contacts of maltreated children who have multiple risk factors or maltreatment types. These evaluations should include a careful assessment for injuries, growth and unmet medical needs.

Continuous chains: childhood maltreatment and intimate partner violence victimization among displaced women in a war context.

BACKGROUND: Childhood victimization has been associated with long-term psychological effects and an increased risk of being victimized in later life. Previous research has primarily focused on sexual abuse during childhood, and a wide range of consequences have been identified. However, a significant gap remains in our understanding of the complex interaction between different forms of childhood abuse and violence in later life, particularly in the context of broader social stressors such as armed conflict and displacement. METHODS: This study examines the association between exposure to different types of childhood maltreatment in the context of family and intimate partner violence (IPV) among displaced women living in refugee camps in northern Iraq. Structured interviews were conducted by trained female psychologists with 332 women aged between 20 and 62 years. RESULTS: Results indicated that over one-third of the participating women reported experiencing at least one occurrence of IPV by their husbands within the past year. In addition, participants reported experiences of different types of maltreatment (physical, emotional, and sexual violence and physical and emotional neglect) perpetrated by family members in their childhood. While all forms of childhood maltreatment showed an association with IPV within the past year, only emotional childhood maltreatment was found to be a significant predictor of IPV in a multivariate analysis. CONCLUSION: The study highlights the ongoing impact of child maltreatment and its contribution to increased vulnerability to IPV victimization in later life. In addition, this study describes the specific cultural and contextual elements that contribute to IPV in refugee camps.

Resilience as a moderator of the relationship between stress and different symptom dimensions of depression in adolescents with a history of childhood maltreatment: A multi-wave longitudinal study.

BACKGROUND: Although childhood maltreatment is a key risk factor for the development of psychopathology including depression in later life, not all children who have been maltreated subsequently become depressed. OBJECTIVE: The study aimed to examine the potentially moderating influence of resilience on the relationship between daily stress and different symptom dimensions of depression in adolescents with a history of childhood maltreatment. PARTICIPANTS AND SETTING: A sample of students (n = 999) aged 12-16 years from middle schools with a history of childhood maltreatment participated in this study. METHODS: A multi-wave longitudinal study was conducted over 12 months. At baseline, adolescent participants completed standardized self-report measures of resilience, depression, and daily stress. The measures of depression and stress were re-administered every three months for the subsequent 12 months. Multi-level modeling was undertaken to analyze the data. RESULTS: In adolescents with a history of childhood maltreatment, lower resilience scores were associated with greater increases in depressed affect, absence of positive affect and somatic symptom, but not the interpersonal concerns symptom dimensions of depression following daily stress. Resilience is therefore as one explanation for the discrepant findings regarding the relationship between stress and different symptom dimensions of depression, especially with regard to the stress-related depressive dimensions. CONCLUSION: Resilience appears to moderate the relationship between daily stress and depression and protect against developing depression in children who have been maltreated. Findings provide potential explanation for the effectiveness of resilience-related therapy in treating depressive symptoms.

Coping motives as a mediator of the relationship between child maltreatment and substance use problems in south African adolescents.

BACKGROUND: Evidence suggests that adults with a history of child maltreatment (CM) engage in substance misuse driven by 'coping motives': maladaptive beliefs that substances help them cope with negative emotions. However, the specificity of this risk pathway is under-researched in younger and non-Western cohorts. OBJECTIVE: The present study aimed to determine whether coping motives play a distinct role compared to other motives for substance use in mediating the relationship between CM and problematic alcohol and marijuana use in a sample of South African adolescents. PARTICIPANTS AND SETTING: A sample of 688 high school students (M age = 15.03 years; 62.5 % female) in Cape Town, South Africa, completed a cross sectional survey. METHODS: Participants completed self-report measures of CM exposure, motives for using alcohol and marijuana (coping, enhancement, social and conformity), and alcohol and marijuana related problems. Participants who endorsed using alcohol (N = 180) or marijuana (N = 136) were included in analysis. A parallel mediation model was conducted for each substance (alcohol and marijuana, respectively) to assess which motives mediated the relationship between CM exposure and substance-related problems. RESULTS: CM exposure predicted both alcohol-and marijuana related problems. The relationship between CM exposure and alcohol-related problems was partially mediated by coping motives (p < .001, 95%CI 0.028, 0.115) and, to a lesser extent, conformity motives (p < .01, 95%CI 0.001, 0.041), but not by social motives or enhancement motives. The relationship between CM exposure and marijuana-related problems was partially mediated by coping motives (p < .001, 95%CI 0.004, 0.037), but not by conformity, social or enhancement motives. CONCLUSIONS: The findings support the importance of coping motives as a mediator between CM and problematic substance use across different substances of abuse in South African adolescents, and the role of conformity motives in problematic alcohol use. Future research should explore whether these findings hold across other sociocultural contexts, and the utility of interventions to address coping motives for substance use in adolescence.