[Editor's note: Dr. Harise Stein at Stanford University edits a web site — abuseresearch.info — that focuses on the effects of abuse, and includes research articles on PACEs. Every month, she posts the summaries of the abstracts and links to research articles that address only ACEs, PCEs and PACEs. Thank you, Harise!! — Rafael Maravilla]
Child Abuse
Bullinger LR, Boy A, Feely M, et al.
Home, but Left Alone: Time at Home and Child Abuse and Neglect During COVID-19. Journal of family issues. 2023;44(2):338-62. PMID: 36743830
Using Georgia data during the pandemic, “referrals plummeted by 58% relative to previous years, driven by fewer referrals from education personnel. After this initial decline, however, each 15 minutes at home was associated with an increase in referrals of material neglect by 3.5% and supervisory neglect by 1%...Supervisory neglect is difficult for CPS to address, especially in the context of COVID-19 where there are limited resources to fix the novel issues facing families…This finding points to the need for greater resources to support parents and children inside their homes.”
Oddo ER, Simpson AN, Maldonado L, Hink AB, Andrews AL.
Mental Health Care Utilization Among Children and Adolescents With a Firearm Injury. JAMA Surg. 2023 Jan 1;158(1):29-34. PMID: 36322057
For 4254 children and adolescents mean age 13.5 years seen for a firearm injury, compared to matched controls, in the year following the injury there was a 1.40 times greater use of mental health services – 1.23 times greater for psychotherapy services and 1.40 times greater for substance use.
Yoon S, Maguire-Jack K, Ploss A, Benavidez JL, Chang Y.
Contextual factors of child behavioral health across developmental stages. Dev Psychopathol. 2023:1-14. PMID: 36734228
This study examined the relative influence of environmental contexts (family, school, neighborhood) on child behavioral health at ages 3, 5, 9, and 15 years for 4,898 children in a fragile families study. “Child physical abuse, emotional abuse, maternal depression, substance use, neighborhood social cohesion, neighborhood poverty, school connectedness, and peer bullying had concurrent relationships with child behavior problems at one or more developmental stages. Early childhood abuse (age 3) and school age environmental contexts (age 9) had lasting effects on later behavior problems.”
de la Rosa R, Zablotny D, Ye M, et al.
Biological Burden of ACEs in Children. Psychosom Med. 2023 Feb-Mar 01;85(2):108-117. PMID: 36728584
Authors used a framework of physiologic “allostatic load” (measuring metabolic, immune, neurologic, and cardiovascular blood markers of health) in 207 children to assess the burden of ACEs, with increased allostatic load especially correlated with caregiver mental illness, poorer perceived general health, and increased odds of child obesity.
Arowolo T, Animasahun A, Baptiste-Roberts K, Bronner Y.
Effect of COVID-19 Pandemic Response and Parental Adverse Childhood Experiences on Child Health and Well-Being.
Journal of child & adolescent trauma. 2023:1-10. PMID: 36818743
From a research review, “Parents with high ACE scores were more likely to cope poorly with childcare duties and engage in child neglect, verbal abuse, and reduced feeding frequency, specifically during the COVID-19 pandemic. The review findings support the framework of inadequate resilience and coping skills of adults with a history of ACEs during periods of stress and unpredictability such as the COVID-19 pandemic. The negative effects of these parental stressors on a child's health and well-being are modifiable and could be mitigated by targeted interventions.”
Geprägs A, Bürgin D, Fegert JM, Brähler E, Clemens V.
Parental stress and physical violence against children during the second year of the COVID-19 pandemic: results of a population-based survey in Germany. Child and adolescent psychiatry and mental health. 2023;17(1):25. PMID: 36804027
Using data from a representative probability sample of the German population July-October 2021, “Higher parental stress levels, a stronger increase of parental stress during the pandemic, having pre-existing psychiatric disorders, and parental experience of child maltreatment predicted an increased use of physical violence against children during the pandemic. Our results…underline the need for low threshold support for families at risk in times of crises.”
O'Hare K, Hussain A, Laurens KR, et al.
Self-reported mental health of children known to child protection services: an Australian population-based record linkage study. Eur Child Adolesc Psychiatry. 2023;32(1):101-12. PMID: 34247296
For 26,960 Australian children, all levels of CPS contact (non-threshold reports, unsubstantiated reports, substantiated reports, and out-of-home care (OOHC)) were associated with problematic self-report in 6 mental health categories – emotional symptoms, conduct problems, hyperactivity/ inattention, peer relationship problems, prosocial behaviors, and psychotic-like experiences. The highest odds of reporting clinical levels of mental health difficulties in at least one domain were 48.1% of children with an OOHC placement and 45.6% of those with substantiated child protection reports.
Stewart SL, Vasudeva AS, Mistry D, Poss JW.
The impact of child maltreatment on mental health outcome improvements among children and youth accessing community mental health care. Child Abuse Negl. 2023;139:106066. PMID: 36791630
For 16,517 Canadian children treated at 58 community mental health agencies, children without a trauma history consistently showed greater improvement than those with trauma. “Sexual abuse was associated with some of the most significant negative impacts on children's mental health improvements…Our findings highlight an urgent need for the implementation of standardized, evidence-based assessments that screen trauma histories of children accessing mental health supports, and research examining the impact of trauma on children's treatment responsiveness.”
Machlin L, Egger HL, Stein CR, et al. Distinct Associations of Deprivation and Threat With Alterations in Brain Structure in Early Childhood. J Am Acad Child Adolesc Psychiatry. 2023 Feb 10:S0890-8567(23)00061-8. PMID: 36775117
Using brain scans from 72 children 5-10 years old, “Results suggest distinct associations of deprivation and threat on brain structure in early childhood. Threat [the presence of domestic violence, sexual abuse, physical abuse, or neighborhood violence] is associated with widespread differences in brain surface area, and deprivation [the presence of neglect] is associated with differences in cortical thickness. These observations are consistent with adult research, and reflect how dimensions of adversity differentially impact neural structure.”
Daigneault I, Paquette G, De La Sablonnière-Griffin M, Dion J.
Childhood Sexual Abuse, Intellectual Disability, and Subsequent Physical and Mental Health Disorders: A Matched Cohort Study. American journal on intellectual and developmental disabilities. 2023;128(2):134-44. PMID: 36807477
Using Canadian administrative databases of children who had a sexual abuse report corroborated by a child protection agency and a matched group from the general population, children with Intellectual disability (ID) were 3.5 times more likely to have a corroborated sexual abuse report when compared to their peers without ID, and a higher post-abuse number of medical consultations for physical and mental health disorders.”
Adult Manifestations of Child Abuse
Kovacs AH, Vervoort D, Lopez KN.
Moving beyond lifestyle: the case for childhood adversity, social determinants of health, and psychosocial factors in cardiovascular risk prediction. Eur Heart J. 2023;44(7):594-7. PMID: 36480299
In this editorial, “We believe there is currently a disproportionate emphasis on CVD risk factors at the individual level and an under-focus on larger societal factors…Now is the time to reconsider adverse childhood experiences, social determinants of health, and psychosocial factors previously used to represent risk modifiers and convert them to formal CVD risk factors and metrics for modelling; these three domains are inter-related with one another as well as with traditional lifestyle risk factors.”
Tan M, Mao P.
Type and dose-response effect of adverse childhood experiences in predicting depression: A systematic review and meta-analysis. Child Abuse Negl. 2023;139:106091. PMID: 36787671
From an extensive research review, authors found that ACEs, regardless of type or quantity, may be a risk factor for depression, with odds ratios ranging from 1.34 to 3.17.
Nieser KJ, Stowe ZN, Newport DJ, Coker JL, Cochran AL.
Detection of differential depressive symptom patterns in a cohort of perinatal women. EClinicalMedicine. 2023;57:101830. PMID: 36798754
Patterns of depressive symptoms for 548 pregnant women were evaluated. About 10% of participants differed in how their depressive symptoms were expressed, “and had more severe responses for all items—particularly for items related to thoughts of self-harm and negative self-judgement. History of childhood trauma and history of social anxiety disorder were strongly associated with this differential symptom pattern.”
Madden RA, Atkinson K, Shen X, et al.
Structural brain correlates of childhood trauma with replication across two large, independent community-based samples. Eur Psychiatry. 2023;66(1):e19. PMID: 36697368
Using brain scan data for 28,226 adults from 2 large studies (Generation Scotland and UK Biobank), similar associations were found between a history of childhood trauma and reduced volume of the overall brain as well as specific brain regions.
Hansbarger M, Ackenbom M, Shepherd JP.
Differences in Sexual and Physical Abuse History by Presenting Chief Complaint in an Outpatient Urogynecology Population. Urogynecology (Hagerstown). 2023;29(3):344-50. PMID: 36808928
Of 1,000 women mean age 58.4 years seen at 7 urogynecology offices in Pennsylvania, those with a lifetime history of physical or sexual abuse were 2.7 times more likely to have a chief complaint of pelvic pain. Other factors associated with abuse were younger age, increased BMI, urinating at night, and smoking, which was the strongest factor with 3.7 times increased risk of abuse.
Zang JCS, May C, Hellwig B, et al.
Proteome analysis of monocytes implicates altered mitochondrial biology in adults reporting adverse childhood experiences. Translational psychiatry. 2023;13(1):31. PMID: 36720844
(Mitochondria are structures found in most cells that generate the energy needed to run the cell. Mitochondria have they own DNA, which are only derived from the mother.) Comparing healthy adults reporting childhood adversity to a control group without childhood adversity, and exposing both groups to psychosocial stress, showed that those with adversity had upregulation of blood proteins related to mitochondrial biology, cellular energy metabolism, and inflammatory biology. These findings were independent of laboratory stress exposure, and were evident especially in females. “In line with the mitochondrial allostatic load model, our findings provide evidence for the long-term effects of childhood adversity on mitochondrial biology.”
Storrie CL, Kitissou K, Messina A.
The Effects of Severe Childhood Physical and Sexual Abuse on Adult Socioeconomic Prosperity. Journal of child & adolescent trauma. 2023;16(1):55-68. PMID: 36776634
Using national data, “We find adults who suffered physical abuse in childhood are more likely to live in poverty. Adult survivors of childhood sexual abuse are less likely to finish high school and more likely to live in poverty. The likelihood of high school noncompletion increases when the individual suffered both forms of abuse…the negative socioeconomic impact in adulthood is larger for women than for men.”
Yu J, Patel RA, Haynie DL, et al.
Adverse childhood experiences and premature mortality through mid-adulthood: A five-decade prospective study. Lancet Reg Health Am. 2022 Nov;15:100349. PMID: 36467261
From a long-term study of 46,129 persons 48% Black and 49.5% female, premature mortality was shown for parent harshness and neglect, family instability, poverty and crowded housing, and poverty and parental separation.
van den Oord CLJD, Copeland WE, Zhao M, et al.
DNA methylation signatures of childhood trauma predict psychiatric disorders and other adverse outcomes 17 years after exposure.
Mol Psychiatry. 2022 Aug;27(8):3367-3373. PMID: 35546634
Using blood methylation data (changes to DNA from outside influences) from 489 participants as teens and as adults, “Trauma-related methylation risk scores (MRSs) significantly predicted adult depression, externalizing problems, nicotine dependence, alcohol use disorder, serious medical problems, social problems and poverty. The predictive power of the MRSs was higher than that of reported trauma…Rather than measuring the occurrence of traumatic events, the MRSs seemed to capture the impact of trauma. The majority of predictive sites did not remain associated with the outcomes, suggesting the signatures of trauma do not become biologically embedded…The MRSs have the potential to be a novel clinical biomarker for the assessment of trauma-related health risks.”
Chen D, Lin L, Li C, Chen W, Zhang Y, Ren Y, et al.
Maternal adverse childhood experiences and health-related quality of life in preschool children: a cross-sectional study. Child and adolescent psychiatry and mental health. 2023;17(1):19. PMID: 36747212
Of 4243 Chinese mother-child dyads who attended randomly selected preschools, 85.8% of mothers reported at least 1 ACE, with 22.3% reporting 3+ ACEs. Compared to children of mothers with no ACEs, children of mothers with any number of ACEs “all had significantly lower scores of physical, social, and school functioning, as well as lower psychosocial health summary score. However, only children of mothers with two or more ACEs had significantly poorer emotional functioning… screening maternal ACEs in young children and promoting targeted interventions might be a feasible way to mitigate or stop the potential negative intergenerational health and wellbeing implications of ACEs.”
Bourassa KJ, Moffitt TE, Harrington H, et al.
Childhood Adversity and Midlife Health: Shining a Light on the Black Box of Psychosocial Mechanisms. Prev Sci. 2022 Sep 9:10.1007/s11121-022-01431-y. PMID: 36083434
From a study of 859 individuals followed from birth to age 45, children who experienced more ACEs had poorer mid-life health; they also experienced more stressful life events, perceived stress, negative emotionality, and poor health behaviors, all of which were factors in poorer mid-life health.
Dunn KE, Turner GM, Oswald LM.
Effects of Early Life Trauma on Risks for Adult Opioid Use Disorder Are Mediated by Stress and Occur Independent of Depression and Anxiety. J Addict Med. 2022 Nov-Dec 01;16(6):709-715. PMID: 35914024
From an online survey of 310 person with exposure to opioids, 93% reported at least 1 lifetime trauma, and 65% met criteria for opioid use disorder (OUD). All types of early life trauma (total, general, physical, emotional, or sexual) showed an almost dose-dependent association with more severe current OUD. Perceived stress, but not psychiatric functioning, was a robust contributor to this association.
Adolescents
Mainali P, Motiwala F, Trivedi C, et al. Sexual Abuse and Its Impact on Suicidal Ideation and Attempts and Psychiatric Illness in Children and Adolescents With Posttraumatic Stress Disorder. The primary care companion for CNS disorders. 2023;25(1). PMID: 36705981
Using a national inpatient database 2006-2014, comparing minors aged 6-17 with PTSD and those with PTSD and sexual abuse, those with sexual abuse were significantly more likely to also have major depressive disorder, substance use disorder, and suicidal behavior.
Jeglic EL, Calkins C, Kaylor L, et al.
The Nature and Scope of Educator Misconduct in K-12. Sex Abuse. 2023;35(2):188-213. PMID: 35499558
Of 6632 recent US high school graduates, “11.7% reported having experienced at least one form of educator sexual misconduct during Grades K-12, with 11% reporting sexual comments and less than 1% reporting other forms of sexual misconduct (e.g., receiving sexual photos/messages, being kissed, touched sexually, or engaging in sexual intercourse/oral sex). Those who reported misconduct showed significantly more difficulties in current psychosocial functioning. Academic teachers most often perpetrated the abuse (63%), followed by coaches and gym teachers (20%). Educators who engaged in sexual misconduct were primarily male (85%), whereas students who reported experiencing educator misconduct were primarily female (72%). Rates of disclosure to authorities were very low (4%) and some sexual grooming behaviors like gift giving (12%) and showing special attention (29%) were reported.”
Hodgdon HB, Lord KA, Suvak MK, et al.
Predictors of symptom severity and change among youth in trauma-informed residential care. Child Abuse Negl. 2023;137:106056. PMID: 36708646
Of 547 youth ages 12-18 in trauma-informed residential care (mean age = 15.84, 43.2 % male) evaluated during 21 months (with considerable attrition), trauma-informed residential care was associated with significant reductions in symptoms of PTSD, depression, dissociation, psychological dysregulation, and externalizing behaviors. Females had more symptoms at intake, but showed equivalent or greater improvement than males. Severity of trauma history was associated with more symptoms at intake, but did not decrease treatment response.
Mark CA, Poltavski DV.
Functional near-infrared spectroscopy is a sensitive marker of neurophysiological deficits on executive function tasks in young adults with a history of child abuse. Applied neuropsychology Adult. 2023:1-14. PMID: 36803059
“Functional near-infrared spectroscopy affords a view into the brain based on blood oxygenation without the need for a big, immobile scanner.” (PNAS.org) This study found that 37 young adults who reported emotional, physical, or sexual abuse as children, compared to a control group, showed significantly higher rate and number of errors when measuring executive function, and a decrease in blood oxygenation in certain related brain areas. “These findings have implications for the development of remediation and treatment strategies in this population.”
Domestic Violence – Effects on Children
Hulsbosch LP, Boekhorst MGBM, Lodder P, et al.
Association between high levels of comorbid anxiety and depressive symptoms and decreased likelihood of birth without intervention: A longitudinal prospective cohort study. BJOG. 2023 Apr;130(5):495-505. PMID: 35974689
Of 1682 Dutch full term low medical risk pregnant women, those with high levels of anxiety and depression were 1/3 less likely to have a spontaneous birth, vs. instrumented (forceps) or cesarian section.
Pernebo K, Almqvist K.
Reduced Posttraumatic Stress in Mothers Taking Part in Group Interventions for Children Exposed to Intimate Partner Violence. Violence Vict. 2023 Feb 1;38(1):130-147. PMID: 36717191
“This study investigated whether interventions for children exposed to intimate partner violence combining parallel groups for children and mothers contribute to positive outcomes for partaking mothers. 39 Swedish mothers reported medium- to large-sized decrease in psychological symptoms, including symptoms of posttraumatic stress, postintervention. During the follow-up period, sustained and further decrease of symptoms was reported. Mothers also reported decreased exposure to violence. Results indicate that these child-focused programs have major and sustainable positive effects on mothers' psychological health.”
Liévano-Karim L, Thaxton T, Bobbitt C, et al.
A Balancing Act: How Professionals in the Foster Care System Balance the Harm of Intimate Partner Violence as Compared to the Harm of Child Removal. International journal on child maltreatment: research, policy and practice. 2023:1-24. PMID: 36785696
“In 2020, 42 participants from four different professional backgrounds (attorneys, nonprofit leadership, licensed therapists, and social workers) were interviewed or participated in a focus group discussion. All groups acknowledged the shortfalls of current intervention practices, which often result in child removal…Participants whose employment required them to advocate for parents tend to view child removal from a non-offending parent as harmful for both the child and IPV survivor…The results of this study strongly suggest that reform is needed, and further research is needed to better understand what changes would best serve the diverse needs of families struggling with IPV and resulting child protection involvement.”
Hiscox LV, Fairchild G, Donald KA, et al.
Antenatal maternal IPV exposure is associated with sex-specific alterations in brain structure among young infants: Evidence from a South African birth cohort. Developmental cognitive neuroscience. 2023;60:101210. PMID: 36764039
Exposure to IPV during pregnancy was measured in 143 South African mothers, and their infants underwent brain MRIs at mean age 3 weeks. Maternal IPV exposure was associated with certain infant brain changes that were different for male and female babies, the results of which stood even after removing participants with pregnancy complications. “Further research is required to understand how these early alterations are linked to the sex-bias in neuropsychiatric outcomes later observed in IPV-exposed children.”
Testa A, Lee J, Semenza DC, et al.
Intimate partner violence and barriers to prenatal care. Soc Sci Med. 2023;320:115700. PMID: 36708607
Using data from 35 states and New York City with 166,840 participants, “women with IPV exposure -especially those who experience IPV both before and during pregnancy - are more likely to experience inadequate prenatal care. In addition, women with IPV exposure incur a higher rate of barriers to prenatal care, including not having transportation, not being able to get time off work, being too busy, being unable to find child care, and keeping the pregnancy a secret.”
Davidson CA, Jackson KT, Kennedy K, et al.
Vaccine Hesitancy Among Canadian Mothers: Differences in Attitudes Towards a Pediatric COVID-19 Vaccine Among Women Who Experience Intimate Partner Violence. Matern Child Health J. 2023:1-9. PMID: 36800061
Of 129 Canadian mothers participating in an online study, 14.5% were hesitant towards routine child vaccinations and 97.0% hesitant about the Covid-19 vaccine for their child. Experiencing IPV was significantly associated with COVID-19 vaccine hesitancy. “Further research is required to fully understand the factors that build confidence and mitigate hesitancy in mothers regarding vaccination, especially mothers who have experienced IPV. Until then, messaging by public health institutions and care provided by healthcare practitioners will be inadequate in improving vaccine confidence.”
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