[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]
Domestic Violence – Effects on Children
Bogat GA, Levendosky AA, Cochran K.
Developmental Consequences of Intimate Partner Violence on Children. Annu Rev Clin Psychol. 2023 May 9;19:303-329. PMID: 36791766
Authors review the research on this topic, including that IPV during pregnancy is a unique stressor affecting women’s conceptions of the unborn child and their sense of themselves as parents, and that parenting and child self-regulation affect the relationship between IPV exposure and child outcomes.
Spearman KJ, Hoppe E, Jagasia E.
A systematic literature review of protective factors mitigating intimate partner violence exposure on early childhood health outcomes. J Adv Nurs. 2023 May;79(5):1664-1677. PMID: 36938995
From a research review of protective factors, buffering, resilience or mitigating factors in early childhood for young children who experienced IPV, individual-level protective factors for young children include emotional self-regulation, child temperament, and child self-esteem. Family-level protective factors were maternal physical and mental health; warm, responsive parenting; knowledge of child development; socioeconomic advantage; caregiver employment; and maternal education.”
Rajesh T, Jonsson KR, Jackisch J, Straatmann VS.
Changes in parents' mental health related to child out-of-home care placements: A Swedish national register study. Child Abuse Negl. 2023;140:106149. PMID: 37011543
In a study of Swedish parents and their children who had been placed in out-of-home care (OOHC), mothers showed highest mental health hospitalization rates at the year of placement (26.6%), and fathers one year after placement (13.4%). Authors discuss hypotheses underlying these findings, “including psychosocial gender differences and opportunities to seek care as means of reunification. There is an urgency to develop strategies to better support these parents throughout the process.”
LGBTQ Concerns
Bochicchio L, Porsch L, Zollweg S, Matthews AK, Hughes TL.
Health Outcomes of Sexual Minority Women Who Have Experienced Adverse Childhood Experiences.
Trauma Violence Abuse. 2023:15248380231162973. PMID: 37070743
“Sexual minority women (SMW; e.g., lesbian, bisexual) report higher rates of almost every negative physical health (e.g., asthma, arthritis, cardiovascular disease), mental health (e.g., depression, anxiety), and substance use outcome compared to heterosexual women…SMW are significantly more likely than heterosexual women to report every type of ACE and a higher total number of ACEs…Our findings provide strong evidence that ACEs are an important risk factor for multiple negative mental health and substance use outcomes among SMW.”
Race/Cultural Concerns
Bishop-Royse J, Saiyed NS, Schober DJ, et al.
Cause-Specific Mortality and Racial Differentials in Life Expectancy, Chicago 2018-2019. Journal of racial and ethnic health disparities. 2023:1-7. PMID: 36973497
In Chicago in 2018, the average life expectancy (ALE) for non-Hispanic Blacks was 71.5 years, 9.1 fewer years than for non-Hispanic Whites (80.6 years). Among females, the racial difference in ALE was 8.21 years, mainly due to cancer and and heart disease; for males, it was 10.53 years, mainly due to homicide and heart disease.
Nguyen TT, Merchant JS, Criss S, et al.
Examining Twitter-Derived Negative Racial Sentiment as Indicators of Cultural Racism: Observational Associations With Preterm Birth and Low Birth Weight Among a Multiracial Sample of Mothers, 2011-2021. J Med Internet Res. 2023;25:e44990. PMID: 37115602
Using A random 1% sample of publicly available tweets from January 1, 2011, to December 31, 2021, Twitter-derived negative state-level racial sentiment toward racially minoritized groups was associated with a higher risk of preterm birth and low birth weight among the total population and specific racially minoritized groups.
Bower KM, Geller RJ, Jeffers N, McDonald M, Alhusen J.
Experiences of racism and perinatal depression: Findings from the pregnancy risk assessment monitoring system, 2018. J Adv Nurs. 2023 May;79(5):1982-1993. PMID: 36630188
Of 7328 non-Hispanic Black respondents with a recent live birth in 2018, “Respondents who reported feeling upset due to the experience of racism in the year prior to delivery had over two-fold higher odds (OR 2.37) of experiencing depression during pregnancy compared to respondents who did not report feeling upset due to the experience of racism, adjusted for maternal age, educational attainment, marital status, pre-pregnancy insurance type, region, and pre-pregnancy depression.”
Brumbaugh JE, Vohr BR, Bell EF, et al.
Early Life Outcomes in Relation to Social Determinants of Health for Children Born Extremely Preterm. J Pediatr. 2023:113443. PMID: 37105408
Of 7438 children born extremely prematurely (14-18 weeks early), 73% had a least 1 risk-associated social determinant of health (SDOH – defined by 3 things in this study - maternal education, insurance, and race). Children born to mothers with public/no insurance were more likely to be readmitted than those born to privately insured mothers. Neurodevelopmental impairment was twice as likely (aOR 2.36) and death 5 times as likely (aOR 5.22) for infants with 3 risk-associated SDOH compared with those with none.
Lawrence WR, Jones GS, Johnson JA, et al.
Discrimination Experiences and All-Cause and Cardiovascular Mortality: Multi-Ethnic Study of Atherosclerosis. Circulation Cardiovascular quality and outcomes. 2023:e009697. PMID: 37017086
In this large multiethnic study with nearly 2 decades of follow-up, experiences of discrimination were linked to higher all-cause and especially cardiovascular mortality, with stronger associations for Black participants.
Rainer T, Lim JK, He Y, et al.
Structural Racism in Behavioral Health Presentation and Management. Hosp Pediatr. 2023 May 1;13(5):461-470. PMID: 37066672
“Nia is a first-grade student with a history of trauma who was brought in by ambulance to the pediatric emergency department for ‘out of control behavior’ at school. This is the first of multiple presentations to the emergency department for psychiatric evaluation, stabilization, and management throughout her elementary and middle school years. At times, clinical teams used involuntary emergency medications and physical restraints, as well as hospital security presence at the bedside, to control Nia's behavior. Nia is Black and her story is a case study of how structural racism manifests for an individual child. Her story highlights the impact of adultification bias and the propensity to mislabel Black youth with diagnoses characterized by patterns of negative behaviors, as opposed to recognizing normative reactions to trauma or other adverse childhood experiences--in Nia's case, poverty, domestic violence, and Child Protective Services involvement.”
Mayne GV, Namazi M.
Social Determinants of Health: Implications for Voice Disorders and Their Treatment. American journal of speech-language pathology. 2023;32(3):1050-64. PMID: 37059074
“Voice is a critical medium of human communication and social interaction; therefore, partial or total loss of voice may have profound implications for quality of life and safety. Problems with the voice can also lead to severe functional and occupational impairment for professionals who rely heavily on vocalization, such as singers, teachers, lawyers, and actors.” Functional voice disorders are caused by improper use of the vocal apparatus that may arise from tension or stiffness of the vocal cords or other structures, and may result in such conditions as vocal fatigue/voice “loss”, coarseness, and hoarseness. Authors discuss social determinants of health, ACEs, stress, and trauma with regards to functional voice disorders.
Falusi O, Chun-Seeley L, de la Torre D, et al.
Teaching the Teachers: Development and Evaluation of a Racial Health Equity Curriculum for Faculty. MedEdPORTAL 2023;19:11305. PMID: 36999061
“Medical faculty are increasingly expected to teach about the impact of racism on health and to model the principles of health equity. However, they often feel ill-equipped to do so, and there is limited literature on faculty development on these topics. We developed a curriculum for faculty education on racism and actions to advance racial health equity.” Access to article and training materials
Perpetrators
Clemens V, Fegert JM, Kavemann B, et al.
Epidemiology of intimate partner violence perpetration and victimisation in a representative sample. Epidemiology and psychiatric sciences. 2023;32:e25. PMID: 37073832
From a 2021 German population study, 50.2% female, mean age 49.5 years, “A significant proportion of persons in Germany reporting IPV are both perpetrator and victim for each IPV form…Major risk factors for IPV perpetration only were male gender and adverse childhood experiences (ACEs) while major risk factors for IPV victimisation only comprised of female gender, low household income, and ACEs. In the perpetration and victimisation group, gender differences were less significant; older age and lower household income did increase the likelihood of combined perpetration and victimisation.”
Providers
Lennon T, Ruddy J, Badesch B, et al.
Pediatric Residents' Outpatient Firearm Screening and Safety Counseling Practices (Or Lack Thereof): A Retrospective Chart Review. Health Promot Pract. 2023:15248399231164909. PMID: 36995124
“The American Academy of Pediatrics recommends that children and adolescents be universally screened for access to firearms and exposure to violence.” Based on a chart review of patients aged 10-25 years seen by pediatric residents at 2 primary care clinics, 24% of patients had exposure to violence or a history of suicidal ideation. Less than 1% of patients were screened for firearm access or exposure to firearm violence, and only 6% were provided risk reduction counseling or any type of firearm safety counseling.
Welles CC, Tong A, Brereton E, et al.
Sources of Clinician Burnout in Providing Care for Underserved Patients in a Safety-Net Healthcare System. J Gen Intern Med. 2023 May;38(6):1468-1475. PMID: 36376633
“Burnout is a common occupational syndrome among healthcare team members and has adverse effects on both clinician well-being and patient healthcare outcomes. Healthcare team members from safety-net healthcare systems (SNHS) may be particularly susceptible, because of the unique and challenging experiences associated with providing high-quality care with limited resources to those who experience health disparities…(1) limited resources, (2) barriers to building trust with patients, (3) administrative requirements, (4) compassion fatigue, and (5) advocacy as a counterbalance to burnout…policy-level interventions to increase funding to SNHS, creation of peer-support and wellness programs, and support for advocacy efforts may help mitigate burnout.”
Selwyn CN, Lathan EC, Platt T, Minchew L.
How Healthcare Providers Reconcile Bad Things Happening to Good Patients: The Role of Just World Beliefs in Attitudes toward Trauma-Informed Care. J Trauma Dissociation. 2023:1-15. PMID: 36987779
“The uptake of trauma-informed practices such as trauma screening and referral among health-care providers remains relatively low. The current study sought to assess the roles of health-care providers’ personal histories of ACEs and personal beliefs in the just world hypothesis in understanding their attitudes toward trauma-informed care.” Of 180 advanced nursing students, those with higher ACE scores were less likely to believe in a just world, and as such were more likely to endorse trauma-informed care.
Bhui K, Butch I.
The trouble with trauma and triggering. Lancet Psychiatry. 2023 Apr 17:S2215-0366(23)00112-8. PMID: 37080220
Authors believe that “Asking and learning about adverse experiences and life events is crucial.” They comment on the possibility that asking doesn’t happen because the asker is either too uncomfortable or is concerned about “triggering” the patient, and that askers need to “develop the skills to manage their responses and potential vicarious trauma.” They also note that “Trigger warnings are useful, if carefully placed and worded, but they should be designed not to overstate fears of re-traumatisation.”
Feldstein DA, Barata I, McGinn T, et al.
Disseminating child abuse clinical decision support among commercial electronic health records: Effects on clinical practice. JAMIA Open. 2023;6(2): ooad022. PMID: 37063409
Electronic health record (EHR)-embedded child abuse clinical decision support (CA-CDS) tools were embedded into two different medical systems with different EHRs after both groups of clinicians expressed similar desires for such a system, and there was an initial training period. At follow-up, one group had rapid uptake and a positive impression, and the other group did not. “When disseminating CA-CDS into different hospital systems and different EHRs, it is critical to recognize how limitations in the functionality of the EHR can impact the success of implementation. The importance of collecting, interpreting, and responding to provider feedback is of critical importance.”
Riebel M, Weiner L.
Feasibility and Acceptability of Group Compassion-Focused Therapy to Treat the Consequences of Childhood Maltreatment in People With Psychiatric Disorders in France. J Nerv Ment Dis. 2023;211(5):393-401. PMID: 37040141
In this small French pilot study, 8 adult patients with a history of childhood maltreatment with difficult-to-treat psychiatric disorders participated in a 12-session group CFT (compassion-focused therapy). Adherence to therapy was 75% and attendance 88.3%, and all participants reported high satisfaction. Posttreatment, self-compassion significantly increased, and depression, anxiety, and posttraumatic scores decreased.
Prevention
Crichton KG, Spencer S, Shapiro R, McPherson P, Izsak E, McDavid LM, et al.
Timely Recognition of Abusive Injuries (TRAIN): Results from a Statewide Quality Improvement Collaborative. Pediatric quality & safety. 2023;8(2):e637. PMID: 37051406
Authors describe how the Institute for Healthcare Improvement's Breakthrough Series Collaborative Model, in which partnerships between organizations facilitate learning from each other and experts, led to significantly decreased infant abusive re-injury rates in 6 Ohio children’s hospitals.
Greene HM, Letson MM, Spencer SP, et al.
Recognizing Nonaccidental Trauma in a Pediatric Tertiary Hospital: A Quality Improvement Imperative. Pediatric quality & safety. 2023;8(2):e644. PMID: 37051404
Authors describe how they standardized the nonaccidental trauma (NAT) workup and improved NAT evaluation completion for children <7 months with concerning injuries in the pediatric emergency department and inpatient settings at an urban, tertiary care children's hospital to 100% compliance, up from 31%.
Bunting L, McCartan C, Davidson G, et al.
The influence of adverse and positive childhood experiences on young people's mental health and experiences of self-harm and suicidal ideation. Child Abuse Negl. 2023;140:106159. PMID: 37028255
From a survey of 1299 Irish adolescents, the prevalence rate of common mood and anxiety disorders was 16%, self-harm 10%, and suicidal ideation 12%. ACEs and PCEs (positive childhood experiences) both independently predicted common mood and anxiety disorders, self-harm and suicidal ideation. Every additional ACE increased the likelihood of all of these disorders, and every additional PCE reduced them.
Keane K, Evans RR.
Exploring the Relationship Between Modifiable Protective Factors and Mental Health Issues Among Children Experiencing Adverse Childhood Experiences Using a Resilience Framework. J Child Adolesc Trauma. 2022 Jul 14;15(4):987-998. PMID: 36439658
Using data from a 2019 National Survey of Children’s Health survey within the National Scientific Council on the Developing Child resilience framework, authors were able to confirm that for children with 4+ ACEs, who had an increased risk of mental health issues, the two factors of self-regulation and a supportive parent/caregiver relationship significantly protected against mental health conditions. “Interventions that teach children skill-based self-regulation and parent/caregiver co-regulation while providing safe and supportive environments can build self-regulation to overcome ACEs.”
Lett E, Hyacinthe MF, Davis DA, Scott KA.
Community Support Persons and Mitigating Obstetric Racism During Childbirth. Ann Fam Med. 2023 Apr 5:2958. PMID: 37019478
Of 806 Black birthing people, 89.3% had a community support person (CSP) present with no hospital affiliation or alignment. The presence of CSPs were associated with fewer acts of obstetric racism across all 3 domains of a validated instrument, the Patient-Reported Experience Measure of Obstetric Racism.
Pond R, Gillmore C, Blanchard N.
Lived experiences of resilience for women who have experienced childhood sexual abuse: A systematic review of qualitative studies. Child Abuse Negl. 2023;140:106152. PMID: 37028256
This research review about lived experiences of resilience processes used by women who had been subjected to childhood sexual abuse included distancing oneself from sexual abuse; building healthy interpersonal, community, and cultural connections; drawing on spiritual belief systems; reframing the sexual abuse; placing blame with the perpetrator; reclaiming self-worth; taking control of one's life; and pursuing meaningful goals. For some, it involved forgiveness of self and others, reclaiming one's sexuality, and/or fighting against diverse forms of oppression.”
Frank M, Daniel L, Hays CN, et al.
Association of Food Insecurity With Multiple Forms of Interpersonal and Self-Directed Violence: A Systematic Review. Trauma Violence Abuse. 2023:15248380231165689. PMID: 37009984
From a research review, food insecurity was significantly associated with IPV, suicide, suicidality, peer violence, bullying, youth dating violence, and child maltreatment. “Results highlight the potential for programs and policies that address food insecurity to function as primary prevention strategies for multiple forms of violence and underscore the importance of trauma-informed approaches in organizations providing food assistance.”
Researchers
Cross LM, Warren-Findlow J, Bowling J, Reeve CL, Issel LM.
A pilot study of the adverse childhood experiences-dimensions questionnaire (ACE-DQ): Associations with depression. Child Abuse Negl. 2023;140:106158. PMID: 36996592
Of 450 participants in a study that compared the original ACE questionnaire with ACE-DQ that includes dimensions of frequency and timing of events and perception of impact, authors believe that the original ACE index may overestimate outcomes such as depression, the full ACE-DQ may be too burdensome to fill out, but that simply adding perception of impact for each ACE to a simple ACE screener may reflect a more accurate measure for screening and research purposes.
Milner JS, Crouch JL, Ammar J, Jensen A.
Effect sizes and effect size benchmarks in family violence research. Child Abuse Negl. 2023;139:106095. PMID: 36989983
“Scholarly journals increasingly request that authors include effect size (ES) estimates when reporting statistical results. However, there is little guidance on how authors should interpret ESs…Some of the challenges to developing ES benchmarks in any scholarly discipline are discussed. For professionals who are not well informed about ESs, the present review is designed to increase their understanding of ESs and what ES benchmarks tell them (and do not tell them) with respect to understanding the meaningfulness of family violence research findings.
Other of Interest
Zwald ML, Van Dyke ME, Chen MS, et al.
Emergency Department Visits for Firearm Injuries Before and During the COVID-19 Pandemic - United States. MMWR Morb Mortal Wkly Rep. 2023;72(13):333-7. PMID: 36995967
The rates of firearm homicide and firearm suicide in 2021 were the highest recorded since 1993 and 1990, with the US firearm homicide rate increased by nearly 35% during the pandemic. “Compared with 2019, the average number of weekly ED visits for firearm injury was 37% higher in 2020, 36% higher in 2021, and 20% higher in 2022. A comprehensive approach is needed to prevent and respond to firearm injuries, including strategies that engage community and street outreach programs, implement hospital-based violence prevention programs, improve community physical environments, enhance secure storage of firearms, and strengthen social and economic supports.”
Timmer-Murillo SC, Schroeder ME, Trevino C, et al.
Comprehensive Firearm Violence Survivor Care: A Review. JAMA Surg. 2023 May 1;158(5):541-547. PMID: 36947025
Firearm violence is a public health crisis placing significant burden on individuals, communities, and health care systems. After firearm injury, there is increased risk of poor health, disability, and psychopathology. The newest 2022 guidelines from the American College of Surgeons require that all trauma centers screen for risk of psychopathology and provide referral to intervention.
Tang X, Lin S, Fang D, Lin B, Yao L, Wang L, Xu Q, Lu L, Xu N.
Efficacy and underlying mechanisms of acupuncture therapy for PTSD: evidence from animal and clinical studies. Front Behav Neurosci. 2023 May 2;17:1163718. PMID: 37200784
“As a major public health problem, posttraumatic stress disorder (PTSD) has a substantial impact on individuals and society. The total excess economic burden of PTSD in the US is estimated to be more than $232.2 billion a year. Acupuncture is widely used in patients with PTSD, and an increasing number of studies have been undertaken to assess acupuncture for the treatment of individuals with PTSD.” In this review, authors discuss the efficacy and biological mechanisms of acupuncture in comparison to psychological treatment and pharmacotherapy, and the most commonly used acupoints and methods. “Acupuncture may be effective in treating PTSD by regulating the structure and components of several brain areas, regulating the neuroendocrine system, and involving signaling pathways…findings indicate that acupuncture has promising potential for treating PTSD.”
Bryant RA, Dawson KS, Azevedo S, et al.
Augmenting trauma-focused psychotherapy for PTSD with brief aerobic exercise: a randomised clinical trial. Lancet Psychiatry. 2023 Jan;10(1):21-29. PMID: 36436532
In this clinical trial, adults with PTSD were randomized to 9 weekly treatments of PTSD exposure therapy including 10 minutes of aerobic exercise, vs. 10 minutes of stretching. At 6 months, the exercise group showed a moderate effect size of decreased PTSD symptoms moreso than the stretching group. “Brief aerobic exercise has the potential to augment long-term gains of exposure therapy for PTSD…in modulating the extinction learning process. This strategy might offer a simple and affordable means to augment treatment gains for exposure therapy in people with PTSD.”
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