[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]
Adolescents
Yau MY, Ge S, Moss HB, Cooper T, Osei A, Ijeaku I, Deas D.
Regional prevalence of adverse childhood experiences in the United States using a nationally representative school-based sample. SSM Popul Health. 2022 Jun 11;19:101145. PMID: 35756547
“This study using a nationally representative school-based sample demonstrated that the prevalence of ACEs varied among the four major census regions in the United States (Northeast, Midwest, South, and West). Overall, ACEs were found to be most prevalent in the Northeast and least prevalent in the South. Compared to the Northeast, individuals in the South reported half the odds of ACE scores of four or above…The Northeast had the highest prevalence of four specific ACEs (emotional abuse, sexual abuse, substance abuse in household, and emotional neglect), and the South had the lowest prevalence of six (emotional abuse, physical abuse, sexual abuse, substance abuse in household, mental illness in household, and physical neglect).” Authors note limitations of the study, including that it omitted a most vulnerable group, those who were not in school to take the survey. They also theorized that lower ACEs in the South may be due to protective factors in more rural areas of increased family, religious, social and community connections and support.
Ziplow J.
The Psychiatric Comorbidities of Migraine in Children and Adolescents. Curr Pain Headache Rep. 2021 Nov 11;25(11):69. PMID: 34766216
“The number of adverse childhood experiences (ACEs) a child is exposed to seems to be near-linearly associated with risk of migraine, but not with tension-type headache. The findings from these studies underscore the importance of utilizing appropriate screening methodologies for identifying psychiatric disorders in children with migraine…and how the proposed shared pathologic mechanisms affect plans for treatment.”
Hammond NG, Colman I, Orr SL.
Adverse childhood experiences and onset of migraine in Canadian adolescents: A cohort study. Headache. 2022 Mar;62(3):319-328. PMID: 35122430
In this long-term Canadian study, ACEs were associated with an increased risk of migraine onset in adolescence, but not for non-migraine frequent headache. Symptoms of depression and anxiety did not impact this relationship.
Salo M, Appleton AA, Tracy M.
Childhood Adversity Trajectories and Violent Behaviors in Adolescence and Early Adulthood. J Interpers Violence. 2022 Aug;37(15-16):NP13978-NP14007. PMID: 33858246
Using data from the Avon Longitudinal Study, “Childhood adversity trajectories exhibited a strong dose-response relation with physical fighting and weapon carrying, with particularly pronounced relations for violent behaviors persisting across both adolescence and early adulthood.”
Hamstra C, Fitzgerald M.
Longitudinal Effects from Childhood Abuse to Bullying Perpetration in Adolescence. J Child Adolesc Trauma. 2022 Jan 31;15(3):869-881. PMID: 35958700
From a national study of adolescents, “childhood abuse was associated with higher levels of depression, anxiety, anger, dissociation, posttraumatic stress, and poor social skills. Only anxiety and poor social skills at age 12 were significantly associated with bullying perpetration when adolescents were 14…Clinicians, teachers, and school administrators may desire to focus efforts on reducing anxiety and increasing social skills to mitigate bullying perpetration.”
Barnes M, Szilassy E, Herbert A, et. al.
Being silenced, loneliness and being heard: understanding pathways to IVP & abuse in young adults. BMC Public Health. 2022 Aug 17;22(1):1562. PMID: 35974354
From interviews with 17 young adult UK females who had experienced IPVA, “All women interviewed experienced at least one type of maltreatment, parental domestic violence, or bullying during childhood. Nearly all experienced IPVA and most had been multi-victimised. Findings indicated a circular pathway: early trauma led to isolation and loneliness, negative labelling and being silenced through negative responses to help seeking, leading to increased experiences of loneliness and intensifying vulnerability to further violence and abuse in young adulthood. The pathway was compounded by intersectionality. Potential ways to break this cycle of loneliness included being heard and supported, especially by teachers.
Cibralic S, Alam M, Mendoza Diaz A, et. al.
Utility of screening for adverse childhood experiences (ACE) in children and young people attending clinical and healthcare settings: a systematic review. BMJ Open. 2022 Aug 25;12(8):e060395. PMID: 36008078
In this research review (through June 2021) of performing ACEs screening in healthcare settings servicing children and adolescents, authors note that while administration of ACE tools was found to be feasible and acceptable, they did not recommend widespread ACE screening since “no follow-up data were collected to determine whether participants accessed services and/or the impact of accessing services.”
Domestic Violence Effects on Children
Reiter JE, Grossman SF, Perkins NH, et. al. Parenting in the Context of Intimate Partner Violence: Understanding Mothers' Perceptions. J Interpers Violence. 2022 Aug 17:8862605221118612. PMID: 35978540
Of 16 females who experienced IPV during both childhood and adulthood, and had at least one school-aged child, “One of the major findings from this work is that women did all within their power to foster close, loving, and nurturing relationships with their children, even when the odds were very much stacked against them. Participants described cultivating strong relationships with their children despite histories of trauma in both childhood and adulthood. It would behoove professionals to move toward treatment methods and modalities that give credence to the strength and resilience survivors already display, without assuming that, because they may not be able to meet certain needs of their children, they are unable to meet all the needs of their children.” This strengths-based approach promotes a holistic view of parenting among IPV survivors.
Berzenski SR, Yates TM.
The development of empathy in child maltreatment contexts. Child Abuse Negl. 2022 Aug 18;133:105827. PMID: 35987049
For 250 children, child emotional abuse and child neglect predicted decreased empathy at age eight, whereas child physical abuse and child exposure to domestic violence predicted increased empathy at age eight. However, children's negative representations of mother figures decreased the positive association between child physical abuse and empathy.
Race/Cultural Concerns
Lambert SF, Boyd RC, Ialongo NS.
Protective factors for suicidal ideation among Black adolescents indirectly exposed to community violence. Suicide Life Threat Behav. 2022 Jun;52(3):478-489. PMID: 35150017
For 447 Black 6th graders, knowledge of family member or peers’ community violence exposure was associated with increased suicidality at grade 7. A protective factor for boys was a sense of self-worth, and for girls was social support.
Ventura CAI, Denton EE, Asack BR.
Implications of systemic racism in emergency medical services: On prehospital bias and complicity.
EClinicalMedicine. 2022 Jun 25;50:101525. PMID: 35784440
Authors cite multiple examples and categories of possible racism with adverse results in care by emergency medical technicians. They recommend: “At the systemic level, we invoke National EMS Education Standards to mandate adequate training in implicit bias, clinical assessment and treatment variances for patients of color, and for state and local EMS authorities to follow suit. We believe that this competency should also be assessed by the national registry EMT exam. In addition, we call for radical efforts to diversify the profession by campaigns to train and employ racial minorities, as approximately 70% of EMTs and paramedics are White.”
Jindal M, Trent M, Mistry KB.
The Intersection of Race, Racism, and Child and Adolescent Health. Pediatr Rev. 2022 Aug 1;43(8):415-425. PMID: 35909135
“This article seeks to provide an overview of the intersection of race, racism, and child/adolescent health in an effort to reduce knowledge gaps among pediatric providers…As racial disparities continue to persist, and in many cases grow, it is incumbent on us all to do our part by committing to lifelong learning, unlearning, and teaching regarding the intersection of race, racism, and health.”
Zarei K, Kahle L, Buckman DW, Choi K, Williams F.
Parent-child nativity, race, ethnicity, and adverse childhood experiences among U.S. children. J Pediatr. 2022 Aug 6:S0022-3476(22)00672-2. PMID: 35944710
From a national children’s health survey, “Across all racial and ethnic groups except Black individuals [where ACEs were consistently high], children in first- and second-generation households were less likely than those in third- and higher generation households to experience any ACEs related to household dysfunction. The prevalence of multiple ACEs generally increased with increasing generation across different racial and ethnic groups.” (Table shows variations in estimated prevalence of ACEs by household generation, race, and ethnicity.)
Joseph B, Sakran JV, Obaid O, et. al.
Nationwide Management of Trauma in Child Abuse: Exploring the Racial, Ethnic, and Socioeconomic Disparities. Ann Surg. 2022 Sep 1;276(3):500-510. PMID: 35762605
Using a database of more than 700 US trauma centers, of 7774 children for whom an abuse report was filed, mean age was 5 years, and the most common form of abuse was physical (92%), followed by neglect (6%), sexual (3%), and psychological (0.1%). The most common injury mechanisms were blunt trauma (63%), burns (10%), and penetrating trauma (10%). The most common perpetrator of abuse was a care provider/teacher (49.5%), followed by a member of the immediate family (30.5%), or a member of the extended/step/foster family (20.0%). Overall, 82% of abuse investigations were initiated for those with abuse reports. Of these, 33% resulted in a change of caregiver. “Black children were more likely to have abuse investigated, and Black and Hispanic children were more likely to experience change of caregiver after investigations, while privately insured children were less likely to experience both”.
Perpetrator
Lane R, Short R, Jones M, et. al.
Relationship conflict and partner violence by UK military personnel following return from deployment in Iraq and Afghanistan. Soc Psychiatry Psychiatr Epidemiol. 2022 Sep;57(9):1795-1805. PMID: 35661897
From a survey of 5437 UK military personnel following deployment in the middle east, “34.7% reported relationship conflict (arguing with partner) and 3.4% reported perpetrating physical IPV post-deployment. There were similar rates of self-reported physical IPV perpetration among males and females. Among our male sample, factors associated with both relationship conflict and physical IPV perpetration post-deployment included being in the Army compared with the Royal Air Force, higher levels of childhood adversity, higher levels of military trauma exposure and recent mental health and alcohol misuse problems.”
Providers
Stige SH, Andersen AC, Halvorsen JE, et. al.
Possible paths to increase detection of child sexual abuse in child and adolescent psychiatry: a meta-synthesis of survivors' and health professionals' experiences of addressing child sexual abuse. Int J Qual Stud Health Well-being. 2022 Dec;17(1):2103934. PMID: 35904225
“Increasing the detection rate of CSA [childhood sexual abuse] within the context of Child and Adolescent Psychiatry (CAP) represents a significant secondary prevention strategy. However, facilitating CSA disclosure when the survivor is reluctant to tell is a highly complex and emotionally demanding clinical task.” In this study, “both survivors and health professionals facing CSA disclosure feel deeply isolated, they experience the consequences of addressing CSA as highly unpredictable, and they need support from others to counteract the negative impact of CSA.”
Felter J, Baker A, Lieberman L, et. al.
Adverse Childhood Experiences and Trauma-Informed Care. J Physician Assist Educ. 2022 Sep 1;33(3):264-269. PMID: 35917473
This basic review of ACEs and trauma-informed care for Physician Assistants also includes core competencies from a variety of PA organizations.
Selvaraj K, Korpics J, Osta AD, et. al.
Parent Perspectives on Adverse Childhood Experiences & Unmet Social Needs Screening in the Medical Home: A Qualitative Study. Acad Pediatr. 2022 Aug 22:S1876-2859(22)00410-7. PMID: 36007805
“We interviewed 25 English-speaking and 15 Spanish-speaking parents who were mostly female, racial/ethnic minorities with ≥1 ACE. Four themes were identified: (1) Pediatricians should ask about ACE and USN [unmet social needs]. (2) Disclosure is a longitudinal process, not a discrete event. (3) Barriers to disclosure are significant, involving concrete and emotional risks for the family. (4) Trauma-informed providers and practices support disclosure…Even if providers screen using trauma-informed principles, parents may prefer not to disclose ACE initially because they regard disclosure as a stepwise process. These findings contribute to a new conceptual framework for thinking of ACE screening not merely as a way to generate information, but as an interactive, therapeutic relationship-building activity irrespective of whether or when it produces disclosure.”
Cruz D, Lichten M, Berg K, George P.
Developmental trauma: Conceptual framework, associated risks and comorbidities, and evaluation and treatment. Front Psychiatry. 2022 Jul 22;13:800687. PMID: 35935425
Authors outline the concept of Developmental Trauma Disorder (DTD). “Developmental Trauma (DT) refers to the complex and pervasive exposure to life-threatening events that (1) occurs through sensitive periods of infant and child development, (2) disrupts interpersonal attachments, (3) compromises an individual’s safety and security operations, (4) alters foundational capacities for cognitive, behavioral, and emotional control, and (5) often contributes to the development of complex PTSD in adulthood.”
Vu TH, Bishop J, McGill L, et. al.
Using systems-mapping to address Adverse Childhood Experiences (ACEs) and trauma: A qualitative study of stakeholder experiences. PLoS One. 2022 Aug 18;17(8):e0273361. PMID: 35980992
In systems mapping projects (SMP), diverse stakeholders work together to document the forces that are creating the outcomes and patterns within the community. 16 stakeholders in Eastern North Carolina used this process and all participants strongly recommended it to other communities. “Systems mapping is a feasible, transferable, and promising modality for understanding and addressing ACEs at the individual, interpersonal, and community-levels, as well as for putting community voices at the forefront of efforts to address ACEs. “How to” full article
Prevention
Yang G, Cao X, Li X, et. al.
Association of Unhealthy Lifestyle and Childhood Adversity with Acceleration of Aging Among UK Biobank Participants. JAMA Netw Open. 2022 Sep 1;5(9):e2230690. PMID: 36066889
Using data from the UK Biobank of 127,495 adults aged 40-69 years, researchers found that childhood adversity was associated with acceleration of “phenotypic aging” (using biomarkers of aging to predict a person’s mortality risk – every 1 year of phenotypic aging = 9% increased risk of mortality). Unhealthy lifestyle factors were partially responsible for this association, underscoring “the potential of lifestyle intervention as well as other strategies to promote healthy aging among adults who have already experienced childhood adversity.”
Puls HT, Chung PJ, Anderson C.
Universal Child Care as a Policy to Prevent Child Maltreatment. Pediatrics. 2022 Aug 1;150(2):e2022056660. PMID: 35909150
“Better access to quality child care might also reduce family stress, supervisory neglect, and families’ need to use inappropriate alternative caregivers, who may perpetrate physical or sexual abuse. Greater spending on child care for lower-income families has been associated with lower rates of maltreatment, foster care placements, and maltreatment-related fatalities…Given that 1 year’s incidence of investigated child maltreatment costs the United States economy an estimated $2 trillion, investments in child care and early education must be weighed against the maltreatment that they may prevent.”
Researchers
Churchill S, Largent EA, Taggert E, Lynch HF.
Diversity in IRB Membership: Views of IRB Chairpersons at U.S. Universities and Academic Medical Centers. AJOB Empir Bioeth. 2022 Aug 22:1-14. PMID: 35993964
Institutional Review Boards review and monitor biomedical research involving human subjects. “Diversity in Institutional Review Board (IRB) membership is important for both intrinsic and instrumental reasons, including fairness, promoting trust, improving decision quality, and responding to systemic racism. Yet U.S. IRBs remain racially and ethnically homogeneous, even as gender diversity has improved. In a survey of 388 IRB Chairs at universities and academic medical centers, chairs were predominantly white and about half female. Only half reported at least one racial/ethnically diverse member, with 85% reporting their boards were 85+% white. 64% of chairs reported satisfaction with their diversity.
Sachser C, Berliner L, Risch E, et. al.
The child and Adolescent Trauma Screen 2 (CATS-2) - validation of an instrument to measure DSM-5 and ICD-11 PTSD and complex PTSD in children and adolescents. Eur J Psychotraumatol. 2022 Aug 1;13(2):2105580. PMID: 35928521
“The study examined the psychometric properties of the Child and Adolescent Trauma Screen 2 (CATS-2) as a measure of posttraumatic stress disorder (PTSD) according to DSM-5 and (Complex) PTSD following the ICD-11 criteria in children and adolescents (7-17 years)…[it] enables clinicians and researchers to crosswalk between both diagnostic systems. International validation has proven good psychometric properties and presents cut-off scores. The CATS-2 is a license-free instrument and is freely accessible.”
White VanGompel E, Lai JS, Davis DA, et. al.
Psychometric validation of a patient-reported experience measure of obstetric racism© (The PREM-OB Scale™ suite). Birth. 2022 Sep;49(3):514-525. PMID: 35301757
“We sought to develop a valid patient-reported experience measure (PREM) of Obstetric Racism© in hospital-based intrapartum care designed for, by, and with Black women as patient, community, and content experts…The PREM-OB Scale™ suite is a valid tool to characterize and quantify obstetric racism for use in perinatal improvement initiatives.” The tool covers 3 factors, including "Humanity," measuring experiences of safety and accountability, autonomy, communication, and empathy; "Racism," measuring experiences of neglect and mistreatment; and "Kinship," measuring hospital denial and disruption of relationships between Black mothers and their child or support system.
Pavone V, Vescio A, Lucenti L, et. al.
Diagnostic Tools in the Detection of Physical Child Abuse: A Systematic Review. Children (Basel). 2022 Aug 20;9(8):1257. PMID: 36010147
After a detailed research review, authors found 7 child physical abuse screening tools, which were analyzed in detail, and all found to be suboptimal in various ways.
Others of Interest
Goolsby C, Schuler K, Krohmer J, Gerstner DN, Weber NW, Slattery DE, Kuhls DA, Kirsch TD. Mass Shootings in America: Consensus Recommendations for Healthcare Response. J Am Coll Surg. 2022 Jul 18. PMID: 36102547
The Uniformed Services University's National Center for Disaster Medicine and Public Health hosted a consensus conference of emergency medical services (EMS) clinicians, emergency medicine physicians (EM), and surgeons who provided medical response to six of the nation's largest recent mass shootings. The three groups created eight consensus recommendations in common that addressed readiness training, public education, triage, communication, patient tracking, medical records, family reunification, and mental health services for responders. Additional recommendations from the emergency medicine and surgery groups included trauma training for clinicians who don’t care for trauma patients, Stop the Bleed education for communities, modern systems to reach and recall staff, a plan for hospitals to rapidly increase capacity, and staffing plans for all categories of hospital leaders and employees.
Houry DE, Simon TR, Crosby AE.
Firearm Homicide and Suicide During the COVID-19 Pandemic: Implications for Clinicians and Health Care Systems. JAMA. 2022 May 17;327(19):1867-1868. PMID: 35536830
Firearms are the method of injury for most homicides and suicides (79% and 53%, respectively, in 2020). A recent report released by the US Centers for Disease Control and Prevention found a 35% increase in the firearm homicide rate in the US between 2019 and 2020, and with this increase, the firearm homicide rate in 2020 was the highest in more than 25 years….counties with higher poverty levels already had the highest firearm homicide rates, and these counties also experienced the greatest increases…In 2020, among males aged 10 to 24 years, non-Hispanic Black youth had the highest firearm homicide rate, and non-Hispanic American Indian or Alaska Native youth had the highest firearm suicide rate, and these groups experienced the largest rate increases from 2019… Health care professionals and systems have an essential role in comprehensive strategies to reduce violence and suicide and corresponding inequities in communities…Clinicians and health systems could intervene and prevent future violence through strategies such as counseling on lethal means, trauma-informed care, and hospital-based interventions.”
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