[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!! — Jane Stevens]
CHILD ABUSE
Segal L, Doidge J, Armfield JM, et. al.
Association of Child Maltreatment With Risk of Death During Childhood in South Australia. JAMA Netw Open. 2021 Jun 1;4(6):e2113221. PMID: 34110393
In this large case-controlled study of Australian children with mean age 3.59 years who were involved with CPS, compared to those who were not, adjusted mortality rate ratios for children who died by age 16 were 2.69 for children with child protection system notification only, 3.16 for CPS investigation unsubstantiated, 2.93 for substantiated maltreatment, and 3.79 for ever placed in out-of-home care. “Deaths from assault or self-harm were most overrepresented, accounting for 11.1% of deaths in children with CPS concerns but just 0.8% of deaths among other children.”
Oikawa M, Kawamura A, Kang C, Yamagata Z, Noguchi H.
Do macroeconomic shocks in the local labor market lead to child maltreatment and death?: Empirical evidence from Japan. Child Abuse Negl. 2021 Dec 27;124:105430. PMID: 34968867
Using data from Japan 2005-2016, a 50% increase in local unemployment rates significantly increased the number of reported child neglect cases (by 80%) and child deaths (by 70%). Further, this increase in local unemployment significantly increased cases of death due to external causes (by 146%), unintentional injuries (by 217%), and unintentional drowning (by 315%).
Blangis F, Allali S, Cohen JF, et. al.
Variations in Guidelines for Diagnosis of Child Physical Abuse in High-Income Countries: A Systematic Review. JAMA Netw Open. 2021 Nov 1;4(11):e2129068. PMID: 34787659
In a review of 20 guidelines on detection of child abuse in children under age 2 from 15 high-income countries, many lacked completeness and were discrepant on major issues. Authors suggest “an international consensus process to produce clear and standardized guidelines.”
Presser MJ, Quiroz HJ, Perez EA, et. al.
Comparing fatal child abuse involving biological and surrogate parents. J Trauma Acute Care Surg. 2022 Feb 1;92(2):362-365. PMID: 34369437
Using data from Georgia 2011-2017 on all homicides of children younger than 18 years, child abuse accounted for half of all pediatric homicides. “Of all cases of fatal child abuse, 60% involved biological and 29% involved surrogate parents. Compared with children killed by biological parents, children killed by surrogate parents were older (4 vs. 3 years), more often male (71% vs. 51%), more likely to survive the initial injury and present to the emergency department before death (96% vs. 69%), and less likely to have a medical comorbidity (2% vs. 11%). Surrogate parents were more likely to be male (90% vs. 48%) and use a firearm (20% vs. 13%) to inflict the injury. The race/ethnicity of the child was not associated with the parent's relationship.”
Liel C, Eickhorst A, Zimmermann P, Stemmler M, Walper S.
Fathers, mothers and family violence: Which risk factors contribute to the occurrence of child maltreatment and exposure to intimate partner violence in early childhood? Findings in a German longitudinal in-depth study. Child Abuse Negl. 2022 Jan;123:105373. PMID: 34801847
Analysis of both caregivers in a small German study of oversampled at-risk families showed that anxiety in mothers and lack of paternal recognition of negative emotion in children were significantly related to child maltreatment.
ADULT MANIFESTATIONS OF CHILD ABUSE
Andersen SL.
Neuroinflammation, Early-Life Adversity, and Brain Development. Harv Rev Psychiatry. 2022 Jan-Feb 01;30(1):24-39. PMID: 34995033
Detailed cellular description of the effects of abuse leading to inflammation and abnormal brain cell development and connections. Authors “call for standardizing methodologies relating to the age of assessing adversity effects, measures to quantify stress and inflammation, and more brain-based measures of biochemistry.” They also note the possible intervention of anti-inflammatory agents.
Mason SM, Frazier PA, Renner LM, et. al.
Childhood Abuse-Related Weight Gain: An Investigation of Potential Resilience Factors. Am J Prev Med. 2022 Jan;62(1):77-86. PMID: 34629199
Using data from 4,247 female and 1,982 male children followed for 17 years, at age 25-32 years body mass index (BMI) showed a 46% increased risk of obesity in those exposed to severe childhood abuse. Less severe abuse did not show a relationship to weight, and usual mental health resilience factors such as supportive relationships with non-family members also did not affect BMI.
Bryan R, Beitz JM.
Critical Connections Among Embedding of Childhood Adversity and Adult Chronic Gastrointestinal and Genitourinary Disorders: A Review of the Literature. Wound Manag Prev. 2021 Nov;67(11):33-47. PMID: 35030096
This research review supported the association of ACEs with adult bowel and urinary symptoms and conditions in a dose–response relationship. Authors present biologically plausible explanations for the impact of ACEs on adult chronic disease.
Smith BT, Brumage MR, Zullig KJ, et. al.
Adverse childhood experiences among females in substance use treatment and their children: A pilot study. Prev Med Rep. 2021 Sep 28;24:101571. PMID: 34976635
Of 50 women from a substance use treatment center compared to a control group in the same geographic area, maternal ACE scores were 4.9 for those in substance use treatment vs. 1.9 in the community, and ACE scores for the children of the women in treatment were 3.9 vs. 1.3 in community children.
Schober DJ, Shrestha S, Bishop-Royse JC.
The Effects of Exposure to Domestic Violence on Sleep Among Urban Adults. Am J Health Promot. 2022 Jan;36(1):129-136. PMID: 34372674
“Sleep disruption has been associated with risk for chronic conditions and ultimately, premature mortality.” For 1543 Adults residing in Chicago, “participants who reported witnessing domestic violence were significantly less likely to report meeting sleep recommendations even after controlling for ever being emotionally or physically abused, frequently feeling stress, demographic factors, and health status.”
Charles LE, Mnatsakanova A, Fekedulegn D, et. al.
Associations of adverse childhood experiences (ACEs) with sleep duration and quality: the BCOPS study. Sleep Med. 2021 Dec 23;89:166-175. PMID: 35026653
Among 206 Buffalo police officers, having 1+ ACEs was associated with sleep fragmentation and significantly lower sleep duration compared to those with 0 ACEs.
Roth SL, Andrews K, Protopopescu A, et. al.
Mental health symptoms in Public Safety Personnel: Examining the effects of ACEs and moral injury. Child Abuse Negl. 2022 Jan;123:105394. PMID: 34808481
Of 294 Canadian and American Public Safety Personnel (e.g. police, firefighters, paramedics), 79% reported exposure to one ACE, and 44% 2+ ACEs. ACEs significantly predicted adverse adult mental health symptoms. Those with higher ACEs reported significantly more symptoms of moral injury following personal or observed moral transgression.
Diaz R, Walker RJ, Lu K, et. al.
The relationship between adverse childhood experiences, the frequency and acuity of emergency department utilization and primary care engagement. Child Abuse Negl. 2022 Jan 10;124:105479. PMID: 35026607
Of 184 adult patients seen at one midwestern academic emergency department, 71.1% reported 1+ ACE and 32.5% 4+ ACEs. Even after adjusting for sociodemographic factors, those with 4+ ACEs had 3.20 times more ED visits in a year than those with 0 ACEs, and the visits were in general of lower acuity (less of an emergency). Number of ACEs were not associated with levels of engagement with primary care practitioners.
Kulkarni J, Leyden O, Gavrilidis E, Thew C, Thomas EHX.
The prevalence of early life trauma in premenstrual dysphoric disorder (PMDD). Psychiatry Res. 2022 Feb;308:114381. PMID: 34999294
“Premenstrual Dysphoric Disorder (PMDD), a debilitating form of Premenstrual Syndrome (PMS)… Eighty-three percent of women with PMDD had experienced early life trauma, with emotional abuse being the most common (71%). All types of trauma were more common amongst PMDD women than the general Australian population.”
Basto-Pereira M, Gouveia-Pereira M, Pereira CR, et. al.
The global impact of adverse childhood experiences on criminal behavior: A cross-continental study. Child Abuse Negl. 2022 Jan 8;124:105459. PMID: 35007971
This study examined the relationship between ACEs and criminal behaviors in 3797 young adults aged 18-20 living in 10 countries located across five continents, after accounting for sex, age, and cross-national differences. “Physical and sexual abuse, physical neglect, and household substance abuse were related to criminal variety, globally, and independently across sexes and countries…This research strengthens the finding that there are cross-cultural mechanisms perpetuating the cycle of violence.”
Condon EM, Dettmer A, Baker E, McFaul C, Stover CS.
Early Life Adversity and Males: Biology, Behavior, and Implications for Fathers' Parenting. Neurosci Biobehav Rev. 2022 Jan 18:104531. PMID: 35063493
From a very detailed review, “We present a conceptual model to describe the biological and behavioral pathways through which exposure to early life abuse may influence parenting among males, with a goal of guiding future research and intervention development in this area.”
Koyama Y, Fujiwara T, Murayama H, et. al.
Association between adverse childhood experiences and brain volumes among Japanese community-dwelling older people: Findings from the NEIGE study. Child Abuse Negl. 2022 Feb;124:105456. PMID: 34991011
Of 143 Japanese elders (aged 65-84 years), 27.1% reported 1 ACE and 6.7% 2+ ACEs. From brain scans, researchers were able to distinguish certain brain areas that were different in volume when exposed to threat ACEs, vs. other areas that were changed due to deprivation ACEs, compared to those elders with 0 ACEs.
Ross J, Armour C, Murphy D.
Childhood adversities in UK treatment-seeking military veterans. BMJ Mil Health. 2022 Feb;168(1):43-48. PMID: 32111681
From a survey of 403 mental health treatment-seeking UK veterans with a 67.2% response rate, 97% reported at least 1 ACE. “The total number of ACEs was related to aggression, common mental health problems and post-traumatic stress disorder.”
ADOLESCENTS
Jackson DB, Posick C, Vaughn MG, Testa A.
Adverse childhood experiences and traumatic brain injury among adolescents: findings from the 2016-2018 National Survey of Children's Health. Eur Child Adolesc Psychiatry. 2022 Feb;31(2):289-297. PMID: 33386525
From a national survey of 42,204 adolescents aged 12-17 years, “results revealed a dose-response relationship between ACEs and TBI [traumatic brain injury], even after accounting for an array of confounding variables. Findings also indicated that associations were of a greater magnitude among youth who are not sports-involved.”
Turner HA, Colburn D.
Independent and Cumulative Effects of Recent Maltreatment on Suicidal Ideation and Thoughts of Self-harm in a National Sample of Youth. J Adolesc Health. 2022 Feb;70(2):329-335. PMID: 34674929
From a national sample of 6364 teens aged 10-17 years, “Over 8% of the sample reported suicidal and/or self-harm ideation in the past month, with females more likely to report these outcomes than males. Youth who experienced recent emotional maltreatment, neglect, or witnessing family violence were more likely to report suicidal or self-harm ideation, independent of the other maltreatment types, presence of an internalizing disorder, and demographics. A dose-response relationship between the number of types of maltreatments and these outcomes was also evident.”
RACE/CULTURAL CONCERNS
Yoon CY, Hazzard VM, Emery RL, et. al.
Everyday discrimination as a predictor of maladaptive and adaptive eating: Findings from EAT 2018. Appetite. 2021 Dec 22;170:105878. PMID: 34952131
From a national study of 1410 adults aged 18-30, after adjustment for age, ethnicity/race, gender, and socioeconomic status, moderate and high levels of discriminatory experiences were associated with 2.2 to 3.1 times greater prevalence of binge eating, compared to young adults with no discrimination experience.
Kliewer W, Robins JL.
Adverse Childhood Experiences Are Associated with Cardiometabolic Risk Indicators and Telomere Length in Low-Income African-American Adolescents. Int J Behav Med. 2022 Feb;29(1):131-135. PMID: 33821432
Data were collected from 108 low-income African-American adolescents (42.6% male, mean age 14.27 years) living in the southeastern USA. ACEs were significantly associated with shortened leukocyte telomere length (marker of premature cell aging), higher levels of C-reactive protein (marker of inflammation), and larger waist circumference. Targeted interventions are discussed.
Antwi-Boasiako K, Fallon B, King B, Trocmé N, Fluke J.
Understanding the overrepresentation of Black children in Ontario’s child welfare system: Perspectives from child welfare workers and community service providers. Child Abuse Negl. 2022 Jan;123:105425. PMID: 34890960
From interviews with Canadian child welfare workers regarding overrepresentation of Black children in their system, “Themes that emerged from the study include the following concerns: racism and bias from referral sources; racism and bias from child welfare workers; lack of cultural sensitivity; lack of workforce diversity/training; lack of culturally appropriate resources; assessment tools; duty to report; fear of liability; lack of collaboration; and poverty.”
Fani N, Harnett NG, Bradley B, et. al.
Racial Discrimination and White Matter Microstructure in Trauma-Exposed Black Women. Biol Psychiatry. 2022 Feb 1;91(3):254-261. PMID: 34776124
From brain scans of 116 Black American women in a long-standing study of trauma, and even after accounting for other trauma, PTSD and demographics, “experiences of racial discrimination are independently related to decrements in white matter microarchitecture throughout the brain. In individuals who have experienced other types of adversity, racial discrimination clearly has additive and distinctive deleterious effects on white matter structure.” (White matter microarchitecture and function have to do with problem-solving, focus, mood, walking and balance.)
PROVIDERS
Sausen KA, Randolph JW, Casciato AN, et. al.
The Development, Preliminary Validation, and Clinical Application of the Quick Parenting Assessment. Prev Sci. 2022 Feb;23(2):306-320. PMID: 34780005
Discussion of the development of and use for the Quick Parenting Assessment. The QPA takes 1 min to complete and assesses for healthy and unhealthy parenting behaviors. “Parenting behaviors may play an outsized role in the pathogenesis of outcomes associated with ACEs. We discuss the clinical application of QPA at our institution and the theoretical potential for this instrument to reduce the rates of short- and long-term health problems.”
Liu SR, Grimes KE, Creedon TB, et. al.
Pediatric ACES assessment within a collaborative practice model: Implications for health equity. Am J Orthopsychiatry. 2021;91(3):386-397. PMID: 33793254
Through a primary care multidisciplinary team, an ACEs questionnaire was collected from 97% of 163 children from a safety-net health system as part of their mental health evaluation. 40% of children and 56% of teens had 4+ ACEs, and there were significant associations between level of ACEs exposure and degree of mental health impairment. “Providers viewed the ACEs assessment process as feasible, acceptable, and to have utility for the care of the study’s diverse pediatric population. Findings highlight benefits, challenges, cultural considerations and recommendations.”
Clark CS, Aboueissa AE.
Nursing students’ ACE scores: a national survey. Int J Nurs Educ Scholarsh. 2021 Dec 28;18(1). PMID: 34963206
From an online survey of US nursing students with 1,094 responses (unknown response rate), over 40% had an ACE score of 4+ vs. the national average of 12.5-13.3% for 4+ ACEs. “This data provides support for Conti-O’Hare’s theory of nurses as wounded healers. Nursing faculty should consider nursing students to be members of a vulnerable population and revise curricula to support nursing students stress resilience.”
Jee S, Forkey H.
Maximizing the Benefit of Screening for Adverse Childhood Experiences. Pediatrics. 2022 Jan 21:e2021054624. PMID: 35067722
“Consensus has highlighted the need to focus on safe, stable, and nurturing relationships and change the paradigm from simply identifying ACEs to promoting resilience. Resilience-informed relational care allows pediatricians to provide support for all children from the pediatric setting. Providers should create a safe and empowering environment to raise and respond to a family’ specific social determinants of health or ACE concerns.”
PREVENTION
Goodman WB, Dodge KA, Bai Y, Murphy RA, O'Donnell K.
Effect of a Universal Postpartum Nurse Home Visiting Program on Child Maltreatment and Emergency Medical Care at 5 Years of Age: A Randomized Clinical Trial. JAMA Netw Open. 2021 Jul 1;4(7):e2116024. PMID: 34232300
“The FC [Family Connect] program includes 1 to 3 nurse home visits beginning at the infant age of 3 weeks designed to identify family-specific needs, deliver education and intervention, and connect families with community resources matched to their needs. Ongoing program engagement with service professionals and an electronic resource directory facilitate effective family connections to the community.” Of 4777 randomized families, families assigned to FC had 39% fewer CPS investigations for suspected child maltreatment through 5 years of age, and 33% less total child emergency medical care use. “Positive effects held across birth risk, child health insurance, child sex, single-parent status, and racial/ethnic groups.”
Brännström L, Vinnerljung B, Almquist YB.
Intergenerational transmission of placement in out-of-home care: Mediation and interaction by educational attainment. Child Abuse Negl. 2022 Jan;123:105436. PMID: 34906787
From a long-term study of 11,338 Swedish families, the odds of having at least one child being placed in out-of-home care (OHC) was 6.67 times higher when parents had also experienced OHC as children. Enhanced educational attainment of the parental OHC population (to at least completing upper secondary school) had the potential to break the intergenerational transmission of OHC into the next generation.
Bruzelius E, Levy NS, Okuda M, Suglia SF, Martins SS.
Prescription Drug Monitoring and Child Maltreatment in the United States, 2004-2018. J Pediatr. 2022 Feb;241:196-202. PMID: 34678247
“We compared the prevalence of total maltreatment incidents and victims in states with and without PDMPs [prescription drug monitoring programs], before and after implementation…We found an association between prescription drug monitoring and reduced maltreatment prevalence at the state level,” especially for neglect and physical abuse, and especially for American Indian/Alaskan Native children.
RESEARCHERS
Nishimi K, Choi KW, Cerutti J, Powers A, Bradley B, Dunn EC.
Measures of adult psychological resilience following early-life adversity: how congruent are different measures? Psychol Med. 2021 Nov;51(15):2637-2646. PMID: 32406816
“We derived four resilience measures…relatively low congruence between resilience measures suggests studies will yield divergent findings about predictors, prevalence, and consequences of resilience. Efforts to clearly define resilience are needed to better understand resilience and inform intervention and prevention efforts.”
Conti G, Pizzo E, Morris S, Melnychuk M.
The economic costs of child maltreatment in UK. Health Econ. 2021 Dec;30(12):3087-3105. PMID: 34523182
Per authors, “The discounted average lifetime incidence cost of nonfatal child maltreatment by a primary caregiver is estimated at £89,390 (95% uncertainty interval £44,896 to £145,508); the largest contributors to this are costs from social care, short-term health, and long-term labor market outcomes. The discounted lifetime cost per death from child maltreatment is estimated at £940,758, comprising health care and lost productivity costs.”
Cooley DT, Jackson Y.
Informant Discrepancies in Child Maltreatment Reporting: A Systematic Review. Child Maltreat. 2022 Feb;27(1):126-145. PMID: 33054358
“Potential informants on child maltreatment include the youth who has experienced the alleged maltreatment, and the youth's caregivers, social workers and case files. When multiple informants are compared, they often disagree…Results showed that more youth tend to report physical, sexual and emotional abuse than seen in case files. By contrast, more case files include neglect than reported by youth. Implications and future directions are discussed.”
Chen CJ, Chen YW, Chang HY, Feng JY.
Screening Tools for Child Abuse Used by Healthcare Providers: A Systematic Review. J Nurs Res. 2022 Feb 1;30(1):e193. PMID: 35050956
“In this systematic literature review, 15 assessment tools of child abuse used by healthcare providers were identified…none of these screening tools achieved an adequate level of evidence…Screening tools must be valid, succinct, user-friendly, and amenable for use with children at every point of care in the healthcare system. Because of the paucity of informative and practical studies in the literature, findings related to the quality of child abuse screening tools were inconclusive.”
OTHER OF INTEREST
Dowdell EB, Freitas E, Owens A, Greenle MM.
School Shooters: Patterns of Adverse Childhood Experiences, Bullying, and Social Media. J Pediatr Health Care. 2022 Jan 18:S0891-5245(21)00290-X. PMID: 35058114
“Since 2013 there have been at least 421 recorded incidents of gunfire on school grounds…Approximately 88% of school shooters had at least one social media account, and 76% posted disturbing content of guns and threatening messages. Over 72% of shooters had at least one reported adverse childhood experience, and 60% reported being bullied in-person or online…Inclusion of questions by pediatric nurses and others about social media, adverse childhood experiences, and experiences of bullying may be proactive measures that can help identify, protect, and intervene with at-risk students.”
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