[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]
Domestic Violence – Effects on Children
Ahmad SI, Rudd KL, LeWinn KZ, et. al.
Maternal childhood trauma and prenatal stressors are associated with child behavioral health. J Dev Orig Health Dis. 2021 Oct 20:1-11. PMID: 34666865
Using data from a study of 1503 mother-child pairs from pregnancy, and adjusting for multiple factors, “maternal childhood trauma, socioeconomic risk, and intimate partner violence were independently, positively associated with child socioemotional-behavioral problems at age one…modifiable environmental factors, including knowledge regarding child development, can mitigate these risks. Both findings support the importance of parental screening and early intervention to promote child socioemotional-behavioral health.”
LGBTQ Concerns
Scheer JR, Clark KA, Talan A, et. al.
Longitudinal associations between childhood sexual abuse-related PTSD symptoms and passive and active suicidal ideation among sexual minority men. Child Abuse Negl. 2021 Oct 9;122:105353. PMID: 34638046
From a survey of 6305 sexual minority men, mean age 33.2 years and 53.5% White, those with a history of childhood sexual abuse (CSA) were 2.5 times more likely to report suicidality than those without a CSA history. CSA-related PTSD was associated with passive suicidal ideation, and regardless of PTSD severity, suicidal ideation was increased in those with lower social support and greater loneliness.
Race/Cultural Concerns
Harris LK, Berry DC, Cortés YI.
Psychosocial factors related to Cardiovascular Disease Risk in Young African American Women: a systematic review. Ethn Health. 2021 Oct 20:1-19. PMID: 34668802
Findings from this review suggest that exposure to adverse psychosocial factors (perceived stress, racial discrimination, internalized racism, depression) may be related to increased CVD risk (higher body mass index and increased blood pressure) in early adulthood (age 19-24) in African American women.
Helminen EC, Scheer JR, Edwards KM, Felver JC.
Adverse childhood experiences exacerbate the association between day-to-day discrimination and mental health symptomatology in undergraduate students. J Affect Disord. 2021 Oct 26:S0165-0327(21)01136-8. PMID: 34715169
For 250 undergraduates, participants with greater discrimination exposure and ACEs reported significantly more depression, anxiety, physical symptoms, and more psychological distress, relative to those with less discrimination exposure and few or no ACEs. Both ACEs and discrimination seemed to have an additive negative impact on mental health. “Reported discrimination experiences included ancestry or national origin, gender, race/skin color, age, religion, height, weight, other aspect of physical appearance, sexual orientation, education/income, and physical disability.
Dormire SL, Gary JC, Norman JM, Harvey IS.
Insights into fear: A phenomenological study of Black mothers. J Adv Nurs. 2021 Nov;77(11):4490-4499. PMID: 34245167
“Previous research has found that Black populations in America fear for their safety. This study identified a pervasive and profound fear for their children, specifically sons who are at a higher risk of being killed in normal daily activities. Mothers also expressed fears about their responsibility to keep them safe by providing the right tools.”
Providers
Balneg K, Van Winkle K.
Do adverse childhood experiences lead to poorer health outcomes? Nursing. 2021 Oct 1;51(10):15-17. PMID: 34580257
This brief review for nurses on the health effects of ACEs includes the nurses’ role and resources.
Sherfinski HT, Condit PE, Williams Al-Kharusy SS, et. al.
Adverse Childhood Experiences: Perceptions, Practices, and Possibilities. WMJ. 2021 Oct;120(3):209-217. PMID: 34710303
This research review concluded “ACEs are a public health concern. However…A large proportion of providers and trainees are unaware of the effects of adverse childhood experiences…the long-term effects of trainings remain largely unexplored. Barriers such as a lack of time, resources, comfort, or consensus regarding how to ethically screen impede broader efforts to implement systematic screenings for adverse childhood experiences.”
Schweer-Collins M, Lanier P.
Health Care Access and Quality Among Children Exposed to Adversity: Implications for Universal Screening of ACEs. Matern Child Health J. 2021 Dec;25(12):1903-1912. PMID: 34665356
From a large national study, high ACEs (4 or more) were associated with lower quality of provider care, including effective care coordination, family-centered care, shared decision making, and referrals for care. Children with high ACEs were also less likely to have a medical home and also had significantly greater difficulty accessing mental health treatment. Similar results were found for children in the moderate ACE (2-3) and low ACE (1) groups…Because findings indicate that children with high ACEs may be the least likely to receive quality care or necessary mental health treatment to address this adversity, universal screening for ACEs should be considered with caution.”
Lucas C, Crowell KR, Olympia RP.
School Nurses on the Front Lines of Healthcare: Red Flags and Red Herrings: Improving the Recognition of Bruises and Burns Associated With Physical Abuse in School-Age Children. NASN Sch Nurse. 2021 Jan;36(1):32-38. PMID: 32741252
“Through a series of case scenarios, this article describes the assessment and management of suspected physical child abuse presenting as bruises and burns. Although it is not uncommon for school-age children to have accidental injuries, recognizing patterns associated with physical child abuse and understanding red flags for abuse is vital…failure to intervene appropriately may leave children at risk for more serious injury or death.”
Constantian MB, Zaborek N.
The Prevalence of Adverse Childhood Experiences, Body Shame, and Revision Request Rate in 218 Plastic Surgery Patients: What Drives Postoperative Dissatisfaction? Plast Reconstr Surg. 2021 Dec 1;148(6):1233-1246. PMID: 34644275
218 consecutive plastic surgery patients (86% aesthetic and 14% reconstructive) completed the ACE Survey and the Experience of Shame Scale. Compared to the general population, patients in this study had higher overall adverse childhood experience prevalence (79.8% versus 64%), emotional abuse (41% versus 11%), emotional neglect (38% versus 15%), family substance abuse (36% versus 27%), and family mental illness (29% versus 19%). 52% had body shame, which was predicted by ACE score. Body shame was associated with more cosmetic operations, more health problems, higher antidepressant use, substance abuse history, demands for additional pain medication, and requests for surgical revision (49% versus 17%).
Intimate Partner Violence, Animal Maltreatment, and Concern for Animal Safekeeping: A Survey of Survivors Who Owned Pets and Livestock. Violence Against Women. 2021 Oct 14:10778012211034215. PMID: 34647504
In this disturbing qualitative and quantitative study of Canadian pet and livestock owners experiencing IPV, 34.5% stated that care for their companion animals prevented them from seeking assistance for IPV. 32.4% reported that their children had witnessed pets being abused, threated, starved or even killed, and perpetrators had refused to allow veterinary care, which prolonged suffering. Several participants put themselves in the path of violence to protect their animals. “I just wish that all safe houses would include whatever pets the woman and her family have.”
Prevention
Rogel A, Loomis AM, Hamlin E, et. al.
The impact of neurofeedback training on children with developmental trauma: A randomized controlled study. Psychol Trauma. 2020 Nov;12(8):918-929. PMID: 32658503
“This pilot study demonstrated that 24 sessions of neurofeedback training significantly decreased PTSD symptoms, internalizing, externalizing, other behavioral and emotional symptoms, and significantly improved the executive functioning of children aged 6-13 years with severe histories of abuse and neglect who had not significantly benefited from any previous therapy.”
Donofry SD, Stillman CM, Hanson JL, et. al.
Promoting brain health through physical activity among adults exposed to early life adversity: Potential mechanisms and theoretical framework. Neurosci Biobehav Rev. 2021 Oct 5:S0149-7634(21)00439-5. PMID: 34624365
Authors review the influence of early life adversity (ELA) on brain health in adulthood, and highlight evidence for the role of physical activity on brain growth factors, stress hormones, inflammation, and epigenetics as a low cost behavioral approach to address the long-term consequences of ELA.
Mehta D, Kelly AB, Laurens KR, et. al.
Child Maltreatment and Long-Term Physical and Mental Health Outcomes: An Exploration of Biopsychosocial Determinants and Implications for Prevention. Child Psychiatry Hum Dev. 2021 Sep 29:1–15. PMID: 34586552
“This review has highlighted the high and most likely underestimated prevalence of child maltreatment, the ongoing challenges of measurement, the profound and long-lasting impacts of child maltreatment on mental and physical health, and the substantial economic costs associated with these impacts…Five recommendations relating to the accurate measurement of trends, research on brain structures and processes, improving the reach and impact of teleservices for detecting, preventing and treating child maladjustment, community-based approaches, and building population-focused multidisciplinary alliances and think tanks are presented.”
Ross KM, Cole S, Sanghera H, Anis L, Hart M, Letourneau N.
The ATTACH program and immune cell gene expression profiles in mothers and children: A pilot randomized controlled trial. Brain Behav Immun Health. 2021 Oct 2;18:100358. PMID: 34647106
For 20 mother-child pairs recruited from a Canadian domestic violence shelter, a 10 week psycho-educational intervention that fosters maternal reflective function showed, after controlling for various factors, that both mother and child participants had “healthier immune cell gene expression profiles post-intervention compared with wait-list controls. Parenting interventions could decrease the impact of toxic stress on maternal-child immune health.”
Morton KR, Lee JW, Spencer-Hwang R.
Plant-based dietary intake moderates adverse childhood experiences association with early mortality in an older Adventist cohort. J Psychosom Res. 2021 Sep 28;151:110633. PMID: 34634675
In this study of 9301 Seventh-day Adventists 2006-2017, the majority being female, White, and 60 years old, “ACEs were adversely associated with survival time…Plant-based intake was associated with a reduction in the association of 4+ ACEs with early mortality above and beyond demographics, animal-based intake, physical health, mental health, BMI, exercise, and worship. We estimate that after 4+ ACEs, those eating high versus low plant-based dietary intake may live 5.4 years longer…however, observational studies cannot determine causality.”
(There are several issues with this study, including unknown impact of lifelong dietary intake vs. present intake, but the concept of diet is something important to consider in ACE outcomes prevention.)
Researchers
Adkins-Jackson PB, Chantarat T, Bailey ZD, Ponce NA.
Measuring Structural Racism: A guide for epidemiologists and other health researchers. Am J Epidemiol. 2021 Sep 25:kwab239. PMID: 34564723
“The goal of this commentary is to inspire the use of up-to-date and theoretically-driven approaches to increase discourse amongst public health researchers on capturing racism as well as to improve evidence of its role as the fundamental cause of racial health inequities.”
Pavarini G, Smith LM, Shaughnessy N, et. al.
Ethical issues in participatory arts methods for young people with adverse childhood experiences. Health Expect. 2021 Oct;24(5):1557-1569. PMID: 34318573
Authors take a detailed look at ethical issues between researchers and vulnerable adolescents with ACEs who are involved in arts-based research. Ethical guidance is offered for project entry, participation, and dissemination of results.
Meehan AJ, Baldwin JR, Lewis SJ, MacLeod JG, Danese A.
Poor Individual Risk Classification From Adverse Childhood Experiences Screening. Am J Prev Med. 2021 Oct 9:S0749-3797(21)00456-6. PMID: 34635382
“The classification accuracy of a recommended clinical definition for high-risk exposure (≥4 versus 0-3 adverse childhood experiences) was evaluated on the basis of sensitivity, specificity, positive and negative predictive values, and positive likelihood ratios…findings suggest that screening based on the adverse childhood experience score does not accurately identify those individuals at high risk of health problems. This can lead to both allocation of unnecessary interventions and lack of provision of necessary support.”
Linde-Krieger LB, Moon CM, Yates TM.
The Implications of Self-Definitions of Child Sexual Abuse for Understanding Socioemotional Adaptation in Young Adulthood. J Child Sex Abus. 2021 Jan;30(1):80-101. PMID: 33206584
In a large and ethnically diverse college student sample of 2,195, those who objectively and subjectively perceived themselves as having experienced childhood sexual abuse showed the largest elevations in mental health and risk behaviors, whereas survivors who did not perceive their experiences as “abuse” evidenced the largest deficits in how they perceived themselves. “These findings indicate that standard screening criteria may misidentify a sizable group of CSA survivors because these individuals do not perceive their experiences as ‘abuse’”.
Other of Interest
Smitherman LC, Golden WC, Walton JR.
Health Disparities and Their Effects on Children and Their Caregivers During the Coronavirus Disease 2019 Pandemic. Pediatr Clin North Am. 2021 Oct;68(5):1133-1145. PMID: 34538304
“The coronavirus disease 2019 (COVID-19) pandemic has uncovered long-standing health disparities in marginalized communities, including racial and ethnic minorities and children with underlying medical and social problems. African Americans, Hispanics, and Native Americans have higher rates of COVID-19 infections and deaths than their population percentages in the United States. Unique populations of children, including children with developmental disabilities, children in the foster care system, children with chronic medical problems, and children who are homeless are particularly vulnerable to COVID-19 infection. This article explores how the COVID-19 pandemic superimposed on health disparities directly and indirectly affects children, adolescents, and their caregivers.”
Balfour ME, Hahn Stephenson A, Delany-Brumsey A,et. al.
Cops, Clinicians, or Both? Collaborative Approaches to Responding to Behavioral Health Emergencies. Psychiatr Serv. 2021 Oct 20:appips202000721. PMID: 34666512
“How a community responds to behavioral health emergencies is both a public health issue and social justice issue…Such crises account for a quarter of police shootings and >2 million jail bookings per year…This policy article reviews best practices for law enforcement crisis responses, outlines the components of a comprehensive continuum-of-crisis care model that provides alternatives to law enforcement involvement and ED use, and offers strategies for collaboration and alignment between law enforcement and clinicians toward common goals. Finally, policy considerations regarding stakeholder engagement, financing, data management, legal statutes, and health equity are presented to assist communities interested in taking steps to build these needed solutions.”
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