[Editor's note: Dr. Harise Stein at Stanford University edits a web site — abuseresearch.info — that focuses on the effects of abuse, and includes research articles on PACEs. Every month, she posts the summaries of the abstracts and links to research articles that address only ACEs, PCEs and PACEs. Thank you, Harise!! — Rafael Maravilla]
Child Abuse
Gaither JR.
National Trends in Pediatric Deaths From Fentanyl, 1999-2021. JAMA Pediatr. 2023 Jul 1;177(7):733-735. PMID: 37155161
“Fentanyl was implicated in 5194 of 13,861 (37.5%) fatal pediatric opioid poisonings between 1999 and 2021. Most deaths were among adolescents aged 15 to 19 years (89.6%) and children aged 0 to 4 years (6.6%). For all ages, 43.8% of deaths occurred at home, and 87.5% were unintentional…Fentanyl is now the primary agent noted in the pediatric opioid crisis. Mirroring trends seen among adults, pediatric deaths from fentanyl began to increase substantially in 2013, resulting in a more than 30-fold increase in mortality between 2013 and 2021. A surge that began in 2018 has led to a nearly 3-fold increase in deaths among older adolescents and a nearly 6-fold increase among children younger than 5 years.”
Camp EA, Greeley CS, Donaruma M, Isaac R.
Current Weight Status of Sexually Assaulted Pediatric Female Patients in an Emergency Department Setting. Child Obes. 2023 Oct;19(7):443-451. PMID: 36206056
Using data from a single pediatric ED (2016-2018) from identified female patients (6-17 years old) with a chief complaint of sexual assault, this group had a 67% increased odds of living with childhood obesity at the time of ED arrival when compared with trauma registry patients. “Further research is needed to identify the biopsychosocial implications for this relationship and the potential to augment clinical care.”
Naik-Mathuria B, Johnson BL, Todd HF, et al.
Development of the Red Flag Scorecard Screening Tool for Identification of Child Physical Abuse in the Emergency Department. J Pediatr Surg. 2023 Sep;58(9):1789-1795. PMID: 36841704
A screening tool ("Red Flag Scorecard") was developed utilizing available evidence-based findings and expert consensus, using a chart review of suspected or confirmed child physical abuse at a level 1 pediatric trauma center. “Of 408 cases, median age was 7 months and 60% were male. The majority (69%) were under 1 year of age. The most common history finding was delay in seeking care (58%), the most common physical exam finding was bruising located away from bony prominences (45%), and the most common imaging finding was unexplained brain injury (49%). The majority (84%) had at least 2 history findings. The combination score of at least 2 history findings and 1 physical/imaging finding was most sensitive (79%). The scorecard would have identified 94% of children who presented with no trauma history. The Red Flag Scorecard may serve as a quick and effective screening tool to raise suspicion for child physical abuse in emergency centers.”
Mele F, Introna F, Santoro V.
Child abuse and neglect: oral and dental signs and the role of the dentist. The Journal of forensic odonto-stomatology. 2023;41(2):21-9. PMID: 37634173
“Many of the injuries are within the scope of dentistry or easily observed by the dental professional during routine dental treatment, and it is essential that the dentist recognizes them. Concerning neglect, it is appropriate to make a distinction between deliberate parental behavior that has the consequence of unavoidable and voluntary neglect towards their children and those conditions of involuntary carelessness determined by socio-economic and cultural factors such as family isolation, lack of finances, parental ignorance, or lack of perceived value of oral health.”
Scheuplein M, Vermeulen S, van Harmelen AL, Alink L.
Child maltreatment and victimization. Handbook of clinical neurology. 2023;197:147-60. PMID: 37633707
“This chapter addresses one of the most societally pervasive consequences of child maltreatment which is known as the "cycle of victimization." This concept depicts the increased risk of maltreated individuals to victimize others later in life, both within and outside the family environment. To understand the architecture of this victimization cycle, the chapter further sheds light on neurocognitive mechanisms aiding different forms of victimization and the buffering role of social support that could help break the cycle of victimization.”
Kellogg ND, Farst KJ, Adams JA.
Interpretation of medical findings in suspected child sexual abuse: An update for 2023. Child Abuse Negl. 2023;145:106283. PMID: 37734774
“This review will summarize new data and recommendations regarding the interpretation of medical findings and sexually transmitted infections (STIs); assessment and management of pediatric patients presenting with suspected sexual abuse or assault; and testing and treating patients for STIs…reasons for changes are discussed.” Article contains multiple tables of updated information.
Tsur N, Talmon A, Shemesh N.
Peritraumatic Pain in Child Maltreatment: A Systematic Literature Review. Trauma Violence Abuse. 2023:15248380231194069. PMID: 37655587
Authors review the experience of pain with childhood maltreatment, and note that while there is research showing an association with childhood maltreatment (CM) and chronic pain later in life, only a small amount of research on pain “demonstrated its high intensity and prevalence in CM incidents, indicating that pain is inherently embedded in the experience of maltreatment.” There is also minimal research on the association of pain at the time and chronic pain later.
Sylvestre A, Di Sante M, Julien C, Bouchard C, Mérette C.
Developmental trajectories of speech and language in neglected children aged 3 to 5 years: Results of the ELLAN study. Child Abuse Negl. 2023;146:106448. PMID: 37722293
“Participants are 69 neglected children and 99 same age non-neglected peers (37 and 46 males respectively) recruited at 36 months of age. Data were collected at home…at six-month intervals between the ages of 3 and 5.5 years using psychometrically robust tools…A large proportion of neglected children present significant speech and language difficulties from the age of 3, but some of them catch up and develop similarly to non-neglected children.”
Kang J, Rodriguez CM.
Spanking and executive functioning in US children: A longitudinal analysis on a matched sample. Child Abuse Negl. 2023;146:106474. PMID: 37742555
Using a representative sample of US children aged 5 to 6, “spanking at age 5 was associated with lower inhibitory control [leading to impulsivity and distractibility] and lower cognitive flexibility [difficulty adapting to change] at age 6, but was not significantly predictive of later working memory. The association with inhibitory control was observed even for low frequency spanking. No evidence of moderation by child gender, parent race/ethnicity, and parental warmth was identified.”
Adult Manifestations of Child Abuse
Papalia N, Spivak BL, Ashford L, et al.
Sexual abuse during childhood and all-cause mortality into middle adulthood: an Australian cohort study. Med J Aust. 2023 Oct 2;219(7):310-315. PMID: 37612256
2759 people (79.8% women) who had experienced medically assessed contact sexual abuse in Victoria while aged 16 years or younger during 1964-1995 were linked to a national mortality database. 115 people under age 50 from this group died (4.2%). In each age group from 15-19 years, the mortality rates for people sexually abused as children were higher than for the general population, and highest for people aged 25-29 years. The age- and sex-adjusted mortality rate was higher than in the general population for all-cause (incident rate ratio 8.25), internal cause (IRR 5.92), and external cause deaths (IRR 12.6). The differences in external cause mortality were greater for people who had experienced penetrative (IRR 14.9) than for those who had experienced non-penetrative sexual abuse as children (IRR, 8.92).
Segal L, Hiscock H.
Child abuse and premature mortality: disrupting the harm cascade. Med J Aust. 2023 Oct 2;219(7):301-302. PMID: 37622210
In an editorial regarding the above article: “Disrupting the inter-generational transmission of trauma — whereby a parent who has suffered serious child abuse does not provide a safe and nurturing environment for their own child, despite their desperate wish to be a good parent — is critical. A regional family hub could provide a platform for improving the skills and capacity of health, education, justice, and social care workers and facilitate a whatever-it-takes service response, driven by a deep understanding of complex trauma to meeting the needs of distressed families in a timely fashion. While such a model may seem radical, something has to change. The terrible health, social, and monetary costs of child abuse and neglect are indefensible on ethical, medical, and financial grounds.”
Basile KC, Chen J, Smith SG, Clayton HB, Simon TR, Mercy JA.
Violent Victimization During Childhood in the United States: Violence Vict. 2023 Jun 1;38(3):375-395. PMID: 37308183
This CDC national phone survey “examined the prevalence and characteristics of five forms of childhood violence victimization and their association with revictimization and negative health conditions among adults…Ages 14-17 were the most common age at first victimization for most violence types; almost half of male (46.7%) and a quarter of female (27.0%) rape victims reported first victimization before age 10. Most victimization was associated with revictimization and negative health, controlling for adult victimization. Primary prevention of childhood violence may reduce later health risks.”
Convertino AD, Mendoza RR.
Posttraumatic stress disorder, traumatic events, and longitudinal eating disorder treatment outcomes: A systematic review. Int J Eat Disord. 2023 Jun;56(6):1055-1074. PMID: 36916450
From a research review, results indicated that while traumatic event exposure was associated with greater eating disorder treatment dropout and greater post-treatment relapse, individuals with a traumatic event history still benefited from treatment similarly to their unexposed peers.
Deol E, Siddiqui Z, Paracha A, et al.
Exploring the link between ACEs and opioid use: A systematic review. Journal of opioid management. 2023;19(4):343-64. PMID: 37644792
From a research review, “Increased frequency of ACEs was directly related to increased risk of OUD [opioid use disorder] and lower onset age. ACEs were also associated with OUD severity. ACEs linked to OUD included childhood neglect, emotional abuse, physical abuse, and sexual abuse. Additionally, dysfunctional childhood home environment, female gender, and psychiatric/behavioral comorbidities increased the risk of OUD, while resilience was found to be a protective factor.”
Lee HY, Song J, Choi EY.
Childhood abuse and opioid prescription use in adulthood: Differences between non-Hispanic Whites and non-Hispanic Blacks in the United States. PLoS One. 2023;18(9):e0291752. PMID: 37733706
From a US national midlife study, “Among non-Hispanic Whites, higher exposure to physical abuse during childhood was associated with greater odds of opioid prescription use in adulthood, even after adjusting for chronic pain, physical and mental health, and sociodemographic characteristics. However, the association…was non-significant among non-Hispanic Black individuals.”
Zhu J, Racine N, Devereux C, Hodgins DC, Madigan S.
Associations between adverse childhood experiences and substance use: A meta-analysis. Child Abuse Negl. 2023:106431. PMID: 37689565
From a research review, “Pooled effect sizes between ACEs and smoking [OR = 1.803], problematic alcohol use [OR = 1.812], heavy alcohol use [OR = 1.537], cannabis use [OR = 1.453] and illicit drug use [OR = 1.695] were significant. Significant moderators contribute to the understanding of the association between ACEs and substance use, and are discussed extensively.”
Madigan S, Deneault AA, Racine N, et al.
Adverse childhood experiences: a meta-analysis of prevalence and moderators among half a million adults in 206 studies. World Psychiatry. 2023;22(3):463-71. PMID: 37713544
“In total, 206 studies from 22 countries, with 546,458 adult participants, were included. The pooled prevalence of the five levels of ACEs was: 39.9% for no ACE; 22.4% for one ACE; 13.0% for two ACEs; 8.7% for three ACEs, and 16.1% for four or more ACEs…there was strong evidence that the prevalence of 4+ ACEs was higher in populations with a history of a mental health condition (47.5%) and with substance abuse or addiction (55.2%), as well as in individuals from low-income households (40.5%) and unhoused individuals (59.7%). There was also good evidence that the prevalence of 4+ ACEs was larger in minoritized racial/ethnic groups…Thus, ACEs are common in the general population, but there are disparities in their prevalence…Both prevention strategies and downstream interventions are needed to reduce the prevalence and mitigate the severity of the effects of ACEs and thereby reduce their deleterious health consequences on future generations.”
Kindermann D, Rollmann I, Orth M, et al.
Direct and indirect effects of adverse and protective childhood experiences on symptom improvement in psychotherapy. Psychother Res. 2023:1-16. PMID: 37706484
In an assessment of 648 completed outpatient psychotherapies, “The presence of adverse childhood experiences was directly associated with a slower improvement rate in psychotherapy. Moreover, a higher number of adverse childhood experiences was associated with greater impairments in the ability to communicate…which in turn was associated with a slower improvement of symptoms. Protective childhood experiences were associated with fewer impairments in specific dimensions of personality functioning, but had no direct effect on the improvement rate.”
Hong SH, Yu CL, Rousson AN, et al.
Examining the Association Between Trauma Characteristics and Adult Depression and Anxiety: Analysis of Types, Variety, Repetition, and Timing of Past Trauma. J Interpers Violence. 2023:8862605231198056. PMID: 37728007
Of 356 community adults reporting on 5 types of childhood trauma, “On average, participants experienced two out of the five trauma types. Regardless of the type, having at least one traumatic experience was linked to higher depression and anxiety scores. Those who experienced all five trauma types reported the highest levels of depression and anxiety. Repeated instances of rape, witnessing trauma to loved ones, and the death of loved ones were significantly associated with elevated depression and anxiety scores.”
Rogerson O, Baguley T, O'Connor DB.
Childhood Trauma and Suicide. Crisis. 2023;44(5):433-41. PMID: 36537105
Of 457 UK individuals who reported experiencing suicide ideation in the past 12 months, “Childhood trauma and its subtypes were associated with an increased risk of reporting recent suicide thoughts, COVID-19-related suicide attempts, and recent suicide attempts. There were also significant indirect effects of childhood trauma on recent suicide ideation and well-being through executive functioning and impulsivity.”
Ward LG, Bublitz M, Sokol N, Brown S, Stroud LR.
Experiences of maltreatment in childhood are associated with increasing anxiety and lower body acceptance over pregnancy. J Psychosom Res. 2023;172:111414. PMID: 37354747
Of 299 pregnant participants from two larger ongoing studies, childhood sexual abuse survivors experienced a greater increase in anxiety over pregnancy compared to other groups. Both childhood sexual abuse and “other” maltreatment groups exhibited lower body acceptance during pregnancy.
Ahn J, Lee SW, Kim K, Jin B, Chung US.
The Relationship Between Childhood Trauma Experience and Complicated Grief: The Importance of Psychological Support for Individuals Coping With Pet Loss in Korea. Journal of Korean medical science. 2023;38(37):e305. PMID: 37724498
Of 137 Korean adults who experienced pet loss, “People who experienced pet loss had significant psychological symptoms, ranging from 32% to 55%. Childhood trauma experiences affect complicated grief, depressive symptoms, anxiety symptoms, insomnia and prolonged grief disorder after pet loss. After pet loss, people with childhood trauma may require more psychological help than those without trauma.”
Zhou A, Ryan J.
Biological Embedding of Early-Life Adversity and a Scoping Review of the Evidence for Intergenerational Epigenetic Transmission of Stress and Trauma in Humans. Genes. 2023;14(8). PMID: 37628690
“We provide an overview of studies in animals and humans that demonstrate the effects of early-life stress on DNA methylation, one of the most widely studied epigenetic mechanisms, and summarize findings from animal models demonstrating the involvement of epigenetics in the transmission of stress across generations…We end with a discussion of key areas for future research to advance understanding of the role of epigenetics in the legacy effects of stress and trauma.”
Scorza P, Duarte CS, Lee S, et al.
Stage 2 Registered Report: Epigenetic Intergenerational Transmission: Mothers' Adverse Childhood Experiences and DNA Methylation. J Am Acad Child Adolesc Psychiatry. 2023;62(10):1110-22. PMID: 37330044
Of 896 mother-infant pairs, there was no correlation with maternal ACE score and DNA methylation in maternal blood, however there was a correlation with maternal ACE score and methylation in cord blood of male infants only. Maternal anxiety or depression did not modify cord blood methylation. Methylation sites were related to mitochondrial function and neuronal development in the cerebellum (part of the brain controlling balance and coordinated movement).
Adolescents
Fung HW, Cong CW, Tan CS, Yuan GF, Liu C, He KL, et al.
Is teacher violence a form of betrayal trauma? Relationship with mental health problems among young adults. Child Abuse Negl. 2023;145:106436. PMID: 37690435
“Considering the substantial amount of time that young people spend in school during their early years, it is important to understand the potential impacts of teachers' behaviors on students' mental health.” From an international sample of 283 young adults aged 18-24, exposure to teacher violence “could be reliably and validly measured using the Teacher Violence Scale (TVS). Current mental health problems - including depressive symptoms, post-traumatic stress, and alcohol misuse - were associated with exposure to teacher violence during high school years…Our findings expand the application of the betrayal trauma theory to school settings and point to the importance of preventing and managing teacher violence.”
Liu J, Teh WL, Tan RHS, et al.
Sleep disturbance as transdiagnostic mediator between adverse childhood experiences and psychopathology in children and adolescents. JCPP Adv. 2023;3(3):e12156. PMID: 37720578
From a research review, the pooled correlations among ACEs, sleep disturbance, and psychopathology were significant; the effect sizes ranged from moderate to high. The indirect effect from ACEs via sleep disturbance to psychopathology was significant, and the direct effect of ACEs on psychopathology was significant.
Islam MI, Salam SS, Kabir E, Khanam R.
Identifying Social Determinants and Measuring Socioeconomic Inequalities in the Use of Four Different Mental Health Services by Australian Adolescents Aged 13-17 Years: Results from a Nationwide Study. Healthcare (Basel, Switzerland). 2023;11(18). PMID: 37761734
From a national Australian adolescent sample, “Overall, 31.9% of the total analytical sample (n = 2268) aged 13-17 years old visited at least one mental health service, with 21.9% accessing a single service and 10% accessing multiple services. The highest percentage of adolescents used online services (20.1%), followed by general mental health services (18.3%), while school services (2.4%) were the least used service. Age, gender, family type and family cohesion significantly increased the use of mental health service usage.” Area of residence was also found to be a significant factor, with teens in richer socioeconomic areas using online services and poorer areas using telephone services. Authors stress the e need to tailor approaches to ten socioeconomic backgrounds.
McCarthy V, Wright-Kelly E, Steinhart B, et al.
Assessment of Reported Time to Access a Loaded Gun Among Colorado Adolescents. JAMA Pediatr. 2023 May 1;177(5):543-545. PMID: 36972035
“Time to access a firearm matters; nearly half of individuals who attempted suicide reported time between ideation and action of under 10 minutes.” From a voluntary, anonymous survey of 41,090 Colorado middle and high school students, 32.3% reported any access to a firearm. Of those, over 25% reported access in under 24 hours and 12.1% in under 10 minutes. A higher proportion of males than females reported access. The highest proportion of access was reported by students who identified as American Indian/Alaska Native (17.5% reported access in <10 minutes), followed by those identifying as White or multiracial or multiethnic. Nearly 40% of students living in rural and town settings reported access to firearms, with roughly 17% reporting access in under 10 minutes. Differences in access by age and sexual orientation were negligible.
Lewis-de Los Angeles WW.
Adverse childhood experiences and accelerometer-measured physical activity and sleep in pre-adolescents. Acad Pediatr. 2023 Sep 23:S1876-2859(23)00364-9. PMID: 37748537
From a national study of pre-adolescents (mean age 11.9 years), there was a dose response relationship between ACEs and reduced daily steps, total sleep duration, and REM sleep.
Weiss NH, Goncharenko S, Forkus SR, Ferguson JJ, Yang M.
Longitudinal Investigation of Bidirectional Relations Between Childhood Trauma and Emotion-Driven Impulsivity in the Adolescent Brain Cognitive Development Study. J Adolesc Health. 2023;73(4):731-8. PMID: 37410001
From a sample of 11,872 9-10 year olds recruited from 21 research sites across the United States, “earlier childhood trauma was associated with higher levels of later negative and positive emotion-driven impulsivity…did not differ by sex…may serve as a point of intervention to reduce subsequent risk for deleterious health outcomes.”
Ojeleye OA, Beckie TM, Oruche UM.
Psychosocial Factors Associated With Perinatal Anxiety and Perinatal Depression Among Adolescents: A Rapid Review. J Psychosoc Nurs Ment Health Serv. 2023:1-10. PMID: 37646603
Factors identified in pregnant adolescents’ depression were: “Social factors included adolescent caregiver trust/attachment, social support, perceived social support, trauma/poly-traumatization, and peer solidarity. Cultural factors included feelings of shame, marital satisfaction, partner's rejection of pregnancy, lack of parental involvement in care, parenting stress, childhood household dysfunction, and adverse childhood events. Environmental factors included neighborhood support, food insecurity, domestic violence, going to church, going out with friends, and sources for obtaining information. Routine assessment of psychosocial factors among perinatal teens is crucial to identify those at higher risk for perinatal anxiety and depression.”
DV – Effects on Children
Maruyama JM, Valente JY, Tovo-Rodrigues L, et al.
Maternal depression trajectories in childhood, subsequent maltreatment, and adolescent emotion regulation and self-esteem: the 2004 Pelotas birth cohort. Eur Child Adolesc Psychiatry. 2023;32(10):1935-45. PMID: 35731302
In this long-term study of Brazilian children and their mothers, maternal depression was negatively associated with offspring self-esteem and emotion regulation at age 15 compared to a group with low maternal depression, while child maltreatment significantly increased negative outcomes. There were no sex differences in child outcomes.
Williams A, Parlier-Ahmad AB, Thompson E, et al.
Peripartum Traumas and Mental Health Outcomes in a Low-Income Sample of NICU Mothers. Children (Basel, Switzerland). 2023;10(9). PMID: 37761438
Of “119 lower-income, racially diverse mothers in a Level IV NICU, mental health concerns were prevalent and highly comorbid, including 51.3% postpartum anxiety, 34.5% postpartum depression, 39.5% post-traumatic stress, and 37% with ≥4 ACEs.” 53.8% of mothers reported multiple peripartum traumas. NICU admission was the most common trauma (61%), followed by birth (19%), pregnancy (9%), and a medical event in the NICU (9%). ACEs predicted peripartum distress. “Trauma-informed care efforts should…recognize that women commonly present to the NICU with childhood trauma history and cumulative peripartum traumas.”
Lamar CE, Jain D, Schmitz KH.
Perils of Auto-Population of Newborn EHR With Maternal Intimate Partner Violence History. Pediatrics. 2023 Oct 1;152(4):e2022060189. PMID: 37712123
“We discuss a case where documentation of intimate partner violence and the safety plan documented in a mother's electronic health record automatically populated her newborn's admission note. This confidential information inadvertently became accessible to the perpetrator: the infant's father.”
Jackson KT, Marshall C, Yates J.
Health-Related Maternal Decision-Making Among Perinatal Women in the Context of Intimate Partner Violence: A Scoping Review. Trauma Violence Abuse. 2023:15248380231198876. PMID: 37728102
From a research review, “Three main themes emerged regarding health-related maternal decision-making by mothers experiencing IPV, including suboptimal breastfeeding practices, under-utilization of maternal and child health services, and poor adherence to medical recommendations/regimens that impact health-related outcomes for mother and child. The well-established risk of poorer health outcomes among women experiencing IPV, alongside the findings of this scoping review, calls for further research specifically addressing health-related decision-making among perinatal women who experience IPV.”
Smith JN, Guttmann A, Kopp A, et al.
Association of maternal risk factors with infant maltreatment: an administrative data cohort study. Arch Dis Child. 2023 Sep 27:archdischild-2022-325239. PMID: 37758290
Of almost 1 million Canadian infants born with linked database information, 0.04% had recorded maltreatment. Maternal age <22 years conferred higher risk of infant maltreatment (adjusted odds ratio 5.5) compared with age ≥22 years. Maternal mental health diagnoses were also associated with maltreatment (aOR 2.0), while refugee status appeared protective (aOR 0.6). The odds of maltreatment increased with higher numbers of maternal risk factors. Maternal age was associated with maltreatment until age 28 years.
Loveday S, Balgovind M, Hall T, Goldfeld S, Sanci L, Hiscock H.
Emotional work of getting help: a qualitative analysis of caregiver-perceived barriers to responding to childhood adversity. Arch Dis Child. 2023;108(10):857-61. PMID: 37290933
From interviews with 17 Australian caregivers of small children on efforts to obtain services from both health and social care sectors, “Five main themes emerged. (1) Emotional work of getting help. Caregivers described that getting help for life challenges was both emotionally taxing and effortful. (2) Trusting relationships are key. Engagement was related to the degree of relational practice and whether they felt judged or demeaned. (3) Wanting to manage on your own. There was a strong desire by caregivers to be independent and to only seek help when it was absolutely necessary. (4) Importance of knowing help was available and how to access it. (5) Overcoming service access barriers including long waiting times, restricted service criteria, transport issues and out-of-pocket expenses.”
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