[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]
Sexual Assault
Holliday R, Nichter B, Holder N, et al.
Childhood Sexual Abuse and Military Sexual Trauma Interact to Increase Suicide Risk: Results from a Nationally Representative Veteran Sample. J Interpers Violence. 2023;38(5-6):5354-69. PMID: 36124932
In a study of 4,069 US military veterans, “After accounting for sociodemographics, psychiatric comorbidity, and trauma-related characteristics, we detected a significant interaction between military sexual trauma and childhood sexual abuse as it related to report of past-year suicidal ideation, lifetime suicide attempt, and risk for future suicide attempt. These findings underscore the impact of sexual trauma throughout the lifespan, highlighting the continued importance of screening for trauma exposure and connecting veterans to appropriate, evidence-based treatment.”
Racial/Cultural Concerns
Egede LE, Walker RJ, Campbell JA, et al.
Modern Day Consequences of Historic Redlining: Finding a Path Forward. J Gen Intern Med. 2023:1-4. PMID: 36746831
“Redlining refers to the practice of systematically denying various services (e.g., credit access) to residents of specific neighborhoods, often based on race/ethnicity and primarily within urban communities. Historical redlining is linked to increased risk of diabetes, hypertension, and early mortality due to heart disease, with evidence suggesting it impacts health through suppressing economic opportunity and human capital, or the knowledge, skills, and value one contributes to society…This paper highlights a path forward by briefly discussing the origins of historical redlining, highlighting the modern-day consequences both on health and at the societal level, and suggest promising initiatives to address the impact.”
Deutsch-Link S, Bittermann T, Nephew L, et al.
Racial and ethnic disparities in psychosocial evaluation and liver transplant waitlisting. Am J Transplant. 2023 Jan 31:S1600-6135(23)00233-2. PMID: 36731782
Using liver transplant data 2014-2021, while there was no significant association with race/ethnicity and waitlisting or not waitlisting for medical reasons, Black race (odds ratio 1.65) and Hispanic/Latinx ethnicity (OR 2.10) were associated with not waitlisting for psychosocial reasons.
Mendenhall R, Lee MJ, Cole SW, et al.
Black Mothers in Racially Segregated Neighborhoods Embodying Structural Violence: PTSD and Depressive Symptoms on the South Side of Chicago. Journal of racial and ethnic health disparities. 2023:1-15. PMID: 36715821
For 69 Black mothers living on the South Side of Chicago, feeling “trapped” in dangerous situations due to lack of financial resources to move out of the neighborhood significantly predicted increased mental distress in the form of PTSD, depressive symptoms, and glucocorticoid receptor (stress hormone system) gene regulation.
Krishnamoorthi M, Balbierz A, Laraque-Arena D, Howell EA.
Addressing the National Crisis Facing Black and Latina Women, Birthing People, and Infants: The Maternal and Child Health Equity Summit. Obstet Gynecol. 2023 Mar 1;141(3):467-472. PMID: 36735384
In a review of the Maternal and Child health Equity Summit to address outcomes experienced by Black and Latina birthing people, recommendations included: “1) quality and standardization of care; 2) adjustment of care strategy based on patient-reported experience; 3) health care professional and institutional accountability to patients; 4) commitment to building trust; and 5) anti-racism practices in education, training, and hiring.”
Lane WG, Seltzer RR.
How Should Clinicians and Health Care Organizations Promote Equity in Child Abuse and Neglect Suspicion, Evaluation, and Reporting? AMA journal of ethics. 2023;25(2):E133-40. PMID: 36754076
“Racial bias and inequity in suspicion, reporting, and substantiation of abuse and neglect and in services offered and delivered, foster care placement, and criminal prosecution are widely documented. In response, clinicians and health care organizations should promote equity by educating clinicians about racial bias, standardizing evaluation using clinical decision support tools, and working with policy makers to support prevention services.”
Letson MM, Crichton KG.
How Should Clinicians Minimize Bias When Responding to Suspicions About Child Abuse? AMA journal of ethics. 2023;25(2):E93-9. PMID: 36754070
“A decision to report suspected abuse is one of great ethical, clinical, and legal importance and can weigh heavily on clinicians who have established relationships with a family. Mandated reporting is done inequitably, however, with overreporting of families with low socioeconomic status and minoritized families and underreporting of families with high socioeconomic status and White families. This article canvasses evidence-based approaches to evaluating and reporting suspicion of child maltreatment in ways that minimize bias and promote equity.”
Kelly D, Milner J.
How Should Race and Resource Context Influence How Neglect Is Considered by Clinicians? AMA journal of ethics. 2023;25(2):E100-8. PMID: 36754071
Authors present the case of a pediatrician faced with a child experiencing possible neglect seemingly due to poverty, the dilemma of being a mandated reporter when CPS/child removal can cause harm, different strategies to consider for this family, and what ideally CPS should look like. Full article
Simons RL, Ong ML, Beach SRH, et al.
Direct and Indirect Effects of Socioeconomic Status and Discrimination on Subjective Cognitive Decline: A Longitudinal Study of African American Women. J Gerontol B Psychol Sci Soc Sci. 2023 Feb 22:gbad029. PMID: 36810805
In this study of 293 African American Women, socioeconomic status and discrimination both directly affected cognitive decline. These factors also influenced depression and accelerated biological aging leading to chronic illness, both of which in turn were also associated with cognitive decline.
Miller CA, Wilkins CL, de Paula Couto C, Farias J, Lisnek JA.
Anti-Black attitudes predict decreased concern about COVID-19 among Whites in the U.S. and Brazil. Soc Sci Med. 2023;320:115712. PMID: 36753995
“In five studies conducted in two countries (US and Brazil, total N = 3425), we found that anti-Black attitudes (above and beyond political orientation, White racial identification, and perceptions of racial disparities) were associated with less concern about COVID-19, lower adoption of health and social distancing behaviors, and greater interest in returning to normalcy.”
Parmar DD, Minnis AM, Caballero E, et al.
Latina mothers' perspectives on adverse experiences and protection of Latinx youth in an agricultural community. BMC Public Health. 2023;23(1):223. PMID: 36732714
20 Latina mothers of Salinas teens, “shared the impacts of immigrant-related experiences on systemic inequities in the United States which are currently missing from the ACEs framework…The most cited community-level ACEs were housing instability and community violence. Immigrant- related adversities included experiences of systemic racism with loss of resources, political instability limiting structural resources, and language-limited accessibility. These were exacerbated by the loss of family supports due to immigration-related family-child separation including deportations and staggered parent-child migration…mothers discussed their strategies for building family unity, instilling resilience in their children, and improving socioeconomic opportunities for their family.”
Perpetrators
Jimenez-Arista LE, Reid DB.
Realization, Self-View, and Disclosure of Pedophilia: A Content Analysis of Online Posts. Sex Abuse. 2023;35(2):214-40. PMID: 35503894
“We conducted a qualitative content analysis of online posts from self-identified individuals with pedophilia, finding four categories: (1) Awareness and Initial Self-View (with emotions including denial, shame, and fear), (2) Disclosure (typically made to family, friends, or therapists, but also done online in an anonymous way), (3) People's Reactions to Disclosure (ranging from rejection to support), and (4) Current Self-View (including minimization, distortions, despair, resignation, and non-offending/anti-contact commitment). Our findings highlight the internal process experienced by individuals with pedophilia when first recognizing their attraction to minors, what is involved in disclosure, the importance of others' reactions after disclosure, and the factors that can reinforce a non-offending commitment. Clinical and social implications are discussed.”
Providers
Weleff J, Potter D.
Key Updates to Understanding Roles of Childhood Trauma in Overall Health. AMA journal of ethics. 2023;25(2):E116-22. PMID: 36754073
“This article reviews recent literature that has changed clinical and social viewpoints on child abuse and neglect and can be used as a primer to better understand (1) influences of child abuse and neglect on physical illness; (2) critical diagnostic advances relevant to persons who have experienced child abuse and neglect; and (3) ethical, research, and practical questions generated by these new understandings.” In addition, authors provide a table comparing core criteria of PTSD, complex PTSD, developmental trauma disorder, and borderline personality disorder.
Barry C, Gundacker C.
ACE: "What Happened to You" Screening for Adverse Childhood Experiences or Trauma-Informed Care. Prim Care. 2023;50(1):71-82. PMID: 36822729
General review article for primary care. “Early recognition of potentially traumatic events during childhood can lead to appropriate anticipatory guidance and referrals as needed to buffer the experience, prevent toxic stress, and prevent negative long-term health outcomes. Helping adults understand the potential influence that ACEs have had on their current health and parenting practices can lead to a more targeted approach to addressing current health needs and provision of parental resource supports to interrupt the cycle of intergenerational trauma.”
Bennett CE, Christian CW.
How Should Clinicians and Students Cope With Secondary Trauma When Caring for Children Traumatized by Abuse or Neglect? AMA journal of ethics. 2023;25(2):E109-15. PMID: 36754072
“When health care professionals encounter child abuse and neglect, they can experience a range of emotions, such as anger, sadness, and frustration. Such feelings can cloud judgment, compromise care, or even undermine one's capacity to complete evaluation of a child. This article discusses key ethical values of honesty, objectivity, compassion, professionalism, respect for persons, and justice, which can be used to guide one's approaches to navigating secondary trauma during and after clinical interactions with children who have suffered abuse or neglect. Strategies for coping with intense feelings are also offered herein.”
Schecter A.
How Should We Respond When Clinicians' Calls to CPS Are Punitively Weaponized Against Families? AMA journal of ethics. 2023;25(2):E159-65. PMID: 36754080
“This narrative illuminates the need for students and clinicians to be well prepared to face ethically and structurally complex realities of identifying and responding to children who might have been abused. The commentary considers how to draw on equity as an ethical value when communicating with children's family members in clinical settings.”
Hornor G.
Nonoffending Caregiver Support After Child Sexual Abuse: Essentials for the Forensic Nurse. J Forensic Nurs. 2023;19(1):60-6. PMID: 36812374
“A disclosure of CSA [childhood sexual abuse] affects not only the child but also everyone close to the child. Nonoffending caregiver support after a disclosure of CSA is key to optimal victim functioning. Forensic nurses play an integral role in the care of CSA victims and are uniquely positioned to ensure best outcomes for both child victims and their nonoffending caregivers.”
Rouse A, Jenkinson E, Warner C.
The use of "art" as a resource in recovery from the impact of sexual abuse in childhood: A qualitative systematic review. Arts Health. 2023;15(1):86-109. PMID: 35220874
“Creative activities can play a significant role in the unique paths to recovery that sexual abuse survivors develop…Arts-based activities were identified as offering a safe space in which to find a voice, to engage in self-exploration, and to communicate experience and connect with others where a new sense of self and empowerment could emerge.”
Nan J, Salina N, Chong ST, Jiang HJ.
Trajectory of suicidal ideation among medical students during the COVID-19 pandemic: the role of childhood trauma. BMC Psychiatry. 2023;23(1):90. PMID: 36747156
Of 2192 Chinese medical students who were assessed during the pandemic, level of suicidal ideation could be placed into two groups – a low level, slowly rising group, and a constant, higher risk level group. Childhood emotional neglect, physical neglect, emotional abuse, and physical abuse all had significant positive predictive effects for the high risk, continuous group.
Prevention
Servot S, St-Amand A, Rousseau M, Simard V, Touchette E.
Sleep ecology, objective sleep characteristics and behavior problems in preschoolers referred to child protection services: An exploratory study. Child Abuse Negl. 2023;138:106075. PMID: 36764173
In this small study of 22 maltreated preschoolers, 95.2% of parents reported suboptimal home sleeping conditions. Better sleep hygiene was associated with less anxiety, depression, and hyperactivity. “Associations between sleep ecology, objective sleep characteristics and behavioral problems deserve to be better understood, and further explored.”
Chang HY, Chang YC, Chang YT, Chen YW, Wu PY, Feng JY.
The Effectiveness of Parenting Programs in Preventing Abusive Head Trauma: A Systematic Review and Meta-Analysis. Trauma Violence Abuse. 2023:15248380231151690. PMID: 36762510
“This review aims to estimate AHT [abusive head trauma] preventive parenting programs' pooled effect on the reduction of AHT incidence, the improvement of parental knowledge, and the increased use of safe strategies in response to infants' inconsolable crying…Eighteen studies were included in this review. AHT preventive parenting programs had a pooled effect on improving parents' knowledge and increasing the use of safe coping strategies in response to inconsolable crying but not on the incidence of AHT and parents' emotional self-regulation…Further efforts to evaluate AHT parenting programs on the reduction of AHT incidence are necessary for decision-making on allocating and disseminating interventions.”
Joshi DS, West AL, Duggan AK, Minkovitz CS.
Referrals to Home Visiting: Current Practice and Unrealized Opportunities. Matern Child Health J. 2023 Mar;27(3):407-412. PMID: 36737527
“Evidence supports ongoing investment in maternal and early childhood home visiting in the US. Yet, a small fraction of eligible families accesses these services, and little is known about how families are referred.” From a survey of stakeholders, “Programs prioritized enrollment of pregnant women; parents with mental health, substance abuse or intimate partner violence concerns; teen parents; and children with developmental delays or child welfare involvement. Most respondents reported capacity to enroll more families in their programs. Few reported receiving any referrals from pediatric providers, child welfare, early care and education, or TANF/other social services.”
Pugh SJ, Murray C, Groenewald CB.
Positive Childhood Experiences and Chronic Pain Among Children and Adolescents in the United States. J Pain. 2023 Feb 10:S1526-5900(23)00034-2. PMID: 36775002
“Parents of 47,514 children ages 6 to 17 years old reported on their child's exposure to 7 PCEs [positive childhood experiences] and 9 ACEs. Associations between PCEs and chronic pain were evaluated…[and] adjusted for sociodemographic factors. We found that PCEs had dose-dependent associations with pediatric chronic pain; children exposed to higher numbers of PCEs (5-7 PCEs) had the lowest reported rate of chronic pain (7.1%), while children exposed to 2 or fewer PCEs had the highest rate of chronic pain (14.7%).” PCEs included 1) the child volunteering in the community; 2) child participating in after-school activities; 3) child having an adult mentor, other than their parent/caregiver; 4) child being a member of a resilient family; 5) child feels connected with their family; 6) child lives in a supportive neighborhood; and 7) child lives in a safe neighborhood.
Researchers
Rubens M, Bruenig D, Adams JAM, Suresh SM, Sathyanarayanan A, Haslam D, et al.
Childhood Maltreatment and DNA Methylation: A Systematic Review. Neurosci Biobehav Rev. 2023:105079. PMID: 36764637
“This systematic review of literature investigating DNA methylation associated with CM [childhood maltreatment] in non-clinical populations aimed to summarise the approaches currently used in research, how the type of maltreatment and age of exposure were encoded via methylation, and which genes have consistently been associated with CM…The ways in which the various forms of CM were conceptualised and measured varied between papers. Future studies would benefit from assessments that employ conceptually robust definitions of CM, and that capture important contextual information such as age of exposure and subtype of CM.
Robinson S, Foley K, Moore T, et al.
Prioritising Children and Young People with Disability in Research About Domestic and Family Violence: Methodological, Ethical and Pragmatic Reflections. J Fam Violence. 2023:1-14. PMID: 36743687
“The perspectives of children and young people with disability who experience domestic and family violence are under-researched, impeding the development of approaches that meet their needs…This article explores methodological, ethical, and practical challenges to centering their voices in research about domestic and family violence.”
Mathews B, Meinck F, Erskine HE, et al.
Adaptation and validation of the Juvenile Victimization Questionnaire-R2 for a national study of child maltreatment in Australia. Child Abuse Negl. 2023;139:106093. PMID: 36805615
Authors describe validation of the Juvenile Victimization Questionnaire-R2 as a a suitable instrument for assessing adult population-wide prevalence of childhood maltreatment. Questions cover childhood physical abuse, sexual abuse, emotional abuse, emotional neglect, experience of IPV, corporal punishment, and internet sexual victimization.
Reopell L, Nolan TS, Gray DM, 2nd, et al.
Community engagement and clinical trial diversity: Navigating barriers and co-designing solutions-A report from the "Health Equity through Diversity" seminar series. PLoS One. 2023;18(2):e0281940. PMID: 36795792
“Despite racial and ethnic minority groups making up nearly half of the US population, underrepresentation in clinical trials remains a critical challenge. The community engaged co-developed solutions detailed in this report to address access, awareness, discrimination and racism, and workforce diversity are critical to advancing clinical trial diversity.”
Popay J, Chekar CK, Griffiths A, et al.
Strengthening the equity focus of applied public health research: introducing the FOR EQUITY platform. Public Health. 2023;215:12-6. PMID: 36608600
Focus On Research and Equity (FOR EQUITY) is a new Web-based platform aiming to strengthen the intersectional equity focus of applied health research…FOR EQUITY encompasses (1) a Health Inequalities Assessment Tool, with an intersectional perspective on inequalities; (2) a FOR EQUITY Guidance Inventory providing access to a range of international research toolkits and guidance; and (3) a FOR EQUITY Library including case studies illustrating how researchers have attempted to integrate an equity lens into the research process, and more general resources on health inequalities.” https://forequity.uk/
Other of Interest
Abramson PR, Abramson TL.
Illuminating Psychological Torment of Child Abuse. AMA journal of ethics. 2023;25(2):E153-8. PMID: 36754079
Discussion of 3 art works depicting child abuse.
Braunold J.
Why 1962 Matters in the History of Clinicians' Responses to Abused and Neglected Children. AMA journal of ethics. 2023;25(2):E148-52. PMID: 36754078
In this brief review of the history of recognition of child abuse, the landmark 1962 article by Dr. Henry Kempe and colleagues, in which the term “battered child syndrome” was coined, led to the first physician mandatory reporting laws in 1963.
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