[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
Debelle G, Efstathiou N, Khan R, et. al.
The Typology and Topography of Child Abuse and Neglect: The Experience of a Tertiary Children's Centre. Int J Environ Res Public Health. 2022 Jul 5;19(13):8213. PMID: 35805871
“A retrospective study of the case records of 452 children referred to a major UK children's tertiary centre for suspected child maltreatment was undertaken. Child maltreatment was substantiated in 65% of referred cases. Domestic violence and abuse and the child's previous involvement with statutory bodies were associated with case substantiation. Physical abuse predominated, with soft tissue injuries, including dog bites and burns, most frequent. Burns were related almost exclusively to supervisory neglect. There were also cases of medical neglect. Emotional abuse was associated with exposure to domestic violence and abuse and to self-harm.”
Dennis CL, Marini F, Dol J, Vigod SN, Grigoriadis S, Brown HK.
Paternal prevalence and risk factors for comorbid depression and anxiety across the first 2 years postpartum: A nationwide Canadian cohort study. Depress Anxiety. 2022 Mar;39(3):233-245. PMID: 34964202
In a Canadian study of new parents, 22.4% of fathers had depression and anxiety symptoms at some point during the first year postpartum, and 13.2% at some point during their second year postpartum. “Strongest risk factors associated with paternal comorbidity [having both depression and anxiety] were poor or fair perceived health at 4 weeks postpartum, depression before pregnancy, anxiety in the current pregnancy, significant adverse childhood experiences, positive ADHD screen, and victim of intimate partner violence. High rates of comorbidity among fathers in the first 2 years postpartum demonstrate the importance of perinatal mental health management at a family level.”
Yazdanpanahi Z, Vizheh M, Azizi M, Hajifoghaha M.
Paternal Postnatal Depression During COVID-19 Pandemic: The Role of Health Care Providers. J Prim Care Community Health. 2022 Jan-Dec;13:21501319221110421. PMID: 35818667
From a research review (which resulted in 3 papers) on paternal postpartum depression (PPD) during Covid, “The findings of the studies showed that paternal PPD increases the rate of child maltreatment, maternal depression, and domestic violence.”
Gustafsson HC, Propper CB.
Developmental Trajectories of Toddler Sleep Problems: Can A Person-Centered Approach Help Identify Children At Risk? Sleep. 2022 Jun 30:zsac142. PMID: 35768173
For 185 families assessed over 3 years after birth of a child, maternal depression, intimate partner violence, and harsh/intrusive parenting behaviors were risk factors for the persistence or development of toddler sleep problems.
Skafida V, Morrison F, Devaney J.
Intimate partner violence and child maltreatment in Scotland - Insights from nationally representative longitudinal survey data. Child Abuse Negl. 2022 Jul 15;132:105784. PMID: 35849873
From a Scottish national survey of parents and children, “In homes with a long-term abusive partner, children are more likely to have been smacked/slapped by the father (odds ratio 1.91), mother (OR 1.84), and both parents (OR 2.31). Maternal IPV frequency and intensity was incrementally associated with children's odds of being smacked/slapped (OR range 1.47-1.70).”
Whitten T, Green MJ, Tzoumakis S, et. al.
Early developmental vulnerabilities following exposure to domestic violence and abuse (DVA): Findings from an Australian population cohort record linkage study. J Psychiatr Res. 2022 Jul 6;153:223-228. PMID: 35841818
Comparing Australian police records of children exposed to DVA as either a victim or witness with school entry data, children exposed to DVA showed developmental difficulties with all 5 domains of school functioning, with girls showing significantly worse development in communication skills and general knowledge than boys. “Findings hold important implications for policy regarding the early intervention and implementation of support services for young children exposed to DVA.”
Roy J, Williamson E, Pitt K, et. al.
'It felt like there was always someone there for us': Supporting children affected by domestic violence and abuse who are identified by general practice. Health Soc Care Community. 2022 Jan;30(1):165-174. PMID: 33963618
UK authors describe a training intervention for general practices to identify and support children and young people exposed to IPV, barriers at the patient and professional level, and benefits to the children who were referred to support services.
Rengasamy ER, Long SA, Rees SC, et. al.
Impact of COVID-19 lockdown: Domestic and child abuse in Bridgend. Child Abuse Negl. 2022 Aug;130(Pt 1):105386. PMID: 34789382
Using Welsh data 23rd March to 30th September 2020 compared to one year prior, there was a 190% increase in self-referral for DV but a 36% decrease in police referral for DV. Regarding child abuse, there was a 198% increase in friend/family referral, 67% decrease in child protection medical examinations, and a significant decrease in referrals from schools.
Moore G, Buckley K, Howarth E, et. al.
Police referrals for domestic abuse before and during the first COVID-19 lockdown: An analysis of routine data from one specialist service in South Wales. J Public Health (Oxf). 2022 Jun 27;44(2):e252-e259. PMID: 34568944
Comparing police referrals to a domestic abuse service in South Wales before and during early covid lockdown, while there was little increase in overall volume, the proportion of those at high risk level increased. In addition, there was a significant increase in referrals called in by children “suggesting increased exposure of children to domestic abuse during school closure.”
Race/Cultural Concerns
Berkman E, Brown E, Scott M, Adiele A.
Racism in child welfare: Ethical considerations of harm. Bioethics. 2022 Mar;36(3):298-304. PMID: 35045196
“Racism has resulted in significant disproportionality and disparity in the US child welfare system. Being Black is not an inherent risk factor for child abuse and neglect yet Black children are almost twice as likely to be victims of substantiated abuse and neglect claims compared to other racial groups. In this paper, we briefly review the impact of racism on child welfare. We then discuss some ethical considerations that mandatory healthcare reporters should think through when determining whether to report potential abuse and neglect. Specifically, we discuss the need for a broader consideration of what constitutes harm.”
Camelo LV, Machado AV, Chor D, et. al.
Racial discrimination is associated with greater arterial stiffness and carotid intima-media thickness: the ELSA-Brasil study. Ann Epidemiol. 2022 Aug;72:40-47. PMID: 35351600
In a long-term study of 13,284 Brazilian adults, and after controlling for multiple factors, various tests of the carotid artery (large artery in neck) were more likely to show early changes of cardiovascular disease in Black and Brown adults with perceived racial discrimination.
Phillippe M.
Telomeres, oxidative stress, and timing for spontaneous term and preterm labor. Am J Obstet Gynecol. 2022 Aug;227(2):148-162. PMID: 35460626
Telomeres are complexes located at the ends of chromosomes. In adults, progressive telomere shortening occurs throughout the lifetime and is thought to contribute to progressive cell aging, and eventual cell death. Authors provide evidence to support the biological plausibility that a telomere-based clock mechanism in the placenta and fetal membranes also determines the length of gestation, leading to the onset of labor. “In the United States, African-American women have a 2-3-fold higher rate of preterm birth. African-American women have multiple risk factors for premature birth, all of which are distinct and potentially additive with regard to epigenetic telomere shortening…this would not only explain the preterm birth disparity but could also explain why highly educated, affluent African-American women continue to have an increased rate of preterm birth.”
Society for Maternal-Fetal Medicine (SMFM).
#62: Best practices in equitable care delivery-Addressing systemic racism and other social determinants of health as causes of obstetrical disparities. Am J Obstet Gynecol. 2022 Aug;227(2):B44-B59. PMID: 35378098
“Focusing primarily on disparities between Black and White individuals born in the United States, this document reviews the effects of social determinants of health and systemic racism on reproductive health outcomes, and recommends multilevel approaches to mitigate disparities in obstetrical outcomes.” This thorough review includes multiple tables/figures outlining the root causes of problems, with lists of recommendations.
Perpetrators
MacManus D, Short R, Lane R, et. al.
Intimate partner violence and abuse experience and perpetration in UK military personnel compared to a general population cohort: A cross-sectional study. Lancet Reg Health Eur. 2022 Jul 1;20:100448. PMID: 35813966
Comparing a sample of UK military personnel with a civilian population, the odds of military personnel experience of IPV was 2.94 times the general population, and perpetration was 3.41 times the general population. “Factors associated with both increased IPVA experience and perpetration included childhood adversity, relationship dissatisfaction, military trauma, and recent mental health and alcohol misuse problems.”
Stevenson MC, Schaefer CT, Ravipati VM.
COVID-19 patient care predicts nurses' parental burnout and child abuse: Mediating effects of compassion fatigue. Child Abuse Negl. 2022 Aug;130(Pt 1):105458. PMID: 34980500
From an anonymous online survey of 244 nurses (median age = 32.4; 87% female) who were parents of young children (age 12 or under), direct care of COVID-19 patients, exposure to patient death and suffering due to COVID-19, and family income loss due to COVID-19 predicted greater compassion fatigue, which in turn, predicted greater parental burnout, child abuse, child neglect, spouse conflict, and substance abuse. Also, as compassion satisfaction increased, parental burnout, child abuse, child neglect, spouse conflict, and substance abuse decreased.
Providers
Canty KW, Giardino AP.
Confronting Child Maltreatment in Youth Sports. Pediatrics. 2022 Jul 1;150(1):e2021055816. PMID: 35773518
“Screening for maltreatment should also be incorporated into the preparticipation sports physical. Patients should be asked about abuse by coaching staff, bullying, hazing, harassment by their peers, pressures to perform when injured, burnout, and familiarity with processes of disclosing abuse and maltreatment.”
Head ML, Heck JL.
Perinatal Care of Childhood Sexual Abuse Survivors: Scoping Review.
MCN Am J Matern Child Nurs. 2022 May-Jun 01;47(3):154-159. PMID: 35090159
“An estimated one in nine women seeking perinatal care is a survivor of childhood sexual abuse (CSA), yet CSA may be unknown to nurses and other health care providers. Childhood sexual abuse can have adverse physical and psychological effects for survivors, and the intimacy of perinatal care can trigger distress like intrusive thoughts…obtaining consent, promoting safety, trust, and control, fostering a healthy nurse-patient relationship, and inquiring about abuse may improve how CSA survivors experience perinatal care.”
Neill C, Read J.
Adequacy of Inquiry About, Documentation of, and Treatment of Trauma and Adversities: A Study of Mental Health Professionals in England. Community Ment Health J. 2022 Aug;58(6):1076-1087. PMID: 35094164
From a chart review of 400 files from 4 mental health centers in England, only 13% of charts contained documentation of any adverse experiences (childhood or adulthood). “Future research endeavours are recommended, including reasons for not routinely asking and type of training needed. Recommendations are made in relation to policy change, staff training, and guidelines to improve routine enquiry about adversities. Ultimately, a move to 'trauma-informed' services, already underway in some areas, is required for all mental health services.”
Choi KR, Hughesdon K, Britton L, et. al.
Interpersonal Trauma in the Lives of Nurses and Perceptions of Nursing Work. West J Nurs Res. 2022 Aug;44(8):734-742. PMID: 33980070
From the Nurses Health Study II, “Nurses reported high levels of emotional (60% childhood; 44% adulthood), physical (45% childhood, 23% adulthood), and sexual trauma (15% childhood, 11% adulthood).”
Maercker A, Cloitre M, Bachem R, et. al.
Complex post-traumatic stress disorder. Lancet. 2022 Jul 2;400(10345):60-72. PMID: 35780794“Complex PTSD has been adopted as a new diagnosis in the ICD-11. Individuals with complex PTSD typically have sustained or multiple exposures to trauma, such as childhood abuse and domestic or community violence. The disorder has a 1-8% population prevalence and up to 50% prevalence in mental health facilities. Progress in diagnostics, assessment, and differentiation from post-traumatic stress disorder and borderline personality disorder is reported, along with assessment and treatment of children and adolescents.”
O'Hara MA, Swerdin HR, Botash AS.
Expanding Trauma-Informed Care to Telemedicine: Brief Report From Child Abuse Medical Professionals. Clin Pediatr (Phila). 2022 Jul 21:99228221111233. PMID: 35864730
“The aim of this report is to offer insights regarding the application of key principles of trauma-informed care when telemedicine is used, and to inform future guidelines for optimal trauma-informed telemedicine for pediatricians caring for children with trauma and adversity…Issues of safety, examination concerns, and confidentiality are key variables to deter telemedicine visits.”
Walsh K, Eggins E, Hine L, et. al.
Child protection training for professionals to improve reporting of child abuse and neglect. Cochrane Database Syst Rev. 2022 Jul 5;7:CD011775. PMID: 35788913
A Cochrane Database review did not find conclusive evidence from existing studies on training outcomes for professionals regarding child protection. “Considering the many professional groups with reporting duties, we strongly recommend further research to assess the effectiveness of training interventions, with a wider range of child-serving professionals.”
Shimkhada R, Miller J, Magnan E, et. al.
Policy Considerations for Routine Screening for Adverse Childhood Events (ACEs). J Am Board Fam Med. 2022 Jul-Aug;35(4):862-866. PMID: 35896468
“In this health policy article, we describe key issues under debate with regards to ACEs screening and estimate potential change in screening utilization and expenditures due to the new ACEs legislation in California…A trauma-informed system to conduct screenings includes properly training providers to conduct and discuss screening, sufficient time to conduct the screening and discuss the health risks of these past (or current, for children) traumas, knowledge about services available to address ACEs, and the ability to refer patients to proper follow-up care if needed. Without these elements, screening risks offering no benefit to the patients.”
Prevention
Fogarty A, Savopoulos P, Seymour M, et. al.
Providing therapeutic services to women and children who have experienced intimate partner violence during the COVID-19 pandemic: Challenges and learnings. Child Abuse Negl. 2022 Aug;130(Pt 1):105365. PMID: 34686360
“The current study highlights the promise of telehealth interventions for parents and children who have experienced IPV…Parents identified several strengths and benefits of Restoring Childhood delivered via telehealth including improvements in parenting skills and confidence, parent-child relationships, and children's emotional-behavioural functioning. Both parents and clinicians noted the creativity utilised during the online approach, and the increased accessibly it offered for families…However, challenges to the telehealth approaches were also noted…including safety and confidentiality, technology challenges, and challenges working from home.”
Roane JS, Jones TL.
A realist model for home visitation program evaluation. J Pediatr Nurs. 2022 May-Jun;64:e6-e14. PMID: 35177363
“Here we discuss the theoretical foundations for home visitation programs, the recent evidence for program effectiveness, significant home visitation program components, and we propose a realist model for home visitation program evaluation that may aid in identifying how, for whom, and under what conditions home visitation programs work to address child maltreatment.”
Pazderka H, Reeson M, Polzin W, et. al.
Five year cost savings of a multimodal treatment program for child sexual abuse (CSA): a social return on investment study. BMC Health Serv Res. 2022 Jul 9;22(1):892. PMID: 35810283
Specialized mental health services for the treatment of Child Sexual Abuse (CSA) are generally expensive and labour intensive that may involve multiple services and therapeutic modalities, provided over the course of several months…Our analyses suggest that each dollar spent in treatment results in an average cost savings of $11.60. The largest value-for-money was identified as the avoidance of events associated with the long-term impacts of CSA. Somewhat surprisingly, savings related to the area of criminal justice were minimal.”
Elam KK, Johnson SL, Ruof A, et. al.
Examining the influence of adversity, family contexts, and a family-based intervention on parent/child telomere length. Eur J Psychotraumatol. 2022 Jun 30;13(1):2088935. PMID: 35789082
“Exposure to adversity, trauma, and negative family environments can prematurely shorten telomeres, the protective caps at the ends of chromosomes [which are a measurement of cellular aging]. Conversely, some evidence indicates that positive environments and psychosocial interventions can buffer the shortening of telomere length (TL).” Parents and adolescents from a sample of divorced families participated in either a family-based New Beginnings Programme (NBP), or an active control. Approximately six years after the intervention, the family-based intervention was associated with longer TL in parents. Also, positive parenting was associated with longer TL in children.
Researchers
Kratchman DM, Vaughn P, Silverman LB, et. al.
The CAPNET multi-center data set for child physical abuse: Rationale, methods and scope. Child Abuse Negl. 2022 Sep;131:105653. PMID: 35779985
The pediatric subspecialty of Child Abuse Pediatrics (CAP) was certified by the American Board of Medical Subspecialties in 2006…CAPNET is multi-center network whose mission is to support CAP-focused research…We describe the rationale, methods and intended scope for the development of the CAPNET research network and data registry.”
Shevlin M, Redican E, McElroy E, et. al.
Measuring positive memories of home and family during childhood: The development and initial validation of the 'Memories of Home and Family Scale'. Curr Psychol. 2022 Jun 17:1-10. PMID: 35756900
“There is a burgeoning evidence base highlighting the positive influence of benevolent childhood experiences, even in the context of adversity”. This article discusses the development and validation of the Memories of Home and Family Scale (MHFS), “a measure which assesses positive recollections of experiences and emotions at home and with family during childhood.”
Pace CS, Muzi S, Rogier G, Meinero LL, Marcenaro S.
The Adverse Childhood Experiences - International Questionnaire (ACE-IQ) in community samples around the world: A systematic review (part I). Child Abuse Negl. 2022 Jul;129:105640. PMID: 35662684
Authors review the limitations and validation concerns of the ACEs International Questionnaire (ACE-IQ), which collects additional data (e.g., witness community violence/terrorism).
Dean LT, Thorpe RJ Jr.
What Structural Racism Is (or Is Not) and How to Measure It: Clarity for Public Health and Medical Researchers. Am J Epidemiol. 2022 Jul 5:kwac112. PMID: 35792088
“There is much heterogeneity in the definition and measurement of structural racism, leading to mixed interpretations of structural racism's impact on health. In this commentary, we trace the evolution of the definitions of structural racism and suggest ways in which the measurement of structural racism should move forward given these definitions. A precise definition of structural racism can offer conceptual clarity, imperative to conducting high quality research.”
Smith KE, Pollak SD.
Early life stress and neural development: Implications for understanding the developmental effects of COVID-19. Cogn Affect Behav Neurosci. 2022 Aug;22(4):643-654. PMID: 33891280
Authors propose a new model of early life stress, oriented on children's perceptions of their environment and their social relationships, rather than specific events. These factors influence central and peripheral nervous system development, changing how children interpret, adapt, and respond to potentially stressful events, with implications for children's mental and physical health outcomes…Incorporating assessment of factors that shift perceptions of stress, including predictability, controllability, and perceived safety, has promise towards illuminating the underlying mechanisms supporting variability in children’s responses to stress.”
Schroeder K, Dumenci L, Sarwer DB, et. al.
The Intersection of Neighborhood Environment and Adverse Childhood Experiences: Methods for Creation of a Neighborhood ACEs Index. Int J Environ Res Public Health. 2022 Jun 25;19(13):7819. PMID: 35805478
“This study evaluated methods for creating a neighborhood adverse childhood experiences (ACEs) index, a composite measure that captures the association between neighborhood environment characteristics (e.g., crime, healthcare access) and individual-level ACEs exposure, for a particular population. A neighborhood ACEs index can help understand and address neighborhood-level influences on health.”
Giabbanelli PJ, Rice KL, Galgoczy MC, et. al.
Pathways to suicide or collections of vicious cycles? Understanding the complexity of suicide through causal mapping. Soc Netw Anal Min. 2022 Jun 15;12(1):1-21. PMID: 35845751
“Suicide is the second leading cause of death among youth ages 10-19 in the USA…We use the methodology of systems mapping to structure the complex interrelationships of suicide and ACEs based on the perceptions of fifteen subject matter experts…Our map is the largest to date on ACEs and suicide among youth, totaling 361 concepts and 946 interrelationships. Using a previously developed open-source software to navigate the map, we are able to explore how trauma may be perpetuated through familial, social, and historical concepts. In particular, we identify connections and pathways between ACEs and youth suicide that have not been identified in prior research, and which are of particular interest for youth suicide prevention.”
Other of Interest
Zimmerman M, Becker L.
Psychiatric Patients Who Do Not Believe They Deserve to Get Better. J Clin Psychiatry. 2022 Jun 8;83(4):21br14314. PMID: 35687863
For 405 adult patients at a single psychiatric clinic program, a significant minority of patients did not believe that they deserved to get better – 4.2% that they did not deserve to get better, and 12.8% weren’t sure. Patients who did not assert that they deserved to feel better were more likely to drop out or take longer to treat. Patient groups who were more likely to feel that they did not deserve to feel better were those with OCD ("frequently ashamed of their symptoms"), and those with PTSD or borderline personality disorder ("Patients with these disorders frequently experience profound shame...and have frequently experienced abuse, bullying, assaults, and other forms of aggression in childhood and as adults.")
Moffitt TE, Caspi A, Ambler A, et. al.
Deep-seated psychological histories of COVID-19 vaccine hesitance and resistance. PNAS Nexus. 2022 May;1(2)
gac034. PMID: 35783503
Using survey data from an ongoing 50-year study of New Zealand residents, “Vaccine-resistant and vaccine-hesitant participants had histories of adverse childhood experiences that foster mistrust, longstanding mental-health problems that foster misinterpretation of messaging, and early-emerging personality traits including tendencies toward extreme negative emotions, shutting down mentally under stress, nonconformism, and fatalism about health. Many vaccine-resistant and -hesitant participants had cognitive difficulties in comprehending health information. Findings held after control for socioeconomic origins. Vaccine intentions are not short-term isolated misunderstandings. They are part of a person's style of interpreting information and making decisions that is laid down before secondary school age. Findings suggest ways to tailor vaccine messaging for hesitant and resistant groups.”
Seeholzer EL, Santiago M, Thomas C, et. al.
Prevalence of Social Determinants of Health Among Health System Employees. J Prim Care Community Health. 2022 Jan-Dec;13:21501319221113956. PMID: 35850615
From a survey at MetroHealth in Cleveland, Ohio, “Of 4191 full-time employees, 46% completed the survey. The percentage of employees at risk for each social determinant were: food insecurity (11%), financial strain (12%), transportation difficulty (4%), inability to pay for housing or utilities (10%), intimate partner violence (4%), social isolation (48%), infrequent physical activity (10%), daily stress (58%), and lack of internet access (3%). Being at risk for specific social determinants was more common among support staff compared to staff physicians and nurses. For example, the survey participants included 436 administrative support staff, a job category that includes secretaries and patient service representatives. Among this group, 20% reported food insecurity, 20% financial strain, and 17% inability to pay for housing or utilities…Social determinants of health are common among health system employees, especially among workers in lower paid job categories. Health systems should routinely screen employees for social determinants and adjust salaries, benefits, and assistance programs to address their social needs.”
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