[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]
Brown J, Spiller V, Carter M, et. al.
Fetal alcohol spectrum disorders (FASD) and youth firesetting: A call on criminal justice, emergency responder, and fire prevention specialists to become informed. Behav Sci Law. 2022 Feb;40(1):186-217. PMID: 34961964
“Central nervous system damage resulting from prenatal exposure to alcohol, often referred to as fetal alcohol spectrum disorders (FASD), commonly manifests as lacking cognitive functioning, problem solving, impulsivity, memory, executive functioning, and social skill deficits. For individuals with FASD, these brain-based deficits translate into impulsive behaviors and poorly thought-out decision-making, coupled with an inability to anticipate and recognize the sometimes very severe consequences of their behaviors…As a result, firesetting behaviors are often attributed to deliberate, willful acts of delinquency, a desire to damage property, thrill seeking, or as attempts for personal gain, rather than being viewed as maladaptive attempts to solve problems by individuals who lack the tools to do this in more appropriate ways.”
Domestic Violence – Effects on Children
Greely JT, Dongarwar D, Crear L, et. al.
Violence against pregnant women and adverse maternal/ fetal outcomes in the United States: racial/ethnic disparities. Women Health. 2022 Jun 14:1-9. PMID: 35702758
Data from the 2002 to 2018 National Inpatient Sample (NIS) was used to analyze pregnancy-related hospitalizations of women aged 15-49 years who experienced violence during pregnancy. When compared to those with no exposure, individuals of all ethnic groups exposed to violence had increased risk of all adverse maternal/fetal outcomes (preterm birth, intrauterine fetal demise, miscarriage, fetal growth restriction, hypertensive disorders of pregnancy, and gestational diabetes).
Renner LM, Piescher KN, Mickelson NL.
Academic Outcomes Among Children Who Experienced or Were Exposed to Physical Abuse. J Interpers Violence. 2022 Jun 2:8862605221101185. PMID: 35653186
Of 1740 Minnesota 8-10 year-olds who were either evaluated for physical abuse by CPS, or were a sibling exposed to child physical abuse, with matched controls, both CPS-involved children and their siblings showed less school attendance over the 4 years of the study than the control group. In addition, both CPS-involved children and their siblings showed declines in reading and math proficiency if they were exposed to IPV. “Siblings of maltreated children are in need of greater attention with respect to assessment and service delivery in the child protection system…they may exhibit feelings of guilt because they were not directly maltreated and/or helplessness because they could not stop the abuse, which may translate into symptoms of depression or anxiety, may lead to behavioral challenges, and possibly to the avoidance of the school environment.”
Savopoulos P, Bryant C, Fogarty A, et. al.
Intimate Partner Violence and Child and Adolescent Cognitive Development: A Systematic Review. Trauma Violence Abuse. 2022 Jun 6:15248380221082081. PMID: 35666939
From a research review on the effects of IPV on children’s cognitive development, “Approximately 70% of studies found a relationship between IPV and poorer cognitive functioning, with general IQ the most frequently assessed domain of functioning, followed by verbal abilities and academic skills. Most studies assessed skills during early childhood, with fewer studies assessing middle childhood and adolescence. Sensitive and positive parenting behaviours and quality of home environment were identified as important preventive factors.” Authors recommend funding for parenting interventions.
Mertin P, Wijendra S, Loetscher T.
Posttraumatic Stress Symptoms and Correlates in Women and Children From Backgrounds of Domestic Violence. J Child Adolesc Trauma. 2021 Aug 12;15(2):391-400. PMID: 35600536
From an Australian study of mother-child pairs who had been exposed to IPV, and wherein the children were old enough to report their own symptoms, Results found no significant relationship between trauma symptoms in the mother and those in her child. Children who met the criteria for PTSD were more likely to have higher levels of anxiety and depression when compared to children who did not meet PTSD criteria. “Results suggest that the emotional responses of older children may tend to reflect their own experiences rather than being a reflection of maternal distress as seems more likely with younger children.”
LGBTQ+ Concerns
Tran NM, Henkhaus LE, Gonzales G.
Adverse Childhood Experiences and Mental Distress Among US Adults by Sexual Orientation. JAMA Psychiatry. 2022 Apr 1;79(4):377-379. PMID: 35195677
“The sample included 61 871 adults; 6.7% identified as sexual minority individuals. Among heterosexual adults, 64% experienced 1+ ACE, and 26% 3+ ACEs. Among sexual minority adults, 83% experienced 1+ ACE, and 52% 3+ ACEs…sexual minority adults had higher odds for all 8 types of ACEs compared with heterosexual adults. Disparities by sexual minority identity were greatest for sexual abuse (adjusted odds ratio, 2.94), household mental illness (aOR, 2.43), and emotional abuse (aOR, 2.30). Sexual minority people experienced more bad mental health days per month at all levels of ACEs.”
Race/Cultural Concerns
Stern JA, Barbarin O, Cassidy J (Eds).
Attachment perspectives on race, prejudice, and anti-racism: Introduction to the Special Issue. Attach Hum Dev. 2022 Jun;24(3):253-259. PMID: 34503390
“The papers in this special issue, highlighted in the introduction, illuminate pathways of risk and resilience in Black children, adolescents, and families and point to the protective power of relationships (and the limits of such protection) for mental and physical health.”
Muscatell KA, Merritt CC, Cohen JR, Chang L, Lindquist KA.
The Stressed Brain: Neural Underpinnings of Social Stress Processing in Humans. Curr Top Behav Neurosci. 2022;54:373-392. PMID: 34796448
“We summarize research that has examined the neural underpinnings of three types of social stressors: social rejection, social evaluation, and racism-related stress. Within our discussion of each type of social stressor, we describe the methods used to induce stress, the brain regions commonly activated among studies investigating that type of stress, and recommendations for future work.”
Braveman P, Dominguez TP, Burke W, et. al.
Explaining the Black-White Disparity in Preterm Birth: A Consensus Statement From a Multi-Disciplinary Scientific Work Group Convened by the March of Dimes. Front. Reprod. Health 2021 3:684207. Full article
Fanta M, Ladzekpo D, Unaka N.
Racism and pediatric health outcomes.
Curr Probl Pediatr Adolesc Health Care. 2021 Oct;51(10):101087. PMID: 34711499
“Racism - a system operating at the intrapersonal, interpersonal, institutional, and structural level - is a serious threat to the health and wellbeing of children and adolescents. This narrative review highlights racism as a social determinant of health, and describes how racism breeds disparate pediatric health outcomes in infant health, asthma, Type 1 diabetes, mental health, and pediatric surgical conditions.”
Okoniewski W, Sundaram M, Chaves-Gnecco D, et. al.
Culturally Sensitive Interventions in Pediatric Primary Care Settings: A Systematic Review. Pediatrics. 2022 Feb 1;149(2):e2021052162. PMID: 35098300
From a research review, “The included articles provide preliminary evidence that culturally sensitive interventions can be feasible and effective and may help eliminate disparities for patients from communities with barriers to equitable care.” Interventions related to a wide variety of health concerns, and included multiple approaches to culturally relevant values and preferences.
Brown A, Auguste E, Omobhude F, Bakana N, Sukhera J.
Symbolic Solidarity or Virtue Signaling? A Critical Discourse Analysis of the Public Statements Released by Academic Medical Organizations in the Wake of the Killing of George Floyd. Acad Med. 2022 Jun 1;97(6):867-875. PMID: 35044980
After the killing of George Floyd, many medical schools released public statements condemning racism and expressing solidarity with Black communities. In an analysis of 45 such statements, authors felt that many statements often reflected power differentials through formal, analytical, guarded, and distanced language; seemed to absolve organizations of structural culpability in maintaining or reinforcing racism; minimized anti-Black racism such as the absence of Black voices and perspectives in statements; and lacked self-reflection on historical and ongoing anti-Black racism in medical organizations. “While these statements are well-intentioned”, the authors underscore the need for meaningful action and and not simply lip service.
Cole AB, Armstrong CM, Giano ZD, Hubach RD.
An update on ACEs domain frequencies across race/ethnicity and sex in a nationally representative sample. Child Abuse Negl. 2022 Jul;129:105686. PMID: 35662683
Using a large national data sample, “AI/ANs [American Indian/Alaskan Native] had the highest ACEs compared to all racial/ethnic groups. Females had higher mean ACEs compared to males of the same racial/ethnic group…Emotional abuse was the most reported ACEs domain across all individuals. AI/AN females and males had the highest ACEs frequencies in family substance use, witnessing intimate partner violence, and sexual and emotional abuse.”
Hankerson SH, Moise N, Wilson D, et. al.
The Intergenerational Impact of Structural Racism and Cumulative Trauma on Depression. Am J Psychiatry. 2022 Jun;179(6):434-440. PMID: 35599541
“Depression among individuals who have been racially and ethnically minoritized in the United States can be vastly different from that of non-Hispanic White Americans. For example, African American adults who have depression rate their symptoms as more severe, have a longer course of illness, and experience more depression-associated disability. The purpose of this review was to conceptualize how structural racism and cumulative trauma can be fundamental drivers of the intergenerational transmission of depression.”
Price MA, Weisz JR, McKetta S, et. al.
Meta-analysis: Are Psychotherapies Less Effective for Black Youth in Communities With Higher Levels of Anti-Black Racism? J Am Acad Child Adolesc Psychiatry. 2022 Jun;61(6):754-763. PMID: 34371101
“Psychotherapies tested with samples of majority-Black youth were significantly less effective in states with higher (vs lower) levels of anti-Black cultural racism, suggesting that anti-Black cultural racism may be one contextual moderator of treatment effect…psychotherapies delivered in environments with high levels of anti-Black cultural racism may need to be modified for Black youth to derive maximum benefit…However, which adaptations maximize efficacy, and why they are effective, is largely unknown.”
Beagan BL, Bizzeth SR, Etowa J.
Interpersonal, institutional, and structural racism in Canadian nursing: A culture of silence. Can J Nurs Res. 2022 Jun 23:8445621221110140. PMID: 35746848
From interviews with 13 self-identified racial minority nurses across Canada, “From entry to nursing education throughout their careers participants experienced racism from instructors, patients, colleagues and managers. Interpersonal racism included comments and actions from patients, but more significantly lack of support from colleagues and managers, and sometimes overt exclusion. Institutional racism included extra scrutiny, heavier workloads, and absence in leadership roles. Structural racism included prevalent assumptions of incompetence, which were countered through extra work, invisibility and hyper-visibility, and expectations of assimilation. Racialized nurses were left to choose among silence, resisting (often at personal cost), assimilation and/or bolstering their credibility through education or extra work. Building community was a key survival strategy.”
McLane P, Mackey L, Holroyd BR, et. al.
Impacts of racism on First Nations patients' emergency care: results of a thematic analysis of healthcare provider interviews in Alberta, Canada. BMC Health Serv Res. 2022 Jun 21;22(1):804. PMID: 35729530
“Sixteen semi-structured interviews were conducted with Canadian emergency department (ED) physicians and nurses between November 2019 and March 2020. ED providers reported that First Nations patients are exposed to disrespect through tone and body language, experience overt racism, and may be neglected or not taken seriously. Recognized barriers to care included communication, resources, access to primary care and the ED environment itself.”
Kawano B, Agarwal S, Krishnamoorthy V, et. al.
Trends in Assault Mortalities Among Asian Americans, 2009-2018. J Surg Res. 2022 Jul;275:336-340. PMID: 35339002
Using national data 2009-2018, assault mortality rates among Asian Americans were highest in Alaska, Mississippi, and rural counties. “These findings emphasize the importance of studying and addressing violence toward Asians in rural regions and Southern states. Future studies should use these results as a baseline to examine the pandemic's impact on assault mortalities among Asian Americans.”
Wu TY, Hsieh HF, Chow CM, et. al.
Examining racism and firearm-related risks among Asian Americans in the United States during the COVID-19 pandemic. Prev Med Rep. 2022 Apr 23;27:101800. PMID: 35656206
From a survey of 916 Asian Americans Dec 2020 – Jana 2021, “Among individuals who purchased a gun since the start of the pandemic, 54.6% were first-time gun owners. Among household gun owners, 42.8% stored loaded guns and 47.1% stored guns unlocked. More than 38% of individual gun owners have carried a gun more frequently since the pandemic. After controlling for family firearm ownership and demographics, Asian Americans who experienced racial discrimination were more likely to purchase a gun and ammunition.”
Providers
Ravi A, Gorelick J, Pal H.
Identifying and Addressing Vicarious Trauma. Am Fam Physician. 2021 May 1;103(9):570-572. PMID: 33929175
“Chronic exposure to secondhand trauma can lead to vicarious trauma, whereby an individual internalizes the emotional experiences of others as though that individual had personally experienced them. Vicarious trauma can result in a change of worldview and disturb a person’s sense of justness and safety of the world…Unaddressed vicarious trauma can compromise ability to provide care or professional services and can affect personal health and relationships.” This article reviews risk factors, symptoms, and variety of intervention tools and techniques.
Miller ML, Gerhart JI, Maffett AJ, et. al.
Experiential Avoidance and Post-traumatic Stress Symptoms Among Child Abuse Counselors and Service Workers: A Brief Report. J Interpers Violence. 2022 Jun;37(11-12):NP10382-NP10392. PMID: 33289447
In this small study of 31 child abuse counselors and service workers, 41.9% reported clinically significant PTSD symptoms. Prominently associated with higher levels of these symptoms were avoidance and emotion regulation difficulties. “Clinicians and other professionals should be attentive to the possibility that similar to the experience of the clients that they serve, inflexible and avoidant reactions to upsetting thoughts, memories, and emotions could paradoxically increase their own distress.”
Matthew A, Moffitt C, Huth-Bocks A, et. al.
Establishing Trauma-Informed Primary Care: Qualitative Guidance from Patients and Staff in an Urban Healthcare Clinic. Children (Basel). 2022 Apr 26;9(5):616. PMID: 35626792
“A successful ambulatory healthcare practice serving children and families is one that is prepared to address both medical and social needs as the two overlap considerably. Patients, including children and their caregivers, expect providers to be non-judgmental and responsive if they are going to share some of their most personal, and potentially distressing, experiences. Through training and ongoing support to providers and staff, as well as commitment to broader trauma-informed structure and processes, identification of childhood adversity and appropriate supportive interventions can occur early so that childhood development and life-long health consequences of exposure can be mitigated.”
Slingsby B, Moore J, Wing R, Garro A, Brown L.
Identifying Barriers to Trainees Addressing Corporal Punishment and Effective Discipline Using Simulation and Semistructured Debriefing. Pediatr Emerg Care. 2022 Jul 1;38(7):312-316. PMID: 35696301
37 trainees participated in a simulated patient visit that included an episode of corporal punishment (CP). “Themes of not having the wording to address CP, not knowing the distinction between CP and physical abuse, previous negative experiences discussing discipline with families, and fear of offending families negatively impacted trainees' ability to intervene during the simulation. Trainees were interested in future education including simulated medical encounters to improve their responses to CP in the future.”
Gewirtz-Meydan A.
Treating Sexual Dysfunctions Among Survivors of Child Sexual Abuse: An Overview of Empirical Research. Trauma Violence Abuse. 2022 Jul;23(3):840-853. PMID: 33317434
“In total, six approaches for treating sexual dysfunctions among CSA [childhood sexual abuse] survivors that provide detailed guidelines for implementing the approach were identified in the literature. Only two of the studies conducted a randomized controlled trial to test the intervention. This overview concludes with important issues to address when treating sexual problems among CSA survivors and a call for additional evidence-based practices for treating sexual problems among survivors of CSA.
Prevention
Saeteurn ER, Wu Q, Vasiliou N, Mabingani D, Krysik J.
Peer parent programs in child welfare: A systematic review. Child Abuse Negl. 2022 May 28;129:105682. PMID: 35640347
“Peer parent programs provide child welfare involved families a unique opportunity to connect with parents who have successfully navigated the child welfare system and who share similar lived experiences…All of the peer parent programs reviewed had a positive impact on reunification rates…Child welfare agencies should consider developing peer parent programs as they appear to be a promising intervention to support parents and increase positive child welfare outcomes.”
Su Y, Meng X, Yang G, D'Arcy C.
The relationship between childhood maltreatment and mental health problems: coping strategies and social support act as mediators. BMC Psychiatry. 2022 May 27;22(1):359. PMID: 35619058
In this national Canadian study, both external positive social support (attachment, guidance, reliable alliance, social integration, and reassurance of worth) and more importantly internal positive coping skills (self-perceived ability to handle unexpected and difficult problems as well as day-to-day demands) acted as direct and indirect buffers between childhood maltreatment and adult major depression, generalized anxiety disorder, and suicidality.
Hemingway A, Sullivan K.
Reducing the incidence of domestic violence: An observational study of an equine-assisted intervention. Fam Process. 2022 Jun;61(2):549-570. PMID: 35355260
“Significant reductions in domestic violence and child-in-need status were found for those families who had a member or members attend and complete the equine-assisted intervention under study…Referrals to this intervention are normally for those families for whom talk-based interventions such as parenting, or education-based interventions are not working.” Overall research to date has found that the interaction between humans and horses may have an impact on human behavior, quality of life, and well-being via improving communication skills, calmness, responsibility, anger management, and pride.
Mizzi AL, McKinnon MC, Becker S.
The Impact of Aerobic Exercise on Mood Symptoms in Trauma-Exposed Young Adults: A Pilot Study. Front Behav Neurosci. 2022 May 25;16:829571. PMID: 35692380
Of 25 low active trauma-exposed young adults with subclinical trauma symptoms but no current or past diagnosis of PTSD, an 8-week intervention significantly reduced mood symptoms in exercisers relative to waitlist controls. “Exercise may be an effective intervention to improve mood and manage or prevent further decline in mental health in those at risk of developing PTSD.”
Maguire-Jack K, Steinman KJ, Lesnick J et. al.
Implementing Triple P during the COVID-19 pandemic with families at risk for substance use. Child Abuse Negl. 2022 Jul;129:105636. PMID: 35483219
From July 2020 – June 2021, 890 high risk parents received services from Positive Parenting Program (Triple-P). “Overall, the results were promising, with improvements seen in family functioning/resilience, nurturing and attachment, parental laxness, and parental over-reactivity. Parents reported positive experiences participating in the program and felt that their relationship with their child had improved. Despite the profound, recent challenges to parenting and service provision, Triple P continues to show promise as an approach to reducing child maltreatment.”
Rudolph JI, Zimmer-Gembeck MJ, Walsh K.
Recall of sexual abuse prevention education at school and home: Associations with sexual abuse experience, disclosure, protective parenting, and knowledge. Child Abuse Negl. 2022 Jul;129:105680. PMID: 35644104
Of 1265 Australian university students, mean age 22.8 years, 24% reported childhood sexual abuse (CSA), 29% reported having received school CSA prevention programming, and 72% reported parental CSA prevention education. Parental involvement/care and monitoring/supervision were associated with lower risk of CSA, but both CSA specific prevention education from either parents or schools were not. “Building parenting capacity to include parenting practices such as monitoring and involvement should be included in CSA prevention efforts.”
Salter M, Hall H.
Reducing Shame, Promoting Dignity: A Model for the Primary Prevention of Complex Post-Traumatic Stress Disorder. Trauma Violence Abuse. 2022 Jul;23(3):906-919. PMID: 33345743
“Complex post-traumatic stress disorder (CPTSD) refers to the complex psychological and psychosocial sequelae caused by prolonged interpersonal abuse…CPTSD is a high prevalence psychiatric condition that is both the cause and effect of significant social problems and inequalities...this article develops a social ecological model of primary prevention to CPTSD with a focus on the reduction of shame and the promotion of dignity at the relational, community, institutional, and macrolevel. A broad overview of this model is provided with examples of preventative programs and interventions.”
Crouch JL, Bridgett DJ, Milner JS, et. al.
Prolonged Infant Crying: Caregiving Quality and Child Physical Abuse Risk. J Interpers Violence. 2022 Jun 2:8862605221106137. PMID: 35654573
Over the course of a 30-minute simulated infant crying task, the quality of both high- and low-risk caregivers diminished, with high-risk caregivers exhibiting lower quality of caregiving behaviors and giving up the task earlier. “The present findings highlight the importance of early intervention designed to support caregivers' abilities to respond effectively to prolonged infant crying.”
Researchers
Barksdale CL, Pérez-Stable E, Gordon J.
Innovative Directions to Advance Mental Health Disparities Research. Am J Psychiatry. 2022 Jun;179(6):397-401. PMID: 35599539
This introduction to a special section reviews the research on mechanisms of mental health disparity and on effective interventions to develop mental health equity.
Brown TH, Homan PA.
Frontiers in measuring structural racism and its health effects. Health Serv Res. 2022 Jun;57(3):443-447. PMID: 35468217
“Scholars have noted that challenges in measuring structural racism in society are one of the reasons that there are relatively few empirical studies on its health effects…This commentary provides a roadmap for research to address critical questions about the links between structural racism and health by utilizing innovative measurement approaches.”
Thorburn S, Lindly OJ.
A systematic search and review of the discrimination in health care measure, and its adaptations. Patient Educ Couns. 2022 Jul;105(7):1703-1713. PMID: 34688522
Authors analyze the use of the Discrimination in Health Care Measure, a scale first published in 2001. “Most studies measured race or ethnicity-based discrimination. All studies made minor revisions to the measure, and most reported high reliabilities… Study results indicate that the measure is easy to use and adapt. Researchers should consider using the Discrimination in Health Care Measure when designing studies that will examine individuals' discriminatory experiences when receiving health care.”
Other of Interest
Ybarra ML, Mitchell KJ, Oppenheim JK.
Violent Media in Childhood and Seriously Violent Behavior in Adolescence and Young Adulthood. J Adolesc Health. 2022 May 9:S1054-139X(22)00349-4. PMID: 35550330
887 children completed a survey on “the amount of music, video games, television, websites with real people, and cartoons that depicted ‘physical fighting, hurting, shooting, or killing’”, and then a follow-up survey 5 years later as adolescents. After adjusting for other factors, the relative odds of reporting seriously violent behavior over time were 1.70 times higher with each incremental increase in the baseline violent media consumption. “The relative odds also were elevated for those frequently exposed to violence in music (adjusted odds ratio = 3.28), television (aOR = 3.51), and video games (aOR = 3.27).” Results were similar at 10 year follow-up.
Riddell CA, Neumann K, Santaularia NJ, et. al.
Excess Google Searches for Child Abuse and Intimate Partner Violence During the COVID-19 Pandemic. J Med Internet Res. 2022 Jun 13;24(6):e36445. PMID: 35700024
Comparing Google searches during 2017-2019 to 2020, relative search volume for “exposure to child abuse” increased by 19%, beginning a month after the Pandemic Unemployment Compensation program ended. Relative search volume was also heightened in 2020 for “child-witnessed IPV”, with a 33% increase occurring after the introduction of shelter-in-place policies.
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