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PACEs Research Corner — December 2022, Part 1


[Editor's note: Dr. Harise Stein at Stanford University edits a web site — — 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

Clemens V, Köhler-Dauner F, Ziegenhain U, Fegert JM.
Predictors of Parental Coping During the Covid-19 Pandemic: A Survey in Germany. Front Psychol. 2021 Sep 10;12:715327. PMID: 34566797
From a survey of 687 German parents of minors during the first lockdown due to the pandemic, younger age of the respective child, income loss, dissatisfaction with the sharing of childcare duties, and parental ACEs were significantly associated with an increase of potential harmful parenting behavior.

Zarei K, Xu G, Zimmerman B, Giannotti M, Strathearn L.
Adverse Childhood Experiences Predict Common Neurodevelopmental and Behavioral Health Conditions among U.S. Children. Children (Basel). 2021 Aug 31;8(9):761. PMID: 34572191
From a large national pediatric database, household challenge ACEs (not including child maltreatment) were over 6-9 times more likely to be associated with behavior problems, depression, and substance use disorder.  Increasing learning disability and attention deficit hyperactivity disorder were also associated with increases of these ACEs.

Singh A, Shah N, Mbeledogu C, Garstang J.
Child wellbeing in the United Kingdom following the COVID-19 lockdowns. Paediatric Child Health (Oxford). 2021 Dec;31(12):445-448. PMID: 34630631
“Children have suffered directly with lack of access to healthcare, and a decline in their mental health. Infant bonding may have been affected due to maternal stress, anxiety or depression, compounded by limited Health Visitor support. Poverty, food insecurity and lack of exercise contributed to increased obesity. Many children will have been exposed to domestic violence, parental mental illness and child abuse without being able to tell teachers or other adults outside of the home, and these Adverse Childhood Experiences (ACE) increase the risk for subsequent health and behaviour problems. Children have spent many hours online for school learning and socialising with friends but faced risks of criminal exploitation and grooming.”

Adult Manifestations of Child Abuse

Layfield SD, Duffy LA, Phillips KA, et. al.
Multiomic biological approaches to the study of child abuse and neglect. Pharmacol Biochem Behav. 2021 Nov;210:173271. PMID: 34508786
“This review begins by providing an overview of childhood abuse, neglect, maltreatment, threat, and toxic stress, and the effects of these forms of adversity on the developing body, brain, and behavior. It then examines examples from the current literature of genomic, epigenomic, transcriptomic, and proteomic discoveries and biomarkers that may help to understand risk and resilience in the aftermath of trauma, predictors of traumatic exposure risk, and potential targets for intervention and prevention.”

Salonsalmi A, Pietiläinen O, Lahelma E, et. al.
Contributions of childhood adversities to chronic pain among mid-life employees. Scand J Public Health. 2021 Jan 18:1403494820981509. PMID: 33461395
Among 40-60-year-old Finnish employees (80% women), “childhood economic difficulties (Odds ratio =1.60), childhood illness (OR=1.74), parental divorce (OR=1.26), parental alcohol problems (OR=1.34) and bullying at school or among peers (OR=1.59) were associated with chronic pain. Working conditions, sleep problems and common mental disorders each slightly attenuated the associations between childhood adversities and chronic pain…the well-being of children might prevent pain and promote well-being in mid-life.”

Miller ES, Fleming O, Ekpe EE, Grobman WA, Heard-Garris N.
Association Between Adverse Childhood Experiences and Adverse Pregnancy Outcomes. Obstet Gynecol. 2021 Nov 1;138(5):770-776. PMID: 34619717
For 1274 pregnant women enrolled in a mental health program for perinatal depression support, 73% reported an ACE score of 1, and 23% reported 3+ ACEs.  After controlling for various factors, “Having a high ACE score was associated with an increased risk of hypertensive disorders of pregnancy and preterm birth.”

Kerkar S, Shankar A, Boynton-Jarrett R, Harville EW.
Adverse Childhood Experiences are Associated with Miscarriage in Adulthood: The GROWH Study. Matern Child Health J. 2021 Mar;25(3):479-486. PMID: 33389588
Using data from 1511 reproductive age women from Louisiana Clinics, those with 4+ ACEs were 1.71 times more likely to experience miscarriage during first pregnancy, and 1.74 times for any pregnancy.

Giano Z, Ernst CW, Snider K, Davis A, O’Neil AM, Hubach RD.
ACE domains and depression: Investigating which specific domains are associated with depression in adulthood. Child Abuse Negl. 2021 Sep 27;122:105335. PMID: 34592672
From a large national survey, “Across all ACE scores, those with a history of family mental illness had the highest likelihood of receiving a depression diagnosis. The second strongest association were those with sexual abuse. No other trends were found among the six other domains. Further, those with a combination of family mental illness and sexual abuse had the highest odds of depression.”

Yang JZ, Kang CY, Yuan J, Zhang Y, Wei YJ, Xu L, Zhou F, Fan X.
Effect of adverse childhood experiences on hypothalamic-pituitary-adrenal (HPA) axis function and antidepressant efficacy in untreated first episode patients with major depressive disorder. Psychoneuroendocrinology. 2021 Sep 25;134:105432. PMID: 34607174
Of 330 Chinese patients with major depression who were treated for the first time with one of 4 anti-depressants, a history of ACEs significantly decreased medication efficacy.  A 12-week response was achieved by 37.2% in the ACEs group vs. 59.0% without ACEs.  Remission was achieved by 15.2% in the ACEs group vs. 32.2% without ACEs.  Exposure to ACEs also influenced measurements of the stress hormone system and was associated with more severe symptoms of depression.

Liu M, Luong L, Lachaud J, Edalati H, Reeves A, Hwang SW.
Adverse childhood experiences and related outcomes among adults experiencing homelessness: a systematic review and meta-analysis. Lancet Public Health. 2021 Sep 29:S2468-2667(21)00189-4. PMID: 34599894
From a research review, lifetime prevalence of one or more ACEs among homeless adults was 89.8% and the lifetime prevalence of four or more ACEs was 53.9%.  ACEs were consistently positively associated with high suicidality, suicide attempt, major depressive disorder, substance misuse, and adult victimization.

Cintora P, Laurent HK.
Childhood Trauma Exposure Exacerbates the Impact of Concurrent Exposure to Intimate Partner Violence on Women's Posttraumatic Symptoms. J Trauma Stress. 2020 Dec;33(6):1102-1110. PMID: 32557954
In this study of low-income mothers followed for 18 months postpartum, increasing IPV led to increasing PTSD symptoms over time.  This effect was heightened when women reported a history of childhood maltreatment.

Tiwari A, Andrews K, Casey R, Liu A, Tonmyr L, Gonzalez A.
Associations Among Child Maltreatment, Mental Health, and Police Contact in Adulthood: Findings From a National Canadian Sample. J Interpers Violence. 2021 Sep;36(17-18):8741-8767. PMID: 31161854
From a survey of 23,846 Canadian adults, childhood experience of physical abuse, sexual abuse, and adult IPV were each associated with 2-3 times increased contact with police as either a criminal or a victim.  Victimization contact increased with increasing number of childhood maltreatment types.

Schickedanz A, Escarce JJ, Halfon N, Sastry N, Chung PJ.
Intergenerational Associations between Parents’ and Children’s Adverse Childhood Experience Scores. Children (Basel). 2021 Aug 29;8(9):747. PMID: 34572179
“Among 2205 parent-child dyads, children of parents with four or more ACEs had 3.25-fold higher risk of experiencing four or more ACEs themselves, compared to children of parents without ACEs.”

Howell KH, Miller-Graff LE, Martinez-Torteya C, et. al.
Charting a Course towards Resilience Following Adverse Childhood Experiences: Addressing Intergenerational Trauma via Strengths-Based Intervention. Children (Basel). 2021 Sep 24;8(10):844. PMID: 34682109
“This review brings together various biological, psychological, and sociological principles that inform our understanding of ACEs and our approach to treatment. Specifically, we document the evolution of ACEs research, focusing on the intergenerational impact of ACEs, the importance of incorporating a resilience framework when examining ACEs, and implementing interventions that address adversity across generations and at multiple levels.”

MacIntosh HB, Ménard AD.
Where are We Now? A Consolidation of the Research on Long-term Impact of Child Sexual Abuse. J Child Sex Abus. 2021 Apr;30(3):253-257. PMID: 33988087
Introduction to this special issue on long-term impacts of childhood sexual abuse on adult functioning and wellbeing. Table of Contents with abstracts

Lin L, Wang HH, Lu C, Chen W, Guo VY.
Adverse Childhood Experiences and Subsequent Chronic Diseases Among Middle-aged or Older Adults in China and Associations With Demographic and Socioeconomic Characteristics. JAMA Netw Open. 2021 Oct 1;4(10):e2130143. PMID: 34694390
From a large national study in China of respondents aged 45 years or older and who had at least one chronic disease, 80.9% reported at least 1 ACE, and 18.0% reported 4+ ACEs.  “Compared with those without ACE exposure, participants who experienced 4 or more ACEs had increased risks of dyslipidemia, chronic lung disease, asthma, liver disease, digestive disease, kidney disease, arthritis, psychiatric disease, memory-related disease, and multimorbidity…regardless of demographic and socioeconomic characteristics during childhood or adulthood.”

Tracy EL, Tracy CT, Kim JJ, Yang R, Kim E.
Cascading effects of childhood abuse on physical health issues in later adulthood through trait anxiety and poor daily sleep quality. J Health Psychol. 2021 Oct;26(12):2342-2348. PMID: 32114830
As part of a US national mid-life study, “Individuals who reported a higher level of childhood abuse reported a higher level of trait anxiety and a lower level of daily sleep quality, leading to an increase in physical health issues. The results highlight the cascading effects of childhood abuse on serious health consequences over the life span.”

Haddad S, Martin-Marchand L, Lafaysse M, et. al.
Repeat induced abortion and adverse childhood experiences in Aquitaine, France: a cross-sectional survey. Eur J Contracept Reprod Health Care. 2021 Feb;26(1):29-35. PMID: 32914679
This study of 806 French women at 25 abortion centers showed a graded link between the extent of ACE exposure and the occurrence of repeat induced abortions, with those with high ACE exposure 7.73 times more likely to have had 3+ abortions.

Schönfelder A, Rath D, Forkmann T, et. al.
Is the relationship between child abuse and suicide attempts mediated by nonsuicidal self-injury and pain tolerance? Clin Psychol Psychother. 2021 Jan;28(1):189-199. PMID: 32816347
For 308 German psychiatric inpatients with a recent suicidal crisis, all types of childhood abuse showed a relationship with non-suicidal self-injury, such as cutting, which itself was “an important predictor for suicide attempts and should be considered in suicide risk assessment.” 

al'Absi M.
The influence of stress and early life adversity on addiction: Psychobiological mechanisms of risk and resilience. Int Rev Neurobiol. 2020;152:71-100. PMID: 32451001
“Preclinical, clinical, and population research demonstrates that stress and early life adversity (ELA) increase vulnerability to initiate, maintain, and relapse in addiction…Our model proposes that long-term effects of stress and ELA on the brain contribute to dysregulation of the stress response, emotional reactivity, reward systems, cognitive dysregulation, and delay discounting that lead to impulsive and high-risk behaviors, such as drug use and relapse.”

Chen G, Gueta K, Ronel N.
Does Self-Change Occur Among Severely Dependent Substance Users? J Psychoactive Drugs. 2020 Sep-Oct;52(4):357-365. PMID: 32490757
For 229 Israeli adults with substance use disorders (SUDs) who were able to move away from addiction, the severity of substance dependence did not differentiate between self-changers and treatment-changers, but rather the severity of psychiatric problems and history of child abuse did. “This indicates a need for treatment interventions targeting all three issues of childhood trauma, SUDs, and psychiatric problems.”

Clemens V, Beschoner P, Jarczok MN, et. al.
The mediating role of COVID-19-related burden in the association between adverse childhood experiences and emotional exhaustion: results of the egePan – VOICE study. Eur J Psychotraumatol. 2021 Oct 1;12(1):1976441. PMID: 34621498
In this survey of 2500 German healthcare professionals during the first lockdown of the pandemic, all types of ACEs were associated with increased emotional exhaustion (EE) on the burnout scale, and there was a positive direct association between increasing ACE score and increasing EE.


Kim-Spoon J, Herd T, Brieant A, Peviani K, et. al.
Maltreatment and brain development: The effects of abuse and neglect on longitudinal trajectories of neural activation during risk processing and cognitive control. Dev Cogn Neurosci. 2021 Apr;48:100939. PMID: 33706181
From brain scans of 167 adolescents assessed annually over 4 years to determine impact of maltreatment, results showed different effects as the result of neglect or abuse.  Neglect was associated with detrimental neurodevelopment of the brain valuation system - estimating the value of alternative options - while abuse had negative effects on the brain control system - control over the pursuit or avoidance of risky options.

Babad S, Zwilling A, Carson KW, et. al.
Risk-Taking Propensity and Sensation Seeking in Survivors of Adverse Childhood Experiences. J Interpers Violence. 2021 Oct;36(19-20):NP10670-NP10687. PMID: 31538863
“ACEs related to environmental instability may have a unique impact on sensation seeking domains in emerging adults. Clarifying the role of sensation seeking in emerging adults can contribute to better understanding of risk and resilience factors in this vulnerable population.”

Mitchell JM, Becker-Blease KA, Soicher RN.
Child Sexual Abuse, Academic Functioning and Educational Outcomes in Emerging Adulthood. J Child Sex Abus. 2021 Apr;30(3):278-297. PMID: 33416025
“In many parts of the world, emerging adults, aged 18 to 25 years old, require education beyond high school to transition to a stable, secure adulthood. Child abuse, trauma, victimization, and adversity have been shown to negatively affect academic functioning and educational attainment during childhood and adolescence. Despite this, many emerging adults who have experienced these adverse events also show remarkable resilience…We find initial evidence that academic functioning and educational outcomes are separable, with more research needed.”

Sani F, Herrera M, Bielawska K.
Child maltreatment is linked to difficulties in identifying with social groups as a young adult. Br J Dev Psychol. 2020 Oct;38(4):491-496. PMID: 32227369
“Subjective feelings of disconnectedness from social groups have been found to be detrimental to mental health…across the lifespan.” In this study of 396 Spanish young adults, “a greater degree of maltreatment received before the age of 14 is linked to a lower number of social groups one identifies with, even after controlling for current levels of depression, anxiety, and borderline personality.”


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