Adversity experienced during childhood manifests deleteriously across the lifespan. This study provides updated frequency estimates of ACEs using the most comprehensive and geographically diverse ...sample to date.
ACEs data were collected via BRFSS (Behavioral Risk Factor Surveillance System). Data from a total of 211,376 adults across 34 states were analyzed. The ACEs survey is comprised of 8 domains: physical/emotional/sexual abuse, household mental illness, household substance use, household domestic violence, incarcerated household member, and parental separation/divorce. Frequencies were calculated for each domain and summed to derive mean ACE scores. Findings were weighted and stratified by demographic variables. Group differences were assessed by post-estimation F-tests.
Most individuals experienced at least one ACE (57.8%) with 21.5% experiencing 3+ ACEs. F-tests showed females had significantly higher ACEs than males (1.64 to 1.46). Multiracial individuals had a significantly higher ACEs (2.39) than all other races/ethnicities, while White individuals had significantly lower mean ACE scores (1.53) than Black (1.66) or Hispanic (1.63) individuals. The 25-to-34 age group had a significantly higher mean ACE score than any other group (1.98). Generally, those with higher income/educational attainment had lower mean ACE scores than those with lower income/educational attainment. Sexual minority individuals had higher ACEs than straight individuals, with significantly higher ACEs in bisexual individuals (3.01).
Findings highlight that childhood adversity is common across sociodemographic, yet higher in certain categories. Identifying at-risk populations for higher ACEs is essential to improving the health outcomes and attainment across the lifespan.
Full text
Available for:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Objective
The aim of this meta‐analysis was to better understand the magnitude and consistency of the association between childhood adversity and borderline personality disorder (BPD) across ...case–control, epidemiological and prospective cohort studies.
Method
Following the review protocol (reference: CRD42017075179), search terms pertaining to adversity and BPD were entered into three search engines. Random‐effects meta‐analysis synthesised the size and consistency of the effects.
Results
A total of 97 studies compared BPD to non‐clinical (k = 40) and clinical (k = 70) controls. Meta‐analysis of case–control studies indicated that individuals with BPD are 13.91 (95% CI 11.11–17.43) times more likely to report childhood adversity than non‐clinical controls. This effect was smaller when considering retrospective cohort (OR: 2.59; 95% CI 0.93–7.30) and epidemiological (OR: 2.56, 95% CI 1.24–5.30) studies. Findings were significant across adversity subtypes with emotional abuse (OR: 38.11, 95% CI: 25.99–55.88) and neglect (OR: 17.73, 95% CI = 13.01–24.17) demonstrating the largest effects. Individuals with BPD were 3.15 (95% CI 2.62–3.79) times more likely to report childhood adversity than other psychiatric groups.
Conclusions
This meta‐analysis corroborates theoretical proposals that exposure to adverse life experiences is associated with BPD. It highlights the importance of considering childhood adversity when treating people diagnosed with BPD.
Full text
Available for:
BFBNIB, DOBA, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, SIK, UILJ, UKNU, UL, UM, UPUK
Adverse childhood experiences (ACEs) before the age of 18 years are pervasive and noteworthy public health concerns. The ACEs are associated with sleep disorders in later life. In this study, we ...conduct a systematic review to explore the effects of ACEs on sleep in adulthood. Using Medical Subject Headings keywords, we searched Medline, PubMed, PubMed Central, the American Psychological Association PsycArticles, and PsychInfo databases to evaluate the association between ACEs and sleep disturbances. ACEs increase the odds of developing chronic short sleep duration, that is, <6 hours of sleep per night compared with optimal sleep duration of 7–9 hours per night during adulthood. The ACEs are positively associated with poor sleep characteristics such as short sleep duration and long-term sleep problems. Clinicians should pay close attention to developmental trauma care, access community health programs, and help develop better coping skills, resiliency, and good sleep habits in their patients.
•The frequency of adverse childhood experiences (ACEs) was almost double among schizophrenic patients than in control subjects.•The history of multiple ACEs is associated with more severe ...symptomatology.•Trauma multiplicity is also associated with more severe suicidal behavior, and this is observed in women.
The current study aims to compare the prevalence of adverse childhood experiences (ACEs) between patients with schizophrenia and non-psychiatric control group, and to analyze the association of having suffered multiple ACEs with clinical symptoms of schizophrenia and suicidal behavior. A multicenter, cross-sectional study was conducted across three facilities in Buenos Aires, Argentina. One-hundred patients with schizophrenia and 50 healthy subjects were assessed with the Adverse Childhood Experiences questionnaire (ACE-Q), the Positive and Negative Syndrome Scale (PANSS), and the Columbia-Suicide Severity Rating Scale (C-SSRS). We observed that the prevalence of at least one ACE in schizophrenic patients was almost double in comparison with the non-psychiatric control group. Multiple ACEs were associated with persistent auditory hallucinations and lower negative symptoms in both sexes. Higher frequency of death ideation and a higher number of suicide attempts were reported among women. The strength of this study is the possibility of comparing the presence of ACEs between schizophrenic patients and non-psychiatric control using the same questionnaire in an under-reported sample of low socio-economic patients assisted in public hospitals. A limitation is that the history of ACEs relied on the retrospective assessment of childhood experiences, and adults could over-report ACEs because of recall bias.
Full text
Available for:
GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
•A scoping review investigating biological measures of adverse childhood experiences (ACEs) in adulthood.•Forty studies were identified, with ACEs often measured retrospectively.•Studies identified ...biomarkers related to inflammation, cardio/metabolic systems, genetics, and endocrine systems.•Studies also identified biomarkers related to composite indices of multiple physiological systems.•Health behaviors, social relationships, psychopathology and socioeconomic factors may help explain some associations.
Adverse Childhood Experiences (ACEs) are stressful and/or traumatic experiences that occur during childhood. Research has demonstrated a link between ACEs and risk of physical and mental health disorders, where early life adversity may become “biologically embedded” and have wide-ranging effects on various physiological systems. The aim of this study was to identify the extent and breadth of recent research activity relating to biological measures of ACEs in adulthood. We undertook a scoping review including published research articles. Medline and PsycINFO were searched for articles from 2007 to July 2017. Articles were eligible if they included adult participants, were written in English, and reported on a biomarker of childhood adversity in adulthood. Forty articles met our inclusion criteria. Studies investigated a range of ACEs that were often measured retrospectively. The studies identified biomarkers related to inflammation (e.g., CRP), cardio/metabolic systems (e.g., BMI), genetics (e.g., telomere length), and endocrine systems (e.g., cortisol), as well as composites of multiple physiological systems. However, not every study identified found significant associations. Health behaviours, emotional distress, social relationships, and socioeconomic factors may help explain some of these associations. Further research is needed to better understand biomarkers of ACEs in adulthood and their relationship to health conditions.
Full text
Available for:
GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK, ZRSKP
Adverse childhood experiences (ACEs) are associated with increased risk of poor mental health outcomes. Although there is interest in screening for ACEs for early identification and intervention, it ...is not known whether screening improves outcomes for children.
To systematically review whether screening for ACEs in children leads to an increase in (1) identification of ACEs, (2) referrals to services, (3) increased uptake of services, and (4) improved mental health outcomes for children and parents.
Ovid Medline, PsycINFO, CINAHL, and Center for Clinical and Translational Research electronic databases were searched between 2009 and 2021.
Studies were included if researchers screened for current ACEs in children aged 0 to 12 years and they had a control comparison.
Information was extracted, including study characteristics, sample demographics, screening tool characteristics, referral rates to services, uptake rates, and mental health outcomes.
A total of 5816 articles were screened, with 4 articles meeting inclusion criteria. Screening for ACEs increases identification of adversity and may increase referrals to services. There are limited data about whether this leads to an increase in referral uptake by families. There are no reported data addressing mental health outcomes.
There are few published control trials of moderate quality.
There is limited evidence that screening for ACEs improves identification of childhood adversity and may improve referrals. If we are to realize the hypothesized benefits of ACEs screening on child and parent mental health, it is essential to understand the barriers for families taking up referrals.
Abstract
Introduction
Individuals with early life adversity (ELA) experience a greater likelihood of sleep disturbance. Sleep disturbance is a hypothesized mechanism underlying the association ...between ELA and adverse health outcomes. However, it is unclear whether sleep disturbance presents differently in individuals with ELA when compared to individuals without ELA. Network analysis provides an analytic framework to examine the relationships and magnitudes of association between symptoms of sleep disturbance. Using a network framework, we investigated the differences in sleep disturbance symptoms between individuals with ELA and individuals without ELA.
Methods
College students (N=507; age=18±1, Female=72%) completed demographic measures, the Childhood Trauma Questionnaire (CTQ), and the Pittsburgh Sleep Quality Index using an online data collection platform from March-December 2020. Using clinical cutoffs, individuals with ELA were separated from individuals without ELA. Using the Pittsburgh Sleep Quality Index (PSQI; alpha=0.79), sleep disturbance was assessed. Two 7-node ELA-specific networks were generated using raw values for the 7 components of the PSQI. To assess network accuracy, stability coefficients were estimated using the ‘bootnet’ and ‘qgraph’ packages in R. The strength of association between each component and all other components of sleep disturbance were estimated using expected influence (EI). Network structures and measures of EI were examined for differences between exposure groups.
Results
Overall, the average global PSQI score was 7.50±3.37. Individuals with ELA had larger global PSQI scores when compared to individuals without ELA (8.18 versus 6.97, t=3.8, p<0.001, d=0.37). For individuals with ELA, sleep quality, duration, and efficiency were most associated with other symptoms of sleep disturbance. For individuals without ELA, subjective sleep quality, sleep latency, and daytime dysfunction were most related to other symptoms of sleep disturbance. Individuals with ELA demonstrated a more interrelated network structure, with greater raw measures of EI in most components of the PSQI.
Conclusion
For individuals with ELA, duration and efficiency strongly underly sleep disturbance. Moreover, most symptoms had greater measures of EI in individuals with ELA when compared to individuals without ELA, suggesting that symptoms of sleep disturbance may be more likely to co-occur in individuals with ELA. Future research may explore the utility of these symptoms in predicting adverse health outcomes.
Support (if any):
Adverse Childhood Experiences (ACEs) screening in healthcare settings is emerging as one of the tangible responses to address the consistent evidence linking ACEs with health. Kaiser Permanente ...Southern California (KPSC) began ACEs screening in pediatric primary care in 2018 and has developed screening and referral processes based on continued feedback from stakeholders as well as data driven assessment.
We give an overview of the state of ACEs screening in pediatric healthcare settings, challenges facing pediatric providers, and suggestions to address them. We then describe the development of our ACEs screening and referral process within KPSC as an example of how a large healthcare system has implemented and adapted ACEs screening from pilot testing, to phased expansion, to complete implementation.
Children aged 2–18 years old who were members of KPSC 2018–2023.
We present data on the tailored screening and referral workflows we have developed, rates of positive screens and referrals, and how the initiation of ACEs screening may affect the rates of visit to behavioral health as a treatment option. We also integrate qualitative data to demonstrate the perspective of parents, with the goal of understanding what might help or hinder receipt of behavioral health treatment after ACEs screening.
We close with future directions for ACEs screening in healthcare settings and considerations for pediatric healthcare providers who may want to begin ACEs screening or adapt their screening and referral processes.
Full text
Available for:
GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
When a serious health or social problem is identified as both prevalent and in need of attention, a common response is to propose that various systems implement routine identification, such as ...universal screening. However, these well-intentioned responses often fail to consider the key requirements necessary to determine whether benefits outweigh harms. Unfortunately, this continues to be the case for calls to implement routine screening for Adverse Childhood Experiences (ACEs). Persistent evidence gaps for this type of screening include the lack of any randomized controlled trials demonstrating that ACEs screening programs lead to any benefits. Rather than being informed by established screening principles, the calls to proceed with ACEs screening appear to rely on the assumption that simply identifying risk factors can lead to beneficial outcomes that outweigh any risk of harms. This may reflect a gap in understanding that patterns identified at the population level (e.g., that more ACEs are associated with more health and social problems) cannot be directly translated to practices at the level of the individual. This commentary does not question the importance of ACEs; rather it identifies that directing limited resources to screening approaches for which there is no evidence that benefits outweigh harms is problematic. Instead, we advocate for the investment in high-quality trials of prevention interventions to determine where best to direct limited resources to reduce the occurrence of ACEs, and for the prioritization of evidence-based treatment services for those with existing health and social conditions, whether or not they are attributed to ACEs.
Full text
Available for:
GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Ample evidence supports significant and enduring associations between adverse childhood experiences (ACEs) and negative outcomes later in life. Subsets of ACEs (e.g. childhood maltreatment and ...household dysfunction) have been examined in Chinese populations, but no known study has comprehensively examined the full constellation of different types of ACEs or patterns of ACE exposure in Chinese samples. As a direct response to the call to establish a global ACEs surveillance framework, this study provides the first translation and validation of the World Health Organization ACE – International Questionnaire (ACE-IQ). Further, patterns of ACE exposure were identified through latent class analysis. The 29-item ACE-IQ was translated and back-translated from English to traditional Chinese to measure exposure to 13 categories of ACEs. The Chinese ACE-IQ demonstrated good content validity; the ACE-IQ domain subscales also showed satisfactory test-retest reliability and semantic equivalence. In a sample of 433 Chinese young adults, three patterns of ACE exposure were uncovered: Low ACEs (65.82%), Household Violence (24.94%), and Multiple ACEs (9.24%). Concurrent exposure to physical abuse, domestic violence, and emotional abuse (i.e. Household Violence) was a novel pattern found in this study sample, and suggests there may be traditional Chinese norms that potentiate risks for violent household environments in the absence of other household risk factors. Findings underscore the importance of examining ACE exposure within local contexts, as children’s adverse experiences may be idiosyncratic to geographic, social, and cultural norms.
Full text
Available for:
GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
PDF
