[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!]
Child Abuse
Westphaln KK, Pike NA, Li VR, Spurrier R, Imagawa KK.
Pediatric Hospital Admissions with Concern for Neglect: Correlations Between Neglect Types and Other Clinical and Environmental Risk Factors. Matern Child Health J. 2024 Sep;28(9):1539-1550. PMID: 38904903
Using data from one children’s hospital for children aged 0-5 years who were hospitalized with concern for neglect during 2016-2020, “The most common neglect types were inadequate nutrition (40%), inability to provide basic care (37%), intrauterine substance exposure (25%), combined types (23%), and inadequate medical care (10%)…Our findings highlight five specific types of neglect seen in an impoverished and ethnically diverse geographic region…Future studies should focus on prevention strategies, tailored interventions, and improved resource allocations.”
Collardeau F, U OL, K AY, Mayhue JG, Fairbrother N.
Prevalence and Course of Unwanted, Intrusive Thoughts of Infant-Related Harm. J Clin Psychiatry. 2024;85(3). PMID: 39145681
“Unwanted, intrusive thoughts (UITs) of infant-related harm are a common postpartum phenomenon and can be classified into thoughts of accidental harm (TAHs) and thoughts of intentional harm (TIHs).” From a study of 763 Canadian pregnant women, assessed twice postpartum, “The prevalence of TAHs and TIHs in the postpartum period was 95.8% and 53.9%, respectively. The most common TAHs included thoughts of the baby suffocating or dying from sudden infant death syndrome; the most common TIHs included thoughts of neglect…The most intense period for TAHs (5.74 weeks postpartum) and TIHs (within first 8 weeks postpartum) was identified. During this period, over 40% of participants reported moderate or extreme distress related to UITs. For most, UITs decreased in frequency or completely resolved by 6 months postpartum…Increased education is necessary to normalize and reduce distress associated with UITs.”
Hornor G, Jennings S.
Emergency Department Care for Prepubescent Patients Who Have Been Sexually Abused: Joint Position Statement. J Forensic Nurs. 2024;20(3):E50-e2. PMID: 39159245
“Pediatric patients who have been sexually abused should not be treated under the same policies or guidelines used in the adult emergency care setting…Although it may not be possible for all emergency care settings to offer pediatric SANE [sexual assault nurse examiner] services, all must be prepared to facilitate access within their community to appropriate facilities and examiners capable of providing a high-quality, evidence-based response for children who have been sexually abused.” In this position statement, the Emergency Nurses Association and the International Association of Forensic Nurses delineate guidelines for such care.
Kamke K, Kirkner A, Goodman KL.
"Nothing Was Done": Experiences of continued sexual abuse after disclosing to a mandated reporter among youth in the United States. Child Abuse Negl. 2024;155:106959. PMID: 39094279
Using data from 124 anonymous hotline chats with youth whose sexual abuse continued after a prior disclosure to a mandated reporter, “In most cases (71 %), the abuse was seemingly not reported or not investigated. Mandated reporters' belief of the victim and minimization of abuse affected reporting decisions. Some mandated reporters tried to address the abuse directly with the perpetrators, endangering victims. Rarely, mandated reporters did not report to respect the victim's wishes. In 24 % of cases, the victim described an investigation that did not result in protection. Victims indicated that investigators "sided to the perpetrator" or said there was not enough evidence. Some victims recanted, often in fear. In 6 % of cases, formal actions were taken but did not provide long-term protection. Victims described temporary cessation of abuse that resumed because their guardian(s) allowed the perpetrator to access them…Disclosing to a mandated reporter can engender traumatic experiences without resulting in long-term safety. Professionals need additional training.”
Koenig SM, Deng L, Onwubiko C, Beierle EA, Russell RT.
Pediatric Burn Injuries: Risk Factors for Increased Mortality. J Surg Res. 2024;301:584-90. PMID: 39089134
From a national database 2017-2019, “13,472 pediatric burn patients (≤14 y old) were identified. The overall mortality was low (<1%). Children with burns to multiple body regions had the highest independent risk of mortality…those from ages 5 to <10 y old had the highest risk of mortality (odds ratio = 11.40). Black children had a significantly higher mortality compared to White children. Nonaccidental burns carried a mortality that was twice that of accidental burns.”
Johnson K, Crumm C, Brown E.
Abusive Pediatric Burns Module in the Child Abuse Pediatrics Curriculum for Physicians (CAP-CuP). MedEdPORTAL. 2024;20:11429. PMID: 39184363
Abusive pediatric burns educational module. Training materials.
Tate AR, Fisher-Owens SA, Spiller L, et al.
Oral and Dental Aspects of Child Abuse and Neglect: Clinical Report. Pediatrics. 2024 Sep 1;154(3):e2024068024. PMID: 39155729
“The purpose of this clinical report is to review the oral aspects of abuse and dental neglect in children and the role of pediatricians, dental professionals, and other physicians in evaluating such conditions. This clinical report addresses recommendations on the evaluation of bite marks, as well as perioral and intraoral injuries, infections, and diseases that may raise suspicion for child abuse or neglect.”
Wensel S, Kerr G, Tamminen KA.
"The abuse of minors you witness or experience": A qualitative study of former professional ballet school students' characterizations of maltreatment. Child Abuse Negl. 2024;155:106982. PMID: 39151248
“Participants were 15 former professional ballet school students (12 women, three men) aged 18-27 years old across six countries…Themes included: 1) psychological maltreatment in and beyond the studio; 2) neglect and devaluation: costs of over-prioritizing ballet; 3) physical abuse: outdated but still rationalized as instrumental; and 4) sexual abuse in blurred private and public spaces… suggested a need for more ballet school community awareness about the multiple potential forms of harm of CM, as well as more research, intervention, and advocacy about CM at ballet schools.”
Adult Manifestations of Child Abuse
Beurel E, Nemeroff CB.
Early Life Adversity, Microbiome, and Inflammatory Responses. Biomolecules. 2024;14(7). PMID: 39062516
“Because the central nervous and immune systems are not fully mature at birth and continue to mature during the postnatal period, a bidirectional interaction between the central nervous system and the immune system has been hypothesized, with traumatic stressors during childhood being pivotal in priming individuals for later adult psychopathology. Similarly, the microbiome, which regulates both neurodevelopment and immune function, also matures during childhood, rendering this interaction between the brain and the immune system even more complex. In this review, we provide evidence for the role of the immune response and the microbiome in the deleterious effects of early life adversity.”
Baldwin JR, Coleman O, Francis ER, Danese A.
Prospective and Retrospective Measures of Child Maltreatment and Their Association With Psychopathology: A Systematic Review and Meta-Analysis. JAMA psychiatry. 2024;81(8):769-81. PMID: 38691376
From a research review, “Psychopathology is more strongly associated with retrospective measures--which capture the first-person, subjective appraisal of childhood events reflected in memory recall--compared to prospective measures--which essentially capture third-person accounts of such events. Maltreatment-related psychopathology may be driven by subjective interpretations of experiences, distressing memories, and associated schemas [negative patterns of how a person sees the world], which could be targeted by cognitive interventions.”
Karimov-Zwienenberg M, Symphor W, Peraud W, et al.
Childhood trauma, PTSD/CPTSD and chronic pain: A systematic review. PLoS One. 2024;19(8):e0309332. PMID: 39213321
“The findings of this systematic review highlight the importance of taking into account childhood trauma, in particular neglect and emotional abuse, in the study of PTSD/ComplexPTSD and chronic pain comorbidity in adults. The long-term impact of childhood trauma was further emphasized by…higher levels of PTSD and perceived distress later in life when compared to adulthood trauma. This review also included evidence on specific neurophysiological patterns in chronic pain patients with PTSD suggesting differential pain modulation processes following trauma, in particular childhood maltreatment.”
Fischer L, Wilson M, Schofield PW, et al.
Exposure to Childhood Adversity and Intimate Partner Violence in a Sample of Incarcerated Women in Australia. Int J Offender Ther Comp Criminol. 2024:306624x241270577. PMID: 39152669
Of 167 women in 3 Western Australia women's prisons, “94% of women had experienced at least one childhood adversity (median 6), and 94% reported being a victim of physical violence by a current or former intimate partner…There was an association between an increased number of ACEs and head injury with a loss of consciousness…Successful rehabilitation of women incarcerated for violent crimes should be cognizant of the histories of extreme violence endured by most of these women.”
Haim-Nachum S, Sopp MR, Lüönd AM, et al.
Childhood maltreatment is linked to larger preferred interpersonal distances towards friends and strangers across the globe. Translational psychiatry. 2024;14(1):339. PMID: 39179529
“Adults (N = 2986) from diverse cultures and socio-economic strata from 43 countries completed a reaction time task measuring CID [comfortable interpersonal distance] towards an approaching stranger and friend. Higher CM [childhood maltreatment] was linked to a larger CID towards both friends and strangers…These findings demonstrate for the first time that CM affects CID across countries and cultures, highlighting the robustness of this association.”
Stevens SK, Boley R, Pollack M, et al.
The influence of neuropeptide Y (NPY) on the relationship between emotion regulation and mood-related pathology in survivors of childhood interpersonal trauma. J Affect Disord. 2024;362:258-62. PMID: 38971192
Neuropeptide Y (NPY) is a 36-amino acid peptide (a protein) that is widely expressed throughout the limbic system (the emotion area of the brain). Recent evidence has highlighted NPY as a marker of resilience to posttraumatic psychopathology. Of 54 adult survivors of childhood interpersonal trauma, higher blood levels of NPY, assumed to be associated with higher brain levels, “decreased the association between emotion regulation and posttraumatic psychopathology in survivors of childhood interpersonal trauma. Further investigation of the contribution of NPY to psychopathology in this population is warranted.”
Lev-Wiesel R, Goldner L, Malishkevich Haas R, et al.
Adult Survivors of Child Sexual Abuse Draw and Describe Their Experiences of Dissociation. Violence Against Women. 2024;30(10):2655-73. PMID: 36794435
“The paper examined how dissociation is experienced and manifested in the drawings and narratives of female survivors of childhood sexual abuse (CSA) diagnosed with dissociative identity disorder…Two main themes emerged: a constant movement between internal and external worlds, and distorted perceptions of time and space.”
Kay SJ, Keefe JR, Milrod BL, Barber JP.
Childhood Trauma and Panic Disorder: The Impact of History of Child Abuse on Illness Severity and Treatment Response. Am J Psychother. 2024:appipsychotherapy20230060. PMID: 39104247
Of 200 patients being seen for panic disorder, those with a history of childhood abuse (HCA), compared to those without, experienced significantly more severe symptoms of panic disorder, agoraphobia, depression, psychosocial impairment, anxiety sensitivity, and personality disorder burden. A history of child abuse also predicted lack of response to applied relaxation training, but not to CBT or panic-focused psychodynamic psychotherapy. “The results of this study highlight the importance of HCA in formulating treatment recommendations.”
Luciani KR, Johal PK, Chao T, Thiessen KA, Schütz CG.
Adult self-reported childhood maltreatment types are associated with treatment satisfaction and alcohol relapse in patients with comorbid substance use and mental health disorders. Am J Addict. 2024;33(5):516-24. PMID: 38504581
Of 258 Canadian inpatients being treated for both mental health disorders and substance use disorders and who were surveyed for treatment satisfaction and relapse, childhood emotional neglect was associated with lower ratings across all treatment domains, and childhood physical neglect was associated with a lower rating for “outcome of care”. Childhood sexual abuse was associated with a greater likelihood of alcohol relapse.
Han YY, Celedón JC.
The effects of violence and related stress on asthma. Ann Allergy Asthma Immunol. 2024 Jul 26:S1081-1206(24)00479-4. PMID: 39069155
Despite certain research limitations, “the aggregate evidence from studies conducted in different locations and populations suggests that exposure to violence affects asthma and asthma outcomes, and that this is explained by direct physiologic effects of violence-related distress and indirect effects (e.g., through risky health behaviors or co-morbidities).”
Vyas CM, Wang S, Menor AM, et al.
Association between childhood abuse and risk of post-COVID-19 conditions: Results from three large prospective cohort studies. Brain Behav Immun. 2024 Aug 25;123:143-150. PMID: 39191351
Of 2851 participants responding from three large national studies, including the Nurses’ Health Studies 2 and 3, mean age 55.8 years, “We observed a dose-dependent relationship between severity of childhood abuse and post-COVID conditions [covid symptoms lasting longer than 1 month]; participants with severe versus no childhood abuse had a 42 % higher subsequent risk of post-COVID conditions. Key lifestyle, health-related, and psychological factors mediated 25.5 % of this association. Both sexual and physical/emotional abuse, were independently associated with post-COVID conditions.”
Adolescents
Senger-Carpenter T, Zhang A, Ordway M, et al.
Anxiety and Depression Symptoms, Adverse Childhood Experiences, and Persistent/Recurrent Pain Across Early Adolescence. Acad Pediatr. 2024 Aug 26:S1876-2859(24)00330-9. PMID: 39197577
From a national survey of 7951 youth, 31.9% reported persistent/recurrent pain (PRP). Higher levels of early ACE exposure were associated with an increased probability of having PRP. Early ACEs also had indirect effects on PRP via higher anxiety and depression symptoms. “Anxiety and depression symptoms are potentially important interventional targets to lower the risk for PRP among youth exposed to ACEs.”
Smith GC, Dolbin-MacNab M, Infurna FJ, et al.
Self-Reported Adverse Childhood Experiences and Risk for Internalizing and Externalizing Difficulties among Adolescent Custodial Grandchildren. Journal of child and family studies. 2024;33(3):982-97. PMID: 39184136
From an online survey of 342 custodial grandchildren (CG) aged 12-18 that included asking about 14 possible types of ACEs, 9% reported 0 ACEs, 48.6% reported 2-5 ACEs, and 30.5% reported 6+ ACEs. Bullying from peers strongly predicted internalizing disorder (such as depression, anxiety) risk. Externalizing disorder (such as anger, aggression) risk was highest among CG who were emotionally abused and encountered neighborhood violence. “The frequency and types of ACEs observed were alarmingly higher than those among the general population.”
Testa A, Jacobs B, Thompson J, et al.
Adverse Childhood Experiences and Police Contact in Canada. J Interpers Violence. 2024:8862605241270047. PMID: 39143752
From a study of 940 Canadian individuals aged 16-30, “individuals with high ACE exposure, particularly those with four or more ACEs, are more likely to have police contact. The results are significant in understanding the interplay between childhood trauma and later encounters with the criminal justice system, emphasizing the need for trauma-informed approaches in policing and healthcare.”
Domestic Violence – Effects on Children
Snyder-Fickler E, Alban C, Liu Y, et al.
What do child maltreatment reports to Child Protective Services tell us about the needs families and communities are experiencing? Children and youth services review. 2023;155. PMID: 39086908
“Utilizing CPS intake reports from a mid-sized urban county in the southeastern United States (N = 2,724)…Improper discipline/physical abuse was the most common maltreatment subtype (34.6%)…salient risk factors included caregiver drug use (20.6 %) and domestic violence (19 %)…Our coding system to extract and assess child maltreatment intake narrative data can provide local agencies with…nuanced details regarding the children's and families' needs.”
Desai S, Stanzo K, Benskin B, et al.
Intimate Partner Violence and Depression Screening of Mothers with Infants in the Neonatal Intensive Care Unit. Am J Perinatol. 2024 Oct;41(13):1789-1796. PMID: 38423031
Of 170 mothers with infants admitted to a Texas neonatal ICU after delivery, all answered “no” to a screening question of “Do you feel safe at home?” when admitted to the hospital. To the screening question “Do you feel sad?” 17% reported a history of depression. However, of 78 women who agreed to participate in a study and were screened with an Abuse Assessment Screen and EPDS (depression screen) 2 days, 2 weeks, and at discharge of their infant from the NICU, 33% of mothers had experienced some type of abuse in their lifetime, 20% reported past year physical and sexual abuse, while 17% were still afraid of their current abuser. In addition, 19% experienced physical abuse since the start of their pregnancy. Women with an abuse history also scored much higher for severe depression. “Our study shows basic intake questions critically underreport depression and abuse and do not distinguish among baby blues, clinical depression, and severe clinical depression. These cracks in the system indicate potentially depressed mothers with sick infants may be returning to an abusive home.”
Blangis F, Drouin J, Launay E, et al.
Maternal, prenatal and postnatal risk factors for early child physical abuse: a French nationwide cohort study. Lancet Reg Health Eur. 2024;42:100921. PMID: 39070743
Of 6,897,384 French infants, 2994 had a diagnosis of early child physical abuse (CPA), with median age of 4 months. Independent factors most strongly associated with early CPA were low financial resources (adjusted hazard ration aHR 1.91), maternal age < 20 years (aHR 7.06), maternal alcohol use disorder (aHR 1.85), opioid use disorder (aHR 1.90), intimate partner violence (aHR 3.33), diagnosis of a chronic mental disorder (aHR 1.50), hospitalization for a mental disorder (aHR 1.88), very preterm birth (aHR 2.15), and diagnosis of a chronic severe neurocognitive disorder in the infant (aHR 14.37).
Temple JR, Baumler E, Wood L.
Intimate Partner Violence and Parenting. JAMA Pediatr. 2024 Aug 26:e242705. PMID: 39186281
Of 337 Texas parents mean age 28.0 years, “compared with their counterparts without IPV experiences, parents who recently experienced IPV reported more stress, were less likely to use positive parenting strategies, and had higher potential for child maltreatment…these findings reinforce an urgent need to prevent IPV. They emphasize that child maltreatment prevention and healthy development promotion may benefit from interventions focusing on teaching positive parenting skills and clinical efforts to treat stress and anxiety among people who have experienced violent relationships.”
Fusco RA, Kulkarni SJ, Pless J.
"He gets mad that I'm sober": Experiences of substance use coercion among postpartum women in recovery. J Subst Use Addict Treat. 2024;164:209407. PMID: 38782092
“The study conducted qualitative interviews with 30 women with substance use disorders [SUD] who had given birth within the past six months… Analysis of the impact of IPV on substance use revealed four themes: 1) sabotaging sobriety, 2) making substance use a condition of the relationship, 3) portraying her as a "bad mom," and 4) furthering social isolation…Findings showed that women with SUDs have specific vulnerabilities that partners may exploit as a way of exerting control.”
McGlothen-Bell K, Cartagena D, Malin KJ, et al.
Reimagining Supportive Approaches at the Intersection of Mandatory Reporting Policies for the Mother-Infant Dyad Affected by Substance Use. Adv Neonatal Care. 2024 Oct 1;24(5):424-434. PMID: 39133542
“While policies aimed at protecting infants from child abuse and neglect are well intentioned, literature regarding the short- and long-term social and legal implications of mandatory reporting policies is emerging…We provide an overview of historical and current trends in mandatory reporting policies for nurses related to substance use in pregnancy and related ethical and social implications for mother-infant dyads…We offer recommendations for practice including the integration of respectful care and family-centered support for the mother-infant dyad affected by substance use.”
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