An exploration of dimensions of early adversity and the development of functional brain network connectivity during adolescence: Implications for trajectories of internalizing symptoms.

Different dimensions of adversity may affect mental health through distinct neurobiological mechanisms, though current supporting evidence consists largely of cross-sectional associations between threat or deprivation and fronto-limbic circuitry. In this exploratory three-wave longitudinal study spanning ages 9-19 years, we examined the associations between experiences of unpredictability, threat, and deprivation with the development of functional connectivity within and between three brain networks implicated in psychopathology: the salience (SAL), default mode (DMN), and fronto-parietal (FPN) networks, and tested whether network trajectories moderated associations between adversity and changes in internalizing symptoms. Connectivity decreased with age on average; these changes differed by dimension of adversity. Whereas family-level deprivation was associated with lower initial levels and more stability across most networks, unpredictability was associated with stability only in SAL connectivity, and threat was associated with stability in FPN and DMN-SAL connectivity. In youth exposed to higher levels of any adversity, lower initial levels and more stability in connectivity were related to smaller increases in internalizing symptoms. Our findings suggest that whereas deprivation is associated with widespread neurodevelopmental differences in cognitive and emotion processing networks, unpredictability is related selectively to salience detection circuitry. Studies with wider developmental windows should examine whether these neurodevelopmental alterations are adaptive or serve to maintain internalizing symptoms.

Classes of childhood adversities and their associations to the mental health of college undergraduates: a nationwide cross-sectional study.

BACKGROUND: Childhood adversities pose deleterious consequences on health and well-being, but limited studies explore whether unique patterns of adverse childhood experiences (ACEs) impact the mental health of emerging adults and the mediating role of current stressful events (CSEs). This study examined classes of ACEs and how they relate to CSEs, psychological distress, and subjective well-being among Eritrean College undergraduates. METHODS: Cross-sectional data on ACEs, CSEs, symptoms of psychological distress, and subjective well-being were collected from a national sample of college students (N = 507). We identified ACE patterns using latent class analysis and further examined whether CSEs mediated the effects of ACE classes on psychological distress and subjective well-being. RESULTS: 86.4% of the sample experienced at least one ACE. Collective violence, domestic violence, and physical abuse were the most common ACEs. Three subgroups, low ACEs (66.3%), household violence (19.1%), and multiple ACEs (14.6%) were identified. We found that relative to low ACEs, household violence (ß = 0.142, 95% CI 0.046, 0.248) and multiple ACEs (ß = 0.501, 95% CI 0.357, 0.666) indirectly influenced psychological distress through CSEs, and CSEs mediated the relationships between household violence (ß = -0.096, 95% CI -0.176, -0.033), multiple ACEs (ß = -0.338, 95% CI -0.498, -0.210), and subjective well-being. However, there were nonsignificant relative direct effects of ACE patterns on both psychological distress and subjective well-being. CONCLUSIONS: Experiencing multiple ACEs and household violence in conjunction with CSEs significantly predict psychological distress and subjective well-being. Contextual interventions for the early identification of ACEs and the management of CSEs may play a crucial role in the prevention of mental health problems.

Dynamic DNA methylation changes in early versus late adulthood suggest nondeterministic effects of childhood adversity: a meta-analysis.

Adverse childhood experiences (ACEs) are associated with a high risk of developing chronic diseases and decreased life expectancy, but no ACE epigenetic biomarkers have been identified until now. The latter may result from the interaction of multiple factors such as age, sex, degree of adversity, and lack of transcriptional effects of DNA methylation changes. We hypothesize that DNA methylation changes are related to childhood adversity levels and current age, and these markers evolve as aging proceeds. Two Gene Expression Omnibus datasets, regarding ACE, were selected (GSE72680 and GSE70603), considering raw- and meta-data availability, including validated ACE index (Childhood Trauma Questionnaire (CTQ) score). For DNA methylation, analyzed probes were restricted to those laying within promoters and first exons, and samples were grouped by CTQ scores terciles, to compare highly (ACE) with non-abused (control) cases. Comparison of control and ACE methylome profile did not retrieve differentially methylated CpG sites (DMCs) after correcting by false discovery rate < 0.05, and this was also observed when samples were separated by sex. In contrast, grouping by decade age ranges (i.e., the 20s, 30s, 40s, and 50s) showed a progressive increase in the number of DMCs and the intensity of changes, mainly related with hypomethylation. Comparison with transcriptome data for ACE subjects in the 40s, and 50s showed a similar age-dependent effect. This study provides evidence that epigenetic markers of ACE are age-dependent, but not defined in the long term. These differences among early, middle, and late adulthood epigenomic profiles suggest a window for interventions aimed to prevent the detrimental effects of ACE.

Childhood trauma, psychiatric disorders, and criminality in women: Associations with serum levels of brain-derived neurotrophic factor.

Psychiatric disorders and childhood trauma are highly prevalent in female inmates. Brain-derived neurotrophic factor (BDNF) plays a number of roles in neuronal survival, structure, and function. Data in the literature suggest that it is a neurobiological substrate that moderates the impact of childhood adversities on the late expression of psychiatric disorders. The aim of this study was to determine whether five childhood trauma subtypes-physical abuse, sexual abuse, emotional abuse, physical neglect, and emotional neglect-are associated with adult psychiatric disorders, BDNF levels, and criminality among incarcerated women. This was a cross-sectional study involving a consecutive sample of 110 women, divided into three groups of women (forensic - mentally ill who committed crimes, clinical psychiatric inpatients and healthy controls). The Childhood Trauma Questionnaire and the Mini-International Neuropsychiatric Interview-Plus were applied in the whole sample, and BDNF levels were measured in a sub-sample of 54 women. The rates of mental illness and childhood trauma were high in the forensic group. Emotional abuse was higher in the clinical and forensic groups than in the healthy control group. Lower BDNF levels were associated with emotional abuse in the forensic group as well as with sexual abuse in the healthy control group. After multinomial logistic regression, lower levels of BDNF, higher levels of emotional abuse and the presence of familial offense were considered factors related to clinical psychiatric group. The results of this study underscore the idea that BDNF may be an important factor related to the development of diseases and criminality in women who are victims of childhood trauma, becoming a possible biological marker.

Effects of Adverse Childhood Experiences, Stress, and Social Support on the Health of College Students.

The goal of the study was to describe the nature of adverse childhood experiences (ACEs) reported by undergraduates and to examine the effect of ACEs, perceived stress, and perceived social support on their health. Although respondents (N = 321) had parents with relatively high levels of education and indicated generally high levels of social support, results nevertheless showed a relatively high level of mental health problems and rates of ACEs that were similar to those in the general population in the state. Those with higher levels of ACEs had greater levels of stress and lower levels of social support. ACEs, social support, and stress explained more than half the variance in mental health scores, with stress making the greatest contribution. Despite the fact that we used different measures and an independent sample, findings generally replicated a previous study. Results point to a need to increase awareness of the association between ACEs and health on college campuses, to examine the effects of ACEs in more detail, and to design ACE-informed programs for this population.

Does childhood victimization predict specific adolescent offending? An analysis of generality versus specificity in the victim-offender overlap.

BACKGROUND: A large body of research has examined the relationship between victimization and future offending, with results suggesting that crime victims are at higher risk of future criminal behavior-known as the victim-offender overlap. Prior studies have primarily examined the relationship between general victimization (e.g., violent victimization, sexual abuse, and more) and general offending (e.g., violence, sexual offending, and drug use), and focused on adult populations. OBJECTIVE: The goal of the present study is to expand on prior literature by examining if specific forms of childhood victimization increase the risk of specific and analogous forms of offending among delinquent youth. METHOD: Based upon a population of 64,329 high-risk youth offenders in Florida, this study evaluates the specificity of the overlap among youth who were physically abused, sexually abused, or witnessed illegal substance use at home during childhood to determine if these forms of victimization increased the risk of violence, sexual offending, and drug use, respectively, when assessed in multivariate logistic regression models. RESULTS: Results provide considerable support for specificity in the victim-offender overlap, as hypothesized. Specifically, experiencing physical abuse (OR = 1.55, p < .001), sexual abuse (OR = 3.58, p < .001) and witnessing household substance abuse (OR = 1.66, p < .001) in childhood each significantly and substantially increased the risk of analogous criminal behavior in adolescence, even when controlling for other risk factors and forms of victimization. CONCLUSION: This study provided novel evidence for specificity in the victim-offender overlap, even after controlling for confounding variables. Practical implications for early intervention and crime prevention are discussed, as well as implications for future research. Highlighting the importance of specificity in the victimization and adverse childhood experience (ACE) paradigms.

Childhood Trauma, Social Networks, and the Mental Health of Adult Survivors.

The purpose of this study was to investigate the relationship of childhood trauma to the quality of social networks and health outcomes later in adulthood. Data were obtained from a convenience sample of 254 adults seen in one of 10 primary care clinics in the state of Texas. Standardized measures of adverse childhood experiences (ACEs), stressful and supportive social relationships, medical conditions, anxiety, depression, and health-related quality of life were administered. Using latent class analysis, subjects were assigned to one of four ACE classes: (a) minimal childhood abuse (56%), (b) physical/verbal abuse of both child and mother with household alcohol abuse (13%), (c) verbal and physical abuse of child with household mental illness (12%), and (d) verbal abuse only (19%). Statistically significant differences across the four ACE classes were found for mental health outcomes in adulthood. Although respondents who were physically and verbally abused as children reported compromised mental health, this was particularly true for those who witnessed physical abuse of their mother. A similar relationship between ACE class and physical health was not found. The quality of adult social networks partly accounted for the relationship between ACE classes and mental health outcomes. Respondents exposed to ACEs with more supportive social networks as adults had diminished odds of reporting poor mental health. Conversely, increasing numbers of stressful social relationships contributed to adverse mental health outcomes. Although efforts to prevent childhood trauma remain a critical priority, the treatment of adult survivors needs to expand its focus on both strengthening social networks and decreasing the negative effects of stressful ones.

Adverse Childhood Experiences Among Gynecology Patients With Chronic Pelvic Pain.

OBJECTIVE: To compare adverse childhood experiences (ACEs) in women with chronic pelvic pain with a control group, and describe occurrence of specific ACEs in women with chronic pelvic pain. METHODS: This case-control study examined the relationship between history of ACEs, traumatic events occurring during childhood as defined by the Centers for Disease Control and Prevention (CDC), and chronic pelvic pain. Patients diagnosed with chronic pelvic pain (n=60) were age-matched to a control group of women without chronic pelvic pain (n=60). All participants completed validated measures to detect for presence of any of the 11 ACEs as identified by the CDC's Behavioral Risk Factor Surveillance System ACE Module. RESULTS: Mean participant age was 40 (±11 years). Total numbers of ACEs were elevated in chronic pelvic pain participants compared with a control group (median 4 [interquartile range 2-6] vs median 1 [interquartile range 0-4], P<.001) and 53% of chronic pelvic pain participants had four or more ACEs, compared with 27% of the control group (odds ratio [OR] 3.14; 95% CI 1.46-6.75). All categories of abuse were more prevalent in chronic pelvic pain compared with the control group: physical (43% vs 15%, OR 4.3; 95% CI 1.8-10.4; P=.001), sexual (55% vs 23%, OR 4.0; 95% CI 1.8-8.8; P<.001) and verbal or emotional (62% vs 33%, OR 3.2; 95% CI 1.5-6.8; P=.003). Regarding household challenges, the subcategory most prevalent in chronic pelvic pain participants compared with the control group was that of witnessed domestic violence (35% vs 8%, OR 5.9; 95% CI 2.1-17.1, P<.001). CONCLUSION: Chronic pelvic pain participants had a greater than threefold odds of having a history of childhood abuse and having witnessed domestic violence during childhood compared with the control group. Women with chronic pelvic pain had increased numbers of ACEs and 53% had four or more ACEs, crossing a threshold that others have found to predict poor overall health outcomes.

The hands that cradle: A pilot study of parent adverse childhood experience scores.

The purpose of this study was to gather population-specific data within a pediatric hospital and contribute to understanding the intergenerational continuity of adverse childhood experiences (ACEs). This descriptive study aimed at measuring the ACE scores of parents or caretakers whose child was a suspected victim of abuse or neglect. The "Finding Your ACE Score questionnaire was used to determine participants' scores." Fifteen participants enrolled in the study (N = 15), and 86.7% had exposure to ACEs. Statistical significance was found when comparing ACE scores with reported income levels (p = .051). This study supports previous findings of ACEs being present in a variety of populations, and it presents practice implications for advance practice registered nurses (APRNs) in various practice settings. Findings support that research regarding how to assess and treat ACEs throughout family members is both necessary and difficult. Additional data regarding the intergenerational continuity of ACEs might influence how APRNs deliver family-specific assessment, treatment, and prevention of ACEs throughout generations of family members.

Identifying Distinct Latent Classes of Adverse Childhood Experiences Among US Children and Their Relationship with Childhood Internalizing Disorders.

This study aimed to determine the relationship between latent classes of adverse childhood experience (ACEs) and internalizing disorders (anxiety and depression) among US children. The 2016 National Survey of Children's Health data for children aged 6-17 was used. Latent class analysis was performed to identify distinct sub-types of ACE exposures and survey-weighted logistic regression models were employed to determine whether these classes were associated with any or comorbid childhood internalizing disorders, after controlling for meaningful covariates. Four latent classes were identified: income hardship, divorce, mental health or substance abuse exposure, and high ACEs overall. Children in three of the four classes were significantly more likely to have any childhood internalizing disorder when compared to children reporting no ACEs, while children in all classes were significantly more likely to have a comorbid history of anxiety and depression. Thus, children exposed to ACEs should receive necessary mental health screenings and treatments.

The co-occurrence of adverse childhood experiences among children investigated for child maltreatment: A latent class analysis.

Children investigated for maltreatment are particularly vulnerable to experiencing multiple adversities. Few studies have examined the extent to which experiences of adversity and different types of maltreatment co-occur in this most vulnerable population of children. Understanding the complex nature of childhood adversity may inform the enhanced tailoring of practices to better meet the needs of maltreated children. Using cross-sectional data from the National Survey of Child and Adolescent Well-Being II (N=5870), this study employed latent class analysis to identify subgroups of children who had experienced multiple forms of maltreatment and associated adversities among four developmental stages: birth to 23 months (infants), 2-5 (preschool age), 6-10 (school age), and 11-18 years-old (adolescents). Three latent classes were identified for infants, preschool-aged children, and adolescents, and four latent classes were identified for school-aged children. Among infants, the groups were characterized by experiences of (1) physical neglect/emotional abuse/caregiver treated violently, (2) physical neglect/household dysfunction, and (3) caregiver divorce. For preschool-aged children, the groups included (1) physical neglect/emotional abuse/caregiver treated violently, (2) physical neglect/household dysfunction, and (3) emotional abuse. Children in the school-age group clustered based on experiencing (1) physical neglect/emotional neglect and abuse/caregiver treated violently, (2) physical neglect/household dysfunction, (3) emotional abuse, and (4) emotional abuse/caregiver divorce. Finally, adolescents were grouped based on (1) physical neglect/emotional abuse/household dysfunction, (2) physical abuse/emotional abuse/household dysfunction, and (3) emotional abuse/caregiver divorce. The results indicate distinct classes of adversity experienced among children investigated for child maltreatment, with both stability across developmental periods and unique age-related vulnerabilities. Implications for practice and future research are discussed.

Childhood adversities are different in Schizophrenic Spectrum Disorders, Bipolar Disorder and Major Depressive Disorder.

BACKGROUND: Research has shown that a history of childhood adversities is common in patients with psychiatric disorders but few studies have investigated links between specific types of adversity and specific psychiatric disorders. METHODS: We investigated the frequency of early childhood adversities in a sample consisting of 91 patients with diagnosis of schizophrenic spectrum disorders (SSD), 74 patients with bipolar disorder (BD), 83 patients with major depressive disorder (MDD) and 85 healthy controls and sought to identify adverse early childhood life events that predict the development of major psychiatric disorders. The Childhood Experiences of Care and Abuse questionnaire was used to collect data on traumatic experiences occurring before the age of 17 years and comprehensive demographic data were also collected. The data were analyzed with chi-squared tests, t-tests, post-hoc and logistic regression. RESULTS: Maternal absence/loss and economic difficulties in the early life were more prevalent in the BD group than other groups. Escape from home, cannabis abuse, psychological abuse, physical abuse and loneliness were more frequent in the SSD group than in other groups. Paternal absence, neglect of core needs, serious familial tension and absence of adult and peer confidants were all less common in the HC group than in the other groups. The regression model confirmed that different types of adversities play a crucial role in the development of the three investigated disorders. CONCLUSIONS: Our results support that SSD, BD and MDD are associated to different childhood adversities. This suggests that psychosocial interventions that reduce the incidence of these early life adversities might reduce the incidence of severe and disabling psychiatric disorders.

Maternal adverse childhood experiences and antepartum risks: the moderating role of social support.

The aims of the current study were to examine the association between maternal adverse childhood experiences (ACEs) and antepartum health risks, and to investigate whether social support moderated this association. It was hypothesized that ACEs would be associated with antepartum health risks; however, social support in the prenatal period would buffer mothers from the deleterious consequences of ACEs. Data from 1994 women (mean age = 31 years) and their infants were collected from a longitudinal cohort recruited in health care offices in Alberta, Canada. Pregnant women completed questionnaires related to ACEs prior to the age of 18 and prenatal social support, and a health care professional assessed the mother's antepartum health risk. ACEs included physical, emotional, and sexual abuse, exposure to domestic violence, as well as exposure to household dysfunction such as parental substance use, mental illness, or incarceration. Regression analyses demonstrated a positive association between ACEs and antepartum health risks. However, a significant interaction between maternal ACEs and social support was also observed. Specifically, women exposed to high ACEs and low social support in pregnancy had high antepartum health risks. However, among mothers who had high ACEs but also high levels of social support, there was no association between ACEs and antepartum health risk. A history of ACEs can place mothers at risk of antepartum health complications. However, a resiliency effect was observed: women with a history of ACEs were buffered from experiencing antepartum health risks if they reported high levels of social support in pregnancy.

Relationship between individual categories of adverse childhood experience and diabetes in adulthood in a sample of US adults: Does it differ by gender?

AIMS: ACEs are known to increase risk for diabetes in adulthood. However, little is known about the differential impact of individual ACE categories on diabetes risk, and whether this relationship is gender specific. METHODS: Data from the 2011 BRFSS was used in this study. Participants included 48,526 adults who completed the ACE module across 5 states. Using logistic regression, we examined the odds of diabetes in adulthood related to eight individual categories of ACEs: sexual abuse, physical abuse, verbal abuse, mental illness, substance abuse, incarceration, separation/divorce, and violence. A gender interaction term was included to test if this relationship varied between men and women. RESULTS: In adjusted analyses, sexual abuse (OR 1.57, CI 1.240; 1.995) had the strongest positive association followed by verbal (OR 1.29, CI 1.117; 1.484) and physical abuse (OR 1.26, CI 1.040; 1.516). Having a parent with mental illness was also significantly associated with increased odds of diabetes (OR 1.19, CI 0.996; 1.416). No interaction between ACEs and diabetes status by gender in any of the eight categories was found. CONCLUSIONS: Overall, this study found that four ACE categories were significantly associated with increased odds of diabetes in adulthood with sexual abuse being the strongest predictor.

Early life adversity and telomere length: a meta-analysis.

Early adversity, in the form of abuse, neglect, socioeconomic status and other adverse experiences, is associated with poor physical and mental health outcomes. To understand the biologic mechanisms underlying these associations, studies have evaluated the relationship between early adversity and telomere length, a marker of cellular senescence. Such results have varied in regard to the size and significance of this relationship. Using meta-analytic techniques, we aimed to clarify the relationship between early adversity and telomere length while exploring factors affecting the association, including adversity type, timing and study design. A comprehensive search in July 2016 of PubMed/MEDLINE, PsycINFO and Web of Science identified 2462 studies. Multiple reviewers appraised studies for inclusion or exclusion using a priori criteria; 3.9% met inclusion criteria. Data were extracted into a structured form; the Newcastle-Ottawa Scale assessed study quality, validity and bias. Forty-one studies (N=30 773) met inclusion criteria. Early adversity and telomere length were significantly associated (Cohen's d effect size=-0.35; 95% CI, -0.46 to -0.24; P<0.0001). Sensitivity analyses revealed no outlier effects. Adversity type and timing significantly impacted the association with telomere length (P<0.0001 and P=0.0025, respectively). Subgroup and meta-regression analyses revealed that medication use, medical or psychiatric conditions, case-control vs longitudinal study design, methodological factors, age and smoking significantly affected the relationship. Comprehensive evaluations of adversity demonstrated more extensive telomere length changes. These results suggest that early adversity may have long-lasting physiological consequences contributing to disease risk and biological aging.