[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
Moss KM, Loxton D, Mishra GD.
Does Timing Matter? Associations Between Intimate Partner Violence Across the Early Life Course and Internalizing and Externalizing Behavior in Children. J Interpers Violence. 2023:8862605231174505. PMID: 37224432
From an Australian study of 2163 mothers, 32% reported that their children had been exposed to IPV. Of these children, 55.2% were exposed at one time, 28.7% at two times, and 16.1% at three times during the study. “Accumulation was the best model for explaining externalizing behaviors in boys and girls and for internalizing in girls. A critical period in middle childhood was identified for internalizing in boys. Overall, the duration of exposure was more important than the timing.”
LGBTQ Concerns
Díaz-Faes DA, Pereda N, Gámez-Guadix M.
The role of adverse childhood experiences in suicide among sexual minority undergraduate students. Death studies. 2023:1-9. PMID: 37203223
Of 924 Spanish undergraduate students, comparing sexual minority to heterosexual participants, “Sexual minority participants reported a significantly higher ACE score (mean 2.70 vs. 1.85)…They also reported a higher prevalence and risk of suicide attempts (33.3% vs. 11.8%)…sexual minority status, emotional abuse and neglect, bias attack, having a household member with mental health problems, bullying and cyberbullying, were significantly associated with suicide attempts.”
Race/Cultural Concerns
Schubiner H, Jackson B, Molina KM, et al. Racism as a Source of Pain. J Gen Intern Med. 2023 May;38(7):1729-1734. PMID: 36737536
“Numerous studies indicate that Black Americans have more severe pain, pain-related disability, and other pain-related outcomes (e.g., disturbed sleep) compared to their White counterparts. This inequity is due in part to the well-replicated finding that Black Americans are less likely to be screened for pain, referred for pain management, and adequately treated than White Americans…We propose that racism is an overlooked but preventable source of, or exacerbating factor for, chronic pain and its consequences, and we advance a framework offering innovative pathways for research, treatment, advocacy, and policy.”
Shah NS, Ning H, Petito LC, et al.
Associations of Clinical and Social Risk Factors With Racial Differences in Premature Cardiovascular Disease. Circulation. 2022 Jul 19;146(3):201-210. PMID: 35607988
In a large study of Black and White adults followed for almost 40 years, Black women were 2.44 times more likely and Black men 1.59 times more likely to have premature cardiovascular disease than White participants. This significantly higher risk was statistically explained by adjustment for prior factors – for women clinical (87% such as BMI, waist circumference, blood pressure, blood sugar and lipid levels), neighborhood (32% such as racial composition, poverty level), and socioeconomic (23% such as education, employment, financial status) factors, and for men clinical (64%), socioeconomic (50%), and lifestyle (34% such as smoking, alcohol, exercise) factors.
Zierath R, Claggett B, Hall ME, et al.
Measures of Food Inadequacy and Cardiovascular Disease Risk in Black Individuals in the US. JAMA Netw Open. 2023 Jan 3;6(1):e2252055. PMID: 36689225
From a study of 3024 Black adults followed a median of 13.8 years, economic food insecurity (defined as receiving food stamps or self-reported not enough money for groceries), but not proximity to unhealthy food options, “was associated with risk of incident cardiovascular disease independent of socioeconomic factors, traditional cardiovascular risk factors, diet quality, perceived stress, and other health behaviors. Economic food insecurity was also associated with markers of inflammation. Economic food insecurity may be a promising potential target for the prevention of CVD.”
Jasthi DL, Lappen JR, Garber S, et al.
Associations between adverse childhood experiences and obstetric outcomes in a predominantly Black-identifying and low-income pregnant population. Am J Obstet Gynecol MFM. 2023:101008. PMID: 37156467
192 pregnant persons age 18+ and English speaking from one medical center were referred to a mental healthcare manager because of elevated psychosocial risks identified by screening tools or provider concerns April 2018 to May 2021. 91.7% self-identified as Black or African American and 94.8% had public insurance (used as a proxy for low income). Adverse childhood experience score ≥4 was reported by 47.4% and score ≥6 by 26%. “High and very high adverse childhood experience score may be associated with chronic health conditions that predate pregnancy and can alter obstetrical outcomes.”
Racic M, Roche-Miranda MI, Fatahi G.
Twelve tips for implementing and teaching anti-racism curriculum in medical education. Med Teach. 2023:1-6. PMID: 37134226
This paper proposes twelve practical and specific tips for implementing and teaching anti-racism in medical education, valuable for designing future curricula and educational activities.
Ramamurthy A, Bhanbhro S, Bruce F, Collier-Sewell F. Racialised experiences of Black and Brown nurses and midwives in UK health education: A qualitative study. Nurse Educ Today. 2023;126:105840. PMID: 37196491
From interviews with 45 UK minority nurses and midwives, “healthcare workers' experiences coalesced around three themes: 1) Racism is an ordinary, everyday experience; 2) Racism is operationalised through power structures; and 3) Racism is maintained through denial and silencing…The findings underscore the importance of understanding racism as a pandemic that we must challenge in response to a post-pandemic society.”
Neblett EW, Jr.
Racial, Ethnic, and Cultural Resilience Factors in African American Youth Mental Health. Annu Rev Clin Psychol. 2023;19:361-79. PMID: 36854288
“This review evaluates recent literature examining ethnic and racial identity, ethnic-racial socialization, religiosity and spirituality, and family and parenting as racial, ethnic, and cultural resilience factors that shape the impact of racism on youth mental health…providing important insights for the development of prevention and intervention efforts and policy.”
Helmus LM, Kyne A.
Prevalence, Correlates, and Sequelae of Child Sexual Abuse (CSA) among Indigenous Canadians: Intersections of Ethnicity, Gender, and Socioeconomic Status. Int J Environ Res Public Health. 2023;20(9). PMID: 37174245
“Among 282 Indigenous participants in Canada recruited from medical panels, CSA was reported by 35% of male, 50% of female, and 57% of trans and gender non-conforming participants. These rates are substantially higher than global meta-analytic estimates (7.6% of boys and 18.0% of girls)…CSA was associated with a variety of other indicators…including mental-health issues (e.g., PTSD), unemployment, and criminal legal-system involvement. Sexual abuse of Indigenous Canadian children is a public-health crisis, and layers of marginalization (e.g., gender, social class) exacerbate this risk.”
Pilarinos A, Field S, Vasarhelyi K, et al.
A qualitative exploration of Indigenous patients' experiences of racism and perspectives on improving cultural safety within health care. CMAJ open. 2023;11(3):E404-e10. PMID: 37130609
From interviews with 26 Canadian Indigenous Peoples, “Despite participants' racist health care experiences, receiving culturally safe care was credited with improving trust in the health care system and well-being. The continued expansion of Indigenous cultural safety education, the creation of welcoming spaces, recruitment of Indigenous staff, and Indigenous self-determination over health care services can improve Indigenous patients' health care experiences.”
Perpetrators
Thomas K, Hamilton-Giachritsis C, Branigan P, Hanson E.
Offenders' approaches to overcoming victim resistance in technology-assisted child sexual abuse. Child Abuse Negl. 2023;141:106143. PMID: 37182413
From interviews with 10 adolescents who had experienced technology-assisted child sexual abuse, authors detail strategies employed by the perpetrators to overcome victim resistance and the victim strategies to resist, de-escalate and end their abuse.
Police and Court Systems
Hartman DT, Wang Y, Wu Y, et al.
Childhood Sexual Abuse: A Longitudinal Study of Disclosures and Denials. Child Maltreat. 2023 Aug;28(3):462-475. PMID: 36988427
Of 99 children involved in a sexual abuse legal case, and interviewed 20 years later, “We found that consistent disclosure [disclosing at both time points] was associated with being older at Time1 and female. Deferred disclosure [denying and then disclosing later] was significantly associated with greater T2 trauma-related symptoms. Higher CSA severity predicted T2 recantation [disclosure followed by denial]. Consistent denial was related to less severe CSA.
Block SD, Johnson HM, Williams LM, et al. Predictors of Prosecutorial Decisions in Reports of Child Sexual Abuse. Child Maltreat. 2023 Aug;28(3):488-499. PMID: 35081788
In a review of 500 US child sexual abuse reports, less than one in five cases proceeded to prosecution. Factors involved in a more likely decision to prosecute included: perpetrators over the age of 35 years (odds ratio 3.99), child having a history of CPS contact (OR 2.42), willingness of the victim to participate in prosecution (OR 2.67), the victim being female (OR 2.59), and positive caregivers support (OR 5.90). “If victims or their family members were unwilling to disclose details or if evidence was insufficient, cases were relatively unlikely to move on.”
Havighurst SS, Mathews B, Doyle FL, et al.
Corporal punishment of children in Australia: The evidence-based case for legislative reform. Aust N Z J Public Health. 2023:100044. PMID: 37142485
“Across all of Australia's states and territories, it is legal for a parent or carer to hit their child. In this paper, we outline the legal context for corporal punishment in Australia and the argument for its reform…Extensive evidence exists demonstrating the adverse effects of corporal punishment. When countries change legislation, educate the public, and provide alternative strategies for parents, rates of corporal punishment decrease.”
Providers
Chhabra N, Hernandez S, Christian E, Rizvanolli L.
Previous exposure to violence among emergency department patients without trauma-related complaints. Am J Emerg Med. 2023;68:92-7. PMID: 36958095
From a survey of 222 ED patients aged 19 to 88 without trauma-related complaints at a US urban public hospital, “43.7% reported directly witnessing violence during their lifetime, 69.4% being personally victimized by violence, and 55.4% personally knowing someone killed by a violent act. Of those personally victimized, 47.4% occurred within the preceding 3 years and 20.1% within 3 months. Lifetime victimization was reported in the following domains: slapping, hitting, or punching (45.9%); robbings or muggings (33.8%); physical threats (28.8%); verbal or emotional abuse (27.5%); being shot at (18.0%); uncomfortable physical touch (15.3%); forced entry while home (14.4%); sexual assault, molestation, or rape (13.5%); or being attacked with a knife (13.5%).” As both lifetime and recent exposure to community violence was common among adult ED patients, authors recommend broader adoption of a trauma-informed care framework and efficient ED trauma screening tools.
Bragge P, Wright B, Grundy E, et al.
What Happens Next? Traumatic Brain Injury (TBI) in the Community. The Journal of head trauma rehabilitation. 2023;38(3):279-82. PMID: 36121684
“Community-based prevention and support of TBI are particularly challenging and under-researched aspects of TBI management. Ongoing cognitive, emotional, and other effects of TBI are not immediately obvious in community settings such as schools, workplaces, sporting clubs, aged care facilities, and support agencies providing homelessness or domestic violence support. This is compounded by a lack of guidance and support materials designed for nonmedical settings. Connectivity Australia, a not-for-profit organization promoting TBI awareness, research, and support, responded to this need by conducting a national survey.” Survey results
Mercer L, Cookson A, Simpson-Adkins G, van Vuuren J.
Prevalence of adverse childhood experiences and associations with personal and professional factors in health and social care workers: A systematic review. Psychol Trauma. 2023. PMID: 37141025
From a very detailed research review, “ACEs among health and social care workers were frequently reported and occurred more often than in the general population. They were also associated with several personal and professional outcomes, including poor physical and mental health, and workplace stress. Understanding staff ACE characteristics can help organizations to consider ways to support staff.”
Bromley H, Davis SK, Morgan B, Taylor-Dunn H.
The Professional Quality of Life of Domestic and Sexual Violence Advocates: A Systematic Review of Possible Risk and Protective Factors. Trauma Violence Abuse. 2023:15248380231171187. PMID: 37199481
“Professionals employed within the field of domestic and sexual violence (DV/SV) are known to experience both positive and negative psychological impacts because of the nature of their work…This group is known to face challenges that are specific to their working practices including scarce resources and frequent exposure to traumatic material…An array of risk and protective factors emerged including communication competence, support from co-workers, office resources, and occupational stigma. A gap in the current evidence base was identified regarding the role that personal strengths may play in the well-being of those employed within the DV/SV sector.”
Whitt-Woosley A, Sprang G.
Analysis of implementation drivers of secondary traumatic stress (STS)-informed organizational change and experiences of STS and burnout in child welfare. Child Abuse Negl. 2023;141:106194. PMID: 37178529
From a study of 382 US child welfare professionals, “The findings of this study provide support for a bifocal approach to addressing secondary traumatic stress in the workplace, where organizations equip workers with adaptive coping skills to individually manage their indirect exposures and subsequent responses, and enact their own strategies to create healthy, trauma-informed environments for their workers…organizations have a legal and ethical responsibility to ensure supportive environments that address the threats of indirect trauma inherent in their work, and attempt to mitigate the harmful effects of such exposures.”
Johnson S, Kasparian NA, Cullum AS, et al.
Addressing Adverse Childhood and Adult Experiences During Prenatal Care. Obstet Gynecol. 2023 May 4;141(6):1072–87. PMID: 37141600
Comprehensive, practical review article on providing inquiry about and response to pregnant patients' past and present adversity and trauma during prenatal care encounters.
Simkin DR.
Post-Traumatic Stress Disorder/Developmental Trauma Disorder/Complex Post-Traumatic Stress Disorder and Complementary and Integrative Medicine/Functional Medicine. Child Adolesc Psychiatr Clin N Am. 2023;32(2):317-65. PMID: 37147042
Author reviews trauma diagnoses and treatment in children, and notes “Traditional therapies may be insufficient because the underlying root of prolonged PTSD may be related to early effects on the developing brain that sustain through adulthood. Developmental Trauma Disorder (based on biology rather than symptoms) may be better suited to identify PTSD in children.” She then reviews in detail the research evidence for a variety of complementary and integrative medicine therapies, including meditation, EMDR, EFT, art therapy, imagery rescripting, yoga, neurofeedback, supplements, etc.
Prevention
Holmes MR, King JA, Miller EK, et al.
Innovations in Trauma-Informed Care: Building the Nation's First System of Trauma-Informed Recreation Centers. Behavioral sciences (Basel, Switzerland). 2023;13(5). PMID: 37232631
“This paper describes the efforts over the past five years to transform the City of Cleveland, Ohio's 22 recreation centers into trauma-informed Neighborhood Resource and Recreation Centers--places where children, youth, and adults can readily acquire the support and services they need in an environment in which trauma-informed care principles are fully embedded in the fabric of the organization's culture.”
Researchers
Hillcoat A, Prakash J, Martin L, et al.
Trauma and female reproductive health across the lifecourse: motivating a research agenda for the future of women's health. Hum Reprod. 2023 May 12:dead087. PMID: 37172265
“We present a set of interlinked working hypotheses proposing relationships between traumatic events and reproductive and mental health that can define a research agenda to better understand reproductive outcomes from a trauma-informed perspective across the lifecourse…and propose several neuroendocrinological mechanisms by which traumatic experiences might increase the risk of adverse health outcomes in these domains.”
Wizentier MM, Stephenson BJK, Goodman MS.
The measurement of racism in health inequities research. Epidemiol Rev. 2023 May 5:mxad004. PMID: 37147182
“In this review, we conduct a descriptive examination of the measurement of racism in the health inequities epidemiological literature.” Authors examine the study design, methods used for analysis, types of measures used, number of measures used, phase of research, viewpoint, components of structural racism measures, and potential methods that have demonstrated potential for future work.
Grocott LR, Avery K, Medenblik AM, et al.
Reactions to Participation in Research on Violence Experiences and Minority Stress Among Sexual and Gender Minority Young Adults. J Interpers Violence. 2023:8862605231169756. PMID: 37119023
For 230 sexual minority young adults participating in research on dating relationships, “gender minority participants and those with higher minority stress and ACEs reported significantly higher negative emotional reactions to participation. Furthermore, gender minority participants scored worse on a scale indicating appreciation for contributing to research.”
Follis S, Breathett K, Garcia L, et al.
Quantifying structural racism in cohort studies to advance prospective evidence. SSM - population health. 2023;22:101417. PMID: 37207111
“Calls-to-action in health research have described a need to improve research on race, ethnicity, and structural racism. Well-established cohort studies typically lack access to novel structural and social determinants of health or precise race and ethnicity categorization, contributing to a loss of rigor to conduct informative analyses and a gap in prospective evidence on the role of structural racism in health outcomes. We propose and implement methods that prospective cohort studies can use to begin to rectify this, using the Women's Health Initiative (WHI) cohort as a case study.”
Other of Interest
Bourassa KJ, Caspi A, Brennan GM, et al.
Which Types of Stress Are Associated With Accelerated Biological Aging? Comparing Perceived Stress, Stressful Life Events, Childhood Adversity, and Posttraumatic Stress Disorder. Psychosom Med. 2023 Jun 1;85(5):389-396. PMID: 37053097
Studying 955 participants from the Dunedin Longitudinal Study, “Higher levels of all four measures of stress were significantly associated with accelerated aging…comparable to associations for smoking and low education, two established risk factors for accelerated aging. People with high levels of perceived stress, numerous adverse childhood experiences (4+), high stressful life event counts, or posttraumatic stress disorder were aging an additional estimated 2.4 months, 1.1 months, 1.4 months, and 1.4 months per year, respectively.”
Gaffey AE, Gathright EC, Fletcher LM, Goldstein CM.
Screening for Psychological Distress and Risk of Cardiovascular Disease and Related Mortality. J Cardiopulm Rehabil Prev. 2022 Nov 1;42(6):404-415. PMID: 36342683
From a research review that summarized 658,331 patients, adults reporting high psychological distress showed a 28% greater risk of incident cardiovascular disease (i.e. atrial fibrillation, acute coronary syndrome, coronary heart disease, peripheral vascular disease, and heart failure hospitalization within 3 years). “Rapid screening for psychological distress is a helpful and efficient approach to understanding the CVD risk profile of an individual.”
Hargrave AS, Sumner JA, Ebrahimi R, Cohen BE.
Posttraumatic Stress Disorder (PTSD) as a Risk Factor for Cardiovascular Disease: Implications for Future Research and Clinical Care. Curr Cardiol Rep. 2022 Dec;24(12):2067-2079. PMID: 36306020
“Posttraumatic stress disorder (PTSD) may be an important risk factor for cardiovascular disease (CVD). We explore the literature linking PTSD to CVD, potential mechanisms, interventions, and clinical implications…Screening for and treating PTSD, as we do for traditional CVD risk factors, is likely an important addition to cardiovascular care…Therefore, this review is a call to action for medical providers to embed trauma-informed practices into their cardiovascular care, including expressing the same concern for mental health effects on CVD as they do when discussing smoking, uncontrolled diabetes, or elevated blood pressure with their patients.”
Gowland RL, Caffell AC, Quade L, et al.
The expendables: Bioarchaeological evidence for pauper apprentices in 19th century England and the health consequences of child labour. PLoS One. 2023;18(5):e0284970. PMID: 37195937
“The large-scale employment of children during the rapid industrialisation of the late 18th and early 19th centuries in England is well documented. During this period, the removal of pauper children from workhouses in cities to work as apprentices in rural mills in the North of England was commonplace…The excavation of a rural churchyard cemetery in the village of Fewston, North Yorkshire, yielded the skeletal remains of 154 individuals, including an unusually large proportion of children aged between 8 to 20 years.” Results of testing showed evidence of “diet low in animal protein, severe growth delays and pathological lesions indicative of early life adversity, as well as respiratory disease, which is a known occupational hazard of mill work. This study has provided unique insights into the harrowing lives of these children; born into poverty and forced to work long hours in dangerous conditions.”
Fang X, Chen Y, Wang J, et al.
Increased intrinsic and synaptic excitability of hypothalamic POMC neurons underlies chronic stress-induced behavioral deficits. Mol Psychiatry. 2023 Mar;28(3):1365-1382. PMID: 36473997
In this mouse study, chronic, unpredictable stress led to increased firing of neurons in one part of the brain hypothalamus in both male and female mice. This increased brain area activity was associated with mouse behaviors that in humans would translate to anhedonia (inability to feel pleasure) and depression.
Biermanns N.
Gatekeepers of Extermination: SS Camp Physicians and Their Scope of Action. Ann Intern Med. 2023 Jun;176(6):853-856. PMID: 37186918
“From 1943 and 1944 onward, SS camp physicians made the individual medical decisions on whether each prisoner was fit for work or was immediately subjected to extermination… This was due to a functional change in the concentration camp system during World War II, where the selection of prisoners, which had previously been carried out by nonmedical SS camp staff, became a main task of the medical camp staff. The initiative to transfer sole responsibility for the selections came from the physicians themselves…It is another long-held myth that Nazi medical crimes were committed by sadistic individual perpetrators in a moral vacuum. In reality, most Nazi physicians had a detailed system of moral values, and it was instead the Nazis’ racist-utilitarian reinterpretation of traditional medical ethical principles and the corresponding conviction of many physicians ‘that their actions were necessary and, therefore, even right and good’ that turned ‘ordinary physicians’ into murderers…What can we learn from this for today’s medical practice?...Our contemporary health care system is unmistakably characterized by implicit and explicit hierarchies of power and value, relationships of dependency, and increasing economization. Physicians…have to prioritize human life and allocate scarce resources—especially in crisis situations. In this context, a personal moral compass and reflection on social and economic factors and their potential influence on medical decisions, as well as recognition of one’s own professional dependency, are needed…Learning from the Holocaust can be a starting point for reflecting on the value of human life in modern medicine.”
Comments (0)