[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
Price JH, Khubchandani J.
Firearm Mortality Among Pre-school Age Children, 2010-2020. J Community Health. 2023 Jun;48(3):414-419. PMID: 36538204
Of firearm deaths of preschool children aged 0-5, “Most deaths (two-thirds) were among males. Non-Hispanic Blacks comprised 56.4% of all deaths in 2020, a 172% increase from 2010. The rate for non-Hispanic Whites increased by 15.4% from 2010 to 2020. The majority of the deaths occurred in the South. Almost two-thirds (65.9%) of all firearm deaths were homicides, 30% were unintentional, and 4.1% were undetermined. Homicides were also the majority of deaths for non-Hispanic Blacks (64.9%), non-Hispanic Whites (60.8%), and Hispanics (81.3%). Sustained awareness campaigns should be implemented to make parents and guardians aware of the profound dangers of unlocked and loaded or unsafely stored firearms in the home. Child healthcare providers should counsel parents and guardians on firearm safety in households. Public health professionals should advocate for laws that can help protect children from firearm violence (e.g., Domestic Violence Restraining Orders, Child Access Prevention laws, and Extreme Risk Protection Order laws).”
Swendiman RA, Scaife JH, Barnes KL, et al.
Hanging and Strangulation Injuries: An Institutional Review From a Level 1 Pediatric Trauma Center. J Pediatr Surg. 2023 Feb 28:S0022-3468(23)00176-8. PMID: 37002058
A retrospective review was conducted that included all patients who presented after hanging or strangulation to a Level I Pediatric Trauma Center from 2011 through 2021. 128 patients met inclusion criteria. The median age was 13 years, 60.9% were male, and 75% were intentional injuries. Mortality was high (32%), and 25% of patients with nonaccidental injuries had a documented prior suicide attempt.
Cameron H, Holland A, Wong T.
Understanding emergency placements for Nova Scotian children in foster care. Paediatr Child Health. 2023;28(2):75-7. PMID: 37151918
“To cope with a critical lack of foster families, Nova Scotia's Department of Community Services uses rented private facilities staffed by subcontracted companies, known as ‘places of safety’. Similar models are used across the country, with places of safety intended to be used for emergency placements only. The mean length of stay in a place of safety was 255 nights in 2020. Male children are far overrepresented, as are Indigenous children. Despite the increasing use of places of safety, little is known about the impacts of these short-term and unhomelike environments.” Authors present advocacy priorities and directions for further research.
Cleveland RW, Deming RS, Helton G, Wilson CR, Ullrich CK.
Revisiting medical neglect concerns in children with life-threatening complex chronic conditions. Child Abuse Negl. 2023;141:106220. PMID: 37207521
From interviews with 20 clinicians caring for children with life-threatening complex chronic conditions (LT-CCC), “Clinicians report that concerns for medical neglect in children with LT-CCCs often arise from a mismatch of medical expectations and the perception of familial ability to provide said medical care. Given the complex and delicate medical and psychosocial environments of care for children with LT-CCCs, these medical neglect concerns are more accurately described as Medical Insufficiency, a new term. By reframing this entity, we can reframe the dialogue surrounding this issue, and reconsider approaches to studying, preventing, and resolving it.”
Naito H, Nitta K, Kakiuchi Y.
Risk factors of self-reported physical child abuse during the COVID-19 pandemic in Japan: work-related changes in men and fear of COVID-19 in women. PeerJ. 2023;11:e15346. PMID: 37180587
From a national representative internet survey of child caregivers conducted in Japan during 2021 asking about effects of the pandemic, male offenders of physical child abuse were more likely to report working from home 4-7 days/week, decreased work, covid infection of self and household members, unwillingness to receive covid vaccine, benevolent sexism, and personal history of child abuse. Female offenders were more likely to report bad relationships with household members, fear of covid, covid infection of self and household members, and history of childhood verbal abuse.
Keogh A, Goldberg A, Schroeder C, et al.
Anogenital HSV in Children: Should Providers Be Concerned for Sexual Abuse? J Pediatr Adolesc Gynecol. 2023;36(3):263-7. PMID: 36693446
“The purpose of this study was to describe how child abuse pediatricians evaluate children with anogenital herpes simplex virus infection and determine whether any consistent practice patterns are followed…although nonsexual transmission of anogenital HSV may be possible, providers must still consider sexual abuse. Children with a first-time outbreak of anogenital HSV should have a comprehensive evaluation for sexual abuse, including interview, physical exam, and testing for sexually transmitted infections.”
van der Hoeven ML, Assink M, Stams GJM, et al.
Victims of Child Abuse Dropping Out of Trauma-Focused Treatment: A Meta-Analysis of Risk Factors. Journal of child & adolescent trauma. 2023;16(2):269-83. PMID: 37234839
“A substantial number of children who experienced child maltreatment drop out of evidence-based trauma-focused treatments.” From a review of studies, risk factors for dropout included being male, child protective services involvement, minority status, low therapist-child support, low youth perception of parental approval, family income, and parental education.
Keefe RJ, Cummings ADL, Smith AE, Greeley CS, Horne BSV.
Psychotropic Medication Prescribing: Youth in Foster Care Compared with Other Medicaid Enrollees. Journal of child and adolescent psychopharmacology. 2023;33(4):149-55. PMID: 37204275
From a large Medicaid state database of children aged 1-18 years, 35% of youth in foster care received at least one prescription for a mental health medication compared to 8% of nonfoster children. Foster children who were prescribed mental health medication received a mean of 2.9 classes of drugs compared to 1.4 for nonfoster children, and they were more likely to be prescribed certain types of medications without a formal diagnosis.
Adult Manifestations of Child Abuse
Vergunst F, Commisso M, Geoffroy MC, et al.
Association of Childhood Externalizing, Internalizing, and Comorbid Symptoms With Long-term Economic and Social Outcomes. JAMA Netw Open. 2023 Jan 3;6(1):e2249568. PMID: 36622675
For 3017 Quebec children aged 6-12 years in 1985, teacher-rated behavioral symptoms included no/low group (45.4%), high externalizing symptoms (29.2% - such as anger, aggression), high internalizing symptoms (11.7% - such as depression, anxiety), and comorbid (13.7% - both types). At follow-up at mean age 37 years, those in the externalizing group (compared to the no/low group) earned $5904 less per year and were 2.0 times more likely to receive welfare. The high internalizing group earned $8473 less per hear year and were 2.07 times more likely to receive welfare. The comorbid group earned $15,031 less and were 3.79 times more likely to receive welfare. The internalizing group was also less likely to have an intimate partner, and the comorbid group was less likely to have an intimate partner or children living at home.
Huang Z, Jordan JD, Zhang Q.
Early life adversity (ELA) as a risk factor for cognitive impairment and Alzheimer's disease (AD). Transl Neurodegener. 2023;12(1):25. PMID: 37173751
“In this review, we scrutinize findings from human and animal studies focusing on the connection of ELA with cognitive impairment and AD… ELA, especially at early postnatal stages, increases susceptibility to cognitive impairment and AD later in life. In terms of mechanisms, ELA could lead to dysregulation of the hypothalamus-pituitary-adrenal axis [stress hormones], altered gut microbiome, persistent inflammation, oligodendrocyte dysfunction [brain cell connections], hypomyelination [brain cell function], and aberrant adult hippocampal neurogenesis [brain growth and repair]…we discuss several interventions [environmental enrichment, exercise, and nutritional supplements in animal models] that may alleviate adverse consequences of ELA.”
Rehan ST, Khan Z, Shuja SH, et al.
Association of adverse childhood experiences with adulthood multiple sclerosis. Brain and behavior. 2023:e3024. PMID: 37128143
From a research review with 11 studies, “Results support a significant association between ACEs and the development of MS, and to developing symptoms earlier…Moreover, the severity of ACEs is also linked with increased relapse rates of MS.”
Elsenburg LK, Bengtsson J, Rieckmann A, Rod NH.
Childhood adversity and risk of type 2 diabetes in early adulthood: results from a population-wide cohort study of 1.2 million individuals. Diabetologia. 2023 Jul;66(7):1218-1222. PMID: 37076640
From a large Danish registry, childhood adversity was significantly associated with increased risk of type 2 diabetes in early adulthood (16-38 years), for both men (Hazard ratio 2.41) and women (HR 1.58).
Bahanan L, Ayoub S.
The association between adverse childhood experiences and oral health: A systematic review. J Public Health Dent. 2023 Jun;83(2):169-176. PMID: 36916213
From a research review of 4 available studies, increasing ACEs were associated with increasing poor dental health as assessed by last dental visit, last cleaning, number of filled teeth, number of extracted teeth, and number of remaining teeth.
Cheng X, Dong X, Liu J, Qu S, Xu H, Yao Y, et al.
Adverse childhood experiences and sleep duration among U.S. 65 years and older: results from the 2020 BRFSS. J Affect Disord. 2023;336:35-41. PMID: 37230260
Among the 42,786 participants (55.8 % female) included in this analysis, 50.5 % reported at least one ACE, and 7.3 % reported 4 or more ACEs. Adjusting for confounding factors, experiencing ACEs was associated with short (Odds ratio 2.03) and long (OR 1.78) sleep duration. Older adults who experienced sexual abuse as children were 146% more likely to report short sleep and 99% more likely to report long sleep. There was a dose-response gradient between ACE scores and sleep duration. Reporting ≥ 4 ACEs had increased risk for short (OR 3.10) and long (OR 2.13) sleep duration compared to respondents reporting no ACEs.
Arnold R, Ahmed F, Clarke A, et al.
The relationship between parental adverse childhood experiences and the health, well-being and development outcomes of their children: a systematic review. Public Health. 2023;219:146-53. PMID: 37186980
In a research review that included 124,043 parents and their children, “Offspring of parents exposed to ACEs had a higher risk of a range of negative health, well-being and developmental outcomes. This relationship differs according to the number and type of parental ACEs…These findings indicate that screening for parental ACEs by health visitors, midwives and other health or social care staff may identify an at-risk population of infants, children and adolescents and improve child outcomes.”
Bravo P, Kim Y, Xerxa Y, et al.
Maternal history of maltreatment and offspring's emotional and behavioral problems in adolescence: Do family factors contribute to the intergenerational risk transmission? Child Abuse Negl. 2023;141:106228. PMID: 37172532
From a large Dutch study of 4912 adolescents and their mothers, adolescents of mothers with a personal history of childhood maltreatment were significantly more likely to report internalizing (such as depression) and externalizing (such as anger) problems, which was linked with poorer family functioning and harsh parenting.
Goodrich KM, Trott A, Rodríguez MN, Waller M, Lilliott E.
The Impact of Adverse Childhood Experiences on Problem Gambling in New Mexico. J Prev (2022). 2023 Jun;44(3):309-324. PMID: 36759431
From a racially mixed sample of of 13,217 New Mexico adults, participants who reported problem gambling had increased odds of also reporting childhood exposure to adults with mental health issues (Odds ratio 1.34), living with incarcerated household members (OR 1.75), how often adults hit each other (OR 1.10) and how often anyone at least 5 years older forced them to have sex (OR 1.42).
Garcia-Grossman IR, Cenzer I, Steinman MA, Williams BA.
History of Incarceration and Its Association with Geriatric and Chronic Health Outcomes in Older Adulthood. JAMA Netw Open. 2023 Jan 3;6(1):e2249785. PMID: 36607638
Of US community dwelling adults over age 50, 7.6% reported a history of prior incarceration. After adjusting for multiple variables, a history of incarceration was associated with all geriatric syndromes evaluated, including cognitive, mobility, vision, and hearing impairment, urinary incontinence, and impairment of the activities of daily living. Incarceration was also associated with increased risk of chronic lung disease, mental health conditions, and heavy alcohol use.
Segal L, Amos J.
The serious health consequences of abuse and neglect in early life. Bmj. 2023;381: 0930. PMID: 37137517
From an editorial: “It is now clear that health outcomes for people exposed to serious child abuse or neglect are poor, and for those subject to the highest level of abuse truly disturbing. Clinicians and leaders in health and human services sectors must step up and provide the services needed. Notification to child protection services cannot be considered the end of our responsibility—it rarely elicits the clinical and related services that families need. Clinicians and health and community services require the capacity, skill, and funding to deliver the intensive and responsive service models needed to address the trauma underlying many, apparently intractable chronic conditions. A long-term commitment to a proportionate response could reduce the disturbing health consequences observed in victims of child abuse and neglect, and prevent the transmission of abuse to another generation.”
Wang YX, Sun Y, Missmer SA, et al.
Association of early life physical and sexual abuse with premature mortality among female nurses: prospective cohort study. Bmj. 2023;381:e073613. PMID: 37137504
Using data from the Nurses’ Health Study II, “Nurses who experienced severe physical abuse or forced sexual activity in childhood and adolescence had a higher crude premature mortality rate than nurses without such abuse in childhood or adolescence…severe physical abuse was associated with a greater risk of mortality due to external causes of injury and poisoning (multivariable adjusted hazard ratio 2.81), suicide (3.05), and diseases of the digestive system (2.4). Forced sexual activity as a child and adolescent was associated with greater risk of mortality due to cardiovascular disease (2.48), external injury or poisoning (3.25), suicide (4.30), respiratory disease (3.74), and diseases of the digestive system (4.83).”
De Rubeis V, Gonzalez A, Tarride JÉ, Griffith LE, Anderson LN.
A longitudinal study evaluating adverse childhood experiences and obesity in adulthood using the Canadian Longitudinal Study on Aging (CLSA). Int J Epidemiol. 2023 May 8:dyad054. PMID: 37155914
From a large Canadian study on aging, 66% of adults had experienced one or more ACE. The odds of obesity increased in a dose-response manner with increasing number of ACEs. A high proportion of people had obesity defined by BMI (31%), waist circumference (43%) and % body fat (74%).
Tabone JK, Cox S, Aylward L, Abunnaja S, Szoka N, Tabone LE.
Addressing Adverse Childhood Experiences and Psychological Symptoms Among Bariatric Patients. Journal of child & adolescent trauma. 2023;16(2):321-7. PMID: 37234836
Of 199 patients seeking bariatric surgery for obesity, “there is a significant association between ACEs and psychological symptoms. The study also revealed that patients who reported having a childhood supportive person were significantly associated with a lower BMI, while those who reported having adulthood supportive person showed significantly less symptoms of depression, anxiety, and binge eating.” Findings have implications for addressing ACEs preoperatively to achieve optimal surgical outcomes.
Sandsæter HL, Eik-Nes TT, Getz LO, et al.
Adverse childhood experiences and pre-pregnancy body mass index in the HUNT study: A population-based cohort study. PLoS One. 2023;18(5):e0285160. PMID: 37130113
Of 6679 Norwegian women surveyed about pre-pregnancy BMI, “Perceiving childhood as difficult was associated with higher odds of pre-pregnancy underweight (Odds Ratio 1.78) and obesity (OR 1.58). A difficult childhood was positively associated with obesity with an adjusted OR of 1.19 (class I obesity), 2.32 (class II obesity,) and 4.62 (class III obesity). Parental divorce was positively associated with obesity (OR 1.34). Bad childhood memories were associated with both overweight (OR 1.34) and obesity (OR 1.63). Parental death was not associated with pre-pregnancy BMI.
Testa A, Jacobs B, Zhang L, Jackson D, Ganson K, Nagata J.
Adverse Childhood Experiences and Prescription Opioid Use During Pregnancy: An Analysis of the North and South Dakota PRAMS, 2019-2020. Res Sq [Preprint]. 2023 May 9:rs.3.rs-2547252. PMID: 37214797
Of 2,999 individuals in a pregnancy risk monitoring program in North and South Dakota, compared to those with no ACEs, recent mothers with three or more ACEs had a 2.4 greater odds of prescription opioid use during pregnancy. “Additional research is needed to better understand the mechanisms that link ACEs and prescription opioid use during pregnancy, as well as how to best support those with ACEs exposure in a trauma-informed manner to reduce the risk of substance use.”
Volkow ND, Blanco C.
Substance use disorders: a comprehensive update of classification, epidemiology, neurobiology, clinical aspects, treatment and prevention. World Psychiatry. 2023;22(2):203-29. PMID: 37159360
“Substance use disorders (SUDs) are highly prevalent and exact a large toll on individuals' health, well-being, and social functioning. Long-lasting changes in brain networks involved in reward, executive function, stress reactivity, mood, and self-awareness underlie the intense drive to consume substances and the inability to control this urge in a person who suffers from addiction (moderate or severe SUD). Biological (including genetics and developmental life stages) and social (including adverse childhood experiences) determinants of health are recognized factors that contribute to vulnerability for or resilience against developing a SUD. Consequently, prevention strategies that target social risk factors can improve outcomes and, when deployed in childhood and adolescence, can decrease the risk for these disorders.”
Yıldız M, Orak U, Aydoğdu R.
Enduring Effects of Early Life Traumas on Adult Suicidal Ideation. Journal of child & adolescent trauma. 2023;16(2):297-307. PMID: 37234841
From a large US national study, childhood emotional abuse, physical abuse, and sexual abuse each was found to be significantly and independently associated with suicidal ideation in adulthood. Between 30-50% of this association was influenced by psychological distress (i.e., depression and anxiety), subjective powerlessness, and perceived social rejection.
Adolescents
Hertz M, Heim Viox M, Massetti GM, et al.
Adverse Childhood Experiences Among US Adolescents Over the Course of the COVID-19 Pandemic. Pediatrics. 2023 Jun 1;151(6):e2022060799. PMID: 37158017
From a national survey of adolescents aged 13-18, among 506 respondents of two survey waves (Fall 2020, Spring 2021), 27.2% experienced violence or abuse, 50.9% experienced a household challenge, and 34.9% experienced a community ACE by Wave 1. By Wave 2, 17.6% experienced 1 new ACE, 6.1% experienced 2 new ACEs and 2.7% experienced 4 or more new ACEs. Those with ≥4 ACEs by Wave 1 were 2.71 times as likely as those with none to report a new ACE at Wave 2. “Nearly one-third of adolescents experienced a new ACE between survey waves. Prevention and trauma-informed approaches in clinical, school, and community settings may be helpful.”
Clayton HB, Kilmer G, DeGue S, et al.
Dating Violence, Sexual Violence, and Bullying Victimization Among High School Students -Youth Risk Behavior Survey, United States, 2021. MMWR Suppl. 2023;72(1):66-74. PMID: 37104527
“In 2021, 8.5% of US high school students reported physical TDV [teen dating violence], 9.7% sexual TDV, 11.0% sexual violence by anyone, 15.0% bullying on school property, and 15.9% electronic bullying victimization during the past 12 months; 8.5% also reported experiencing forced sex in their lifetime.” Disparities were observed for females, racial and ethnic minority students, and sex and gender minority students.
Kellum CE, Kemp KM, Mrug S, Pollock JS, Seifert ME, Feig DI.
Adverse childhood experiences are associated with vascular changes in adolescents that are risk factors for future cardiovascular disease. Pediatr Nephrol. 2023 Jul;38(7):2155-2163. PMID: 36622441
Of 86 Alabama adolescents, for those with 1+ ACE compared to 0 ACE, while ambulatory and sleep blood pressure readings were similar, those with 1+ ACE showed increased vascular stiffness, a risk factor for future cardiovascular disease. “Adolescence could present an opportunity for early detections/interventions to mitigate adverse cardiovascular outcomes in adulthood.”
Budden T, Hafizuddin A, Dimmock JA, et al.
Support needs and experiences of young people living in families with mental illness. J Adolesc. 2023 Jun;95(4):784-796. PMID: 36808749
Interviews with 25 Australian adolescents mean age 13.6 years who lived with a family member with mental illness revealed lived experiences (i.e., increased responsibilities, missing out, and stigmatization), and support experiences, needs, and preferences (i.e., respite, shared experiences with like-minded others, education, and flexibility).
Doom JR, Young ES, Farrell AK, Roisman GI, Simpson JA.
Behavioral, cognitive, and socioemotional pathways from early childhood adversity to BMI: Evidence from two prospective, longitudinal studies. Dev Psychopathol. 2023;35(2):749-65. PMID: 35545317
Authors analyze how two different studies of high-risk family groups identified the importance of various childhood life factors influencing impulsivity and emotional dysregulation, leading to overeating and weight gain.
McMullan J, Robinson J, Varley N.
The Neglect of Adolescent Neglect. Comprehensive child and adolescent nursing. 2023;46(2):98-101. PMID: 36787497
Authors bring up the concept that while neglect is more identifiable in children, it is more complicated in adolescents where there is a gray area of neglect vs. growing up and becoming more independent. However, neglect does happen to adolescents. It is important that health personnel have awareness that “anti-social and disruptive behaviors may not be the result of ‘normal’ teenage development, and that decisions to leave home may not signify independence, but in fact may be the result of neglect and harmful parental relationships…We must acknowledge that they are not adults and thus advocate for their needs yet respect that they are beginning to form a strong sense of self.”
Friedman JK, Yoon CY, Emery Tavernier RL, et al.
Associations of childhood maltreatment with binge eating and binge drinking in emerging adult women. Preventive medicine reports. 2023;33:102217. PMID: 37223561
From a diverse sample of 788 students from Minneapolis middle and high schools followed over time, 62% reported at least one ACE. “Experiences of physical abuse had the strongest association with a ten-percentage point higher predicted probability [PP] of binge drinking, and seven-percentage point higher PP of co-occurring binge eating and drinking. Emotional abuse had the strongest association with an 11-percentage point higher PP binge eating only.”
Hébert É, Fortin L, Fortin A, Paradis A, Hébert M.
The Associations between Self-Silencing and Delinquency in Adolescent Who Experienced Child Sexual Abuse. J Child Sex Abus. 2023;32(4):438-54. PMID: 36776021
For 110 adolescents seeking services following child sexual abuse, and after controlling for a variety of factors, self-silencing (i.e., low assertiveness and self-expression, conflict avoidance, presenting a non-authentic self, anger, and hostility) was positively associated with delinquent behaviors, affiliation with delinquent peers, alcohol and drug use, and aggressive behaviors. “Implementing interventions aimed at increasing adolescents' assertiveness, conflict management skills, and emotion regulation…may lower their involvement in delinquency.”
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