[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
Shusterman GR, Fluke JD, Nunez JJ, Fettig NB, Kebede BK.
Child maltreatment reporting during the initial weeks of COVID-19 in the US: Findings from NCANDS. Child Abuse Negl. 2022;134:105929. PMID: 36270070
From a national database, “In 2020, CPS screened in 39% fewer reports than during the same period in 2019, and the proportion of reports substantiated increased from 18 to 22%. Reports from all report sources decreased, especially from teachers (90% decrease) and daycare providers (65% decrease). The odds for substantiation were significantly higher during 2020 than in 2019…Explanations for the increase in percent of substantiation in the context of reduction of reports are considered.”
Liu Y, Shepherd-Banigan M, Evans KE, et al.
Do children evaluated for maltreatment have higher subsequent emergency department and inpatient care utilization compared to a general pediatric sample? Child Abuse Negl. 2022;134:105938. PMID: 36330904
For 367 children who received a maltreatment evaluation at a US child abuse and neglect subspecialty clinic, compared to the general pediatric population, children with a maltreatment evaluation were 30% more likely to be seen for an ED visit or inpatient hospitalization for any reason, and 4.4 times more likely to be seen for a maltreatment-related visit.
Malthaner LQ, Jetelina KK, Loria H, McLeigh JD.
Healthcare utilization among children with a history of neonatal opioid withdrawal syndrome. Child Abuse Negl. 2022;134:105934. PMID: 36302288
595 North Texas children with a history of neonatal opioid withdrawal syndrome (NOWS), compared to matched controls, had “significantly higher healthcare expenditures, and with the exception of hospitalizations, higher healthcare utilization beyond the newborn visit. These findings suggest the needs for interventions for children with NOWS beyond the immediate neonatal period.”
Ruffolo LI, Gaba H, Dale BS, et al.
Outcomes after Child Physical Abuse and Association with Community-Level Social Determinants of Health. J Am Coll Surg. 2022;235(5):810-8. PMID: 36102552
Of 184 children admitted for suspected physical abuse, those whose residential address was in the more impoverished percentiles “presented with more severe injuries, had higher area injury scores in the abdomen and extremities, and required admission to the intensive care unit more often.” Children from more impoverished neighborhoods were more likely to be discharged to a different caretaker than children from better off neighborhoods (71% caretaker change vs 49% caretaker change). “Child abuse reduction strategies might consider increased support for families with fewer resources and social support systems.”
Schuurmans IK, Luik AI, de Maat DA, et. al.
The association of early life stress with IQ-achievement discrepancy in children: A population-based study. Child Dev. 2022;93(6):1837-47. PMID: 35822555
For 2401 children in a Generation R Study, early life stress at age 0-10 was associated at age 12 with lower IQ, lower academic achievement, and greater IQ-achievement discrepancy (variance in academic achievement not explained by IQ).
Thackeray JD, Crichton KG, McPherson P, et. al.
Identification of Initial and Subsequent Injury in Young Infants: Opportunities for Quality Improvement in the Evaluation of Child Abuse. Pediatr Emerg Care. 2022 Jun 1;38(6):e1279-e1284. PMID: 35504033
Using data from 6 children’s hospitals to identify infants < 6 months old who were seen for an injury, and seen for another injury within one year, diagnosis codes for most common initial injuries were fractures (37.0%), bruising/ecchymosis (35.9%), and superficial injuries (28.3%). Using a different data method, reviewing consult notes of children seen at 18 months for suspected child abuse, 10.8% had had at least one initial injury, mainly 64.9% bruising. Completion of a skeletal survey ranged from 4.4% to 71.7%. “A standardized quality improvement approach may improve identification of injury.”
Chen Q, Chan KL, Chen M, Lo CK, Ip P.
Associating sleep quality, quality of life and child poly-victimization. Child Abuse Negl. 2022;133:105846. PMID: 35994886
From a large study of Hong Kong schoolchildren, “children who experienced four or more types of victimization were more likely to show parasomnia [such as sleepwalking, sleep talking, nightmares, and sleep terrors] and daytime dysfunction symptoms [such as daytime sleepiness] than those experiencing one to three types of victimization and non-victims.” It also revealed significant relationships between child poly-victimization and lower levels of quality of life, which were affected by parasomnia and daytime dysfunction.
Lavoie J, Williams S, Lyon TD, Quas JA.
Do children unintentionally report maltreatment? Comparison of disclosures of neglect versus sexual abuse. Child Abuse Negl. 2022;133:105824. PMID: 35970086
In this chart review of substantiated cases of child neglect and child sexual abuse, neglect was most often initially suspected via contact with emergency services, while sexual abuse was most often suspected from children’s statements. “Children may benefit from greater knowledge about their needs for safety, supervision, and provision in the home, which could increase the likelihood they would disclose neglect.”
Nystrom A, Richards TN, Wood H, Cox LM, Gross M.
Examining missingness among children in out-of-home care placement in Nebraska. Child Abuse Negl. 2022;134:105874. PMID: 36088663
“About 30 % of Nebraska's missing children are in OOH [out-of-home] care. Children missing from OOH care are older and are more likely to be Black…also more likely to be in group care, on probation, and have greater placement instability compared to children in OOH care who are not missing. Case contexts of missingness include unmet substance use and mental health challenges, experiences with violence and victimization, and few bonds to school.”
Greeley C.
Advances in child abuse and neglect research and practice. Child Abuse Negl. 2022;134:105875. PMID: 36088662
Authors discuss CAPNET (Child Abuse Pediatrics (CAP) clinical services (CAPNET)), a group of 11 US children’s hospitals, whose mission is “To improve the care of children by child abuse pediatricians… [by conducting] multisite, collaborative, patient-oriented research.” They also note challenges, gaps, and opportunities for the future of the database.
Adult Manifestations of Child Abuse
D'Arcy-Bewick S, Terracciano A, Turiano N, et. al.
Childhood abuse and neglect, and mortality risk in adulthood: A systematic review and meta-analysis. Child Abuse Negl. 2022;134:105922. PMID: 36244209
A research review of studies involving 265,858 individuals suggested an association between childhood abuse and neglect and 1.86 times increased mortality risk in adulthood. “Specific types of abuse (physical, emotional, sexual) were unrelated to mortality risk, but subgroup analyses suggested that physical and emotional abuse were associated with greater mortality risk among women.”
Childhood Trauma Meta-Analysis Study Group.
Treatment efficacy and effectiveness in adults with major depressive disorder and childhood trauma history: a systematic review and meta-analysis. Lancet Psychiatry. 2022 Nov;9(11):860-873. PMID: 36156242
From a large research review, “Contrary to previous studies, we found evidence that the symptoms of patients with major depressive disorder and childhood trauma significantly improve after pharmacological and psychotherapeutic treatments, notwithstanding their higher severity of depressive symptoms.” In a commentary on this study (PMID 36156241), the author notes that “Although these results are very important and encouraging for clinical practice, we should be cautious in their interpretation.” There is a range of “improvement” with incomplete response; and patients with a history of childhood trauma also have additive increased problems with sleep, substance use, recurrent/persistent depression, anxiety, PTSD, suicidality, obesity, diabetes, and heart disease. “Therefore, people with major depressive disorder and a history of childhood trauma should receive special attention.”
Ng E, Wong EHY, Lipsman N, Nestor SM, Giacobbe P.
Adverse childhood experiences and repetitive transcranial magnetic stimulation outcomes for depression. J Affect Disord. 2023;320:716-24. PMID: 36206889
Of 99 patients receiving trans-cranial magnetic stimulation (TMS) for major depression, patients had a mean of 2.4 ACEs. ACE score did not affect depression outcomes. “Presence of high levels of ACEs should not preclude consideration of TMS for depression.”
Poletti S, Paolini M, Ernst J, Bollettini I, Melloni E, Vai B, et al.
Long-term effect of childhood trauma: Role of inflammation and white matter in mood disorders. Brain Behav Immun Health. 2022;26:100529. PMID: 36237478
In this study of 100 adult patients with bipolar disorder (BD) and 100 adult patients with major depressive disorder (MDD), different increased inflammatory blood factors were found for each group, which correlated with different brain white matter microstructure findings. Per authors, findings suggest that inflammation may be causative on the detrimental effect of early abuse on brain structure, with different mechanisms underlying brain alterations in BD and MDD.
Voss S, Frenzel S, Klinger-König J, et al.
Interaction of childhood abuse and depressive symptoms on cortical thickness: a general population study. Eur Arch Psychiatry Clin Neurosci. 2022;272(8):1523-34. PMID: 35217912
Using brain scans for 1551 individuals from the general population, cortical brain thickness was measured in 34 different regions. “Our results suggest that childhood abuse is associated with reduced cortical thickness in subjects with depressive symptoms. In abused subjects without depressive symptoms, larger cortical thickness [was found, and] might act compensatory and thus reflect resilience against depressive symptoms.”
Jabbi MM, Harvey PD, Kotwicki RJ, Nemeroff CB.
Specific Associations Between Type of Childhood Abuse and Elevated C-Reactive Protein in Young Adult Psychiatric Rehabilitation Participants. Int J Neuropsychopharmacol. 2022;25(11):891-9. PMID: 36124823
Of 280 patients admitted to a psychiatric inpatient unit, mean age 27.3 years, 26% had significantly elevated levels of CRP, an inflammatory marker. “Compared with a history of emotional or physical abuse, a history of childhood sexual trauma was more specifically associated with elevated CRP.”
Wamser-Nanney R.
Types of childhood maltreatment, posttraumatic stress symptoms, and indices of fertility. Psychol Trauma. 2022;14(8):1263-71. PMID: 35007093
For 275 trauma-exposed females, mean age 38.8, who had been or who had tried to become pregnant, “none of the maltreatment types, nor PTSS, was related to longer length to conception. Minorities reported longer length of time to conceive. PTSS was tied to fewer number of live births. A history of neglect corresponded with a greater number of miscarriages, as well as greater use of fertility treatments.”
Stout ME, Tsotsoros CE, Hawkins MAW.
Does Loneliness Mediate the Relationship Between Adverse Childhood Experiences (ACEs) and Pain Catastrophizing Among Women? Journal of child & adolescent trauma. 2022;15(4):1137-43. PMID: 36439660
From an online survey of 109 female participants, mean age 39.8 years, results indicated that increased ACEs were related to greater loneliness, which, in turn, was related to greater pain catastrophizing. “Loneliness is a possible mechanism by which ACEs adversely impact cognitive and emotional well-being in adulthood…which might make dealing with stressful situations such as pain more difficult and, therefore, increase one's catastrophic thinking patterns.”
Adolescents
Landberg Å, Svedin CG, Jonsson LS.
Patterns of disclosure and perceived societal responses after child sexual abuse. Child Abuse Negl. 2022;134:105914. PMID: 36270071
From a survey of 3282 Swedish high school students, a substantial share of abused girls and most abused boys had not yet told anyone about the abuse, leaving them unable to access protection or rehabilitation. Participants who had disclosed sexual abuse had most often turned to a peer, more rarely to an adult, and seldom to a professional or volunteer. Although the societal responses that the participants perceived were mixed, more severe abuse was associated with more negative societal responses. Most participants stated that they did not need any professional support; and among the minority who had sought help, half were satisfied and a third dissatisfied.
Rancher C, McDonald R, Kamata A, Jackson M, Jouriles EN.
Self-Blame in Adolescents Who Have Been Sexually Abused: Factor Structure and Differential Correlates of Abuse-Specific and Global Measures. Assessment. 2022;29(8):1676-85. PMID: 34189941
From a study of 493 adolescents, 91% female, who had been sexually abused, authors note that in assessing self-blame it is important to distinguish between abuse-specific self-blame, and global/general self-blame, for evaluating subsequent impact and interventions.
Pechtel P, Harris J, Karl A, et al.
Emerging ecophenotype: reward anticipation is linked to high-risk behaviours after sexual abuse. Soc Cogn Affect Neurosci. 2022;17(11):1035-43. PMID: 35438797
For 48 female adolescents in 3 groups - major depression and history of childhood sexual abuse (CSA), major depression and no CSA, and controls – brain scans showed that reward areas of the brain “appear to play a key role in high-risk behaviors [HRB] for adolescents with CSA irrespective of depression, providing initial support for a CSA ecophenotype [a specific physiology variation as a function of life factors, such as heredity and environment]. Such information is pivotal to identify at-risk youth and prevent HRB in adolescents after CSA.”
Domestic Violence – Effects on Children
Younas F, Gutman LM.
Parental Risk and Protective Factors in Child Maltreatment: A Systematic Review of the Evidence. Trauma Violence Abuse. 2022:15248380221134634. PMID: 36448533
Of childhood maltreatment risk factors,“At the micro level, findings mirror results of prior systematic reviews such as parental substance abuse, history of childhood maltreatment, and intimate partner violence (IPV). Social support was the most significant protective factor across all ecological levels and across all maltreatment types except child sexual abuse…IPV was a common risk factor across all maltreatment types.”
Spearman KJ, Hardesty JL, Campbell J.
Post-separation abuse: A concept analysis. J Adv Nurs. 2022 May 27:10.1111/jan.15310. PMID: 35621362
“Post-separation abuse can be defined as the ongoing, willful pattern of intimidation of a former intimate partner including legal abuse, economic abuse, threats and endangerment to children, isolation and discrediting and harassment and stalking. An analysis of literature identified essential attributes including fear and intimidation; domination, power and control; intrusion and entrapment; omnipresence; and manipulation of systems. Consequences include lethality, adverse health consequences, and institutional violence and betrayal, such as loss of child custody and economic deprivation.”
LGBTQ Concerns
Prince DM, Ray-Novak M, Gillani B, Peterson E.
Sexual and Gender Minority Youth in Foster Care: An Evidence-Based Theoretical Conceptual Model of Disproportionality and Psychological Comorbidities. Trauma Violence Abuse. 2022;23(5):1643-57. PMID: 33942681
“Sexual and gender minority youth (SGMY) are overrepresented in the foster care system and experience greater foster-care-related stressors than their non-SGM peers. These factors may further elevate their risk of anxiety/depressive, PTSD, self-harm, and suicidality…[research] identifies three critical areas for intervention: family acceptance, community belonging and queer chosen/constructed family, and affirming and nondiscriminatory child welfare policy.”
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