[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]
Child Abuse
Wilson RF, Fortson BL, Zhou H, et al.
Trends in Homicide Rates for US Children Aged 0 to 17 Years, 1999 to 2020. JAMA Pediatr. 2023 Feb 1;177(2):187-197. PMID: 36534407
This study included 38,362 homicide victims (69.4% male) from 1999-2020. The overall child homicide rate has increased annually since 2013, after downward trends 2007-2013, with a precipitous rise from 2019 to 2020. Homicide rates recently increased significantly for boys; children in the 6-10, 11-15, and 16-17 year-old age groups; Black and Hispanic children; and children in the south, rural, and urban areas. Homicide rates have decreased for girls, infants, 1-5 year-olds, Asian or Pacific Islander children, White children, and children in the Northeast. “Homicides of children 10 years or younger were most commonly precipitated by abuse/neglect, and perpetrated by parents/caregivers. Homicides of 11- to 17-year-olds were most commonly precipitated by crime and arguments and perpetrated by someone known to them, especially friends and acquaintances.”
Esposito T, Caldwell J, Chabot M, et al.
Childhood Prevalence of Involvement with the Child Protection System in Quebec: A Longitudinal Study. Int J Environ Res Public Health. 2022;20(1). PMID: 36612946
In the first ever study of its kind in Canada, child protection involvement in Quebec over 17 years showed that “before reaching the age of 18 years, over 18% of children were reported to child protection at least once, one in every ten children (10.1%) in the province had a report that led to the finding of their security or development being compromised, and over 5% were placed outside the home…neglect was a primary concern in close to half (47.6%) of cases.” These findings only captured initial incidents of involvement with child protection, not recurrent involvement.
Vermeulen S, Alink LRA, van Berkel SR.
Child Maltreatment During School and Childcare Closure Due to the COVID-19 Pandemic. Child Maltreat. 2023 Feb;28(1):13-23. PMID: 35105228
“Based on reports of childcare professionals and primary and secondary school teachers (N = 444) in the Netherlands, “The prevalence of emotional neglect was found to be three times higher during the lockdown…and was reflected in overall emotional neglect as well as for two main subtypes of emotional neglect: educational neglect and witnessing domestic violence. No significant differences were found for other types of child maltreatment. Most of the reported cases of maltreatment were already problematic before the lockdown and became worse during the lockdown.”
Park WJ, Walsh KA.
COVID-19 and the unseen pandemic of child abuse. BMJ paediatrics open. 2022;6(1). PMID: 36645748
In this editorial examining the effects of pandemic lockdown on children, authors discuss disparate data on abuse as well as results from a variety of counties that did and did not close schools, making the case for keeping schools open. “The desire for a sense of security may be a tempting bias towards emphasising the resilience of children, but it is ethically problematic to push children towards abuse in the name of public health. Suffering in silence is not resilience. In the face of uncertainty, protecting vulnerable children ought to be of the utmost priority. It is our view that the collateral damage of prolonged school closures for society’s most vulnerable members is a powerful ethical consideration against any pandemic response.”
Palusci VJ, Schnitzer PG, Collier A.
Social and demographic characteristics of child maltreatment fatalities among children ages 5-17 years. Child Abuse Negl. 2023;136:106002. PMID: 36621053
1478 maltreatment-related deaths were identified from national data among children aged 5-17 during 2009-2018. “Higher proportions of older children were non-Hispanic white, had a history of chronic disease or disability, had problems in school, and had a history of mental health issues. Forty-three percent of the maltreatment deaths were due to homicide and 10% by suicide. Higher proportions (65%) of younger children (5-10 years old) died by homicide, compared to older children (35% among ages 11-17y). While 58% of deaths overall were related to neglect, 68% of deaths in older children were related to neglect, including 80% of suicides.”
Raza F, Yeh HW, Goggin K, Connelly M, Sullivant S.
Rates of Positive Suicide Screens in the Emergency Department and Outpatient Clinics at a Tertiary Care Children's Hospital. J Adolesc Health. 2023 Jan 14:S1054-139X(22)01019-9. PMID: 36646562
“Suicide screening results from healthcare encounters at one tertiary care children’s hospital occurring between February 2019 and January 2020 were estimated for ambulatory clinics (OP), urgent care (UC) clinics, and the emergency department (ED)…Positive screens were found in 10.8% of visits overall. Rates of positive screens were 14.5% in the ED, 9.9% in OP, and 9.3% in UC. Rates of positive screens in outpatient clinics were highest in child abuse 33.4% and adolescent specialty 19.2%.”
Ashworth E, Jarman I, McCabe P, et al.
Suicidal Crisis among Children and Young People: Associations with ACEs and Socio-Demographic Factors. Int J Environ Res Public Health. 2023;20(2). PMID: 36674021
“This is a case series study of children and young people (aged 8-16) experiencing suicidal crisis who presented in a paediatric Emergency Department in England between March 2019 and March 2021 (n = 240). Results revealed a significant association between suicidal crisis and…those experiencing "household risk" and those experiencing "parental risk". Female sex, history of self-harm, mental health difficulties, and previous input from mental health services were also associated with repeat hospital attendances.”
Evangelist M, Thomas MMC, Waldfogel J.
Child protective services contact and youth outcomes. Child Abuse Negl. 2023;136:105994. PMID: 36630851
Using data from the Fragile Families Study of children born in 20 US cities, “CPS contact was associated with an 88% increase in the probability of smoking, a 29% increase in externalizing behavior, a 27% increase in internalizing behavior, an 18% increase in the probability of being expelled, a 7.5% increase in a depression, a 6.9% increase in anxiety, a 6.2% reduction in happiness, a 6.0% increase in impulsivity, and a 5.5% increase in school troubles…Despite a federal mandate to improve child wellbeing, we found no evidence that contact with the child welfare system improves child outcomes. Rather, CPS contact was associated with worse mental health and developmental outcomes.”
Garstang J, Dickens J, Menka M, Taylor J.
Improving professional practice in the investigation and management of intrafamilial child sexual abuse. Child Abuse Negl. 2023;137:106053. PMID: 36689782
From an analysis of 25 English child protection reviews featuring intrafamilial child sexual abuse (CSA), “Half of perpetrators were known by services to have previously abused children, but issues with professional practice enabled them to continue. Most children did not disclose CSA verbally, showing challenging or sexualised behaviour; but professionals lacked knowledge and confidence on how to intervene without verbal disclosure, which limited safeguarding actions. Non-engagement by families with services was common, with some non-abusing parents complicit in abuse and deception. Significant neglect occurred in half the families, which diverted professional attention away from CSA…CSA is deliberate abuse of children involving considerable deception by perpetrators in contrast to some other types of child abuse. This difference in abuser behaviour makes child protection more difficult, particularly when professionals do not recognise and respond to children's non-verbal disclosures.”
Adult Manifestations of Child Abuse
Najman JM, Scott JG, Farrington DP, et al.
Does Childhood Maltreatment Lead to Low Life Success? Comparing Agency and Self-Reports. J Interpers Violence. 2023 Jan;38(1-2):NP1320-NP1342. PMID: 35466762
From an Australian study of individuals from pre-birth to age 30, “Childhood maltreatment whether measured by agency report or self-report predicts overall low life success” – low life success was predicted by childhood maltreatment OR = 2.60, physical abuse OR = 2.37, sexual abuse OR = 2.85, emotional abuse OR = 2.53, and neglect OR = 2.36.
Eid K, Torkildsen Ø, Aarseth J, et al.
Abuse and revictimization in adulthood in multiple sclerosis: a cross-sectional study during pregnancy. J Neurol. 2022 Nov;269(11):5901-5909. PMID: 35780399
Of 106 Norwegian pregnant women with Multiple Sclerosis (MS) from a national registry, those with MS reported increased rates of adult abuse (26% vs. 20%), lifetime emotional abuse (21% vs. 13%), and lifetime sexual abuse (10% vs. 6%). In addition, women with MS were 2.37 times more likely to report rape as an adult, and 2.23 times more likely to report adult revictimization after child abuse. The risk of abuse during pregnancy was the same for those both with and without MS.
Teigen PK, Hagemann CT, Fors EA, et al.
Chronic vulvar pain in gynecological outpatients. Scand J Pain. 2022 Jul 11;23(1):97-103. PMID: 35822705
From a questionnaire answered by 762 women at a Norwegian gynecology outpatient clinic, 17.1% reported chronic vulvar pain (CVP) during the past year (pain in the vulvar area exceeding three months of duration, with a reported prevalence of 7-8% in the general population). Those with CVP were 2.0 times more likely to report child sexual abuse.
Kapoor E.
Childhood adversity and gynecological conditions. Case Rep Womens Health. 2022 Aug 12;36:e00438. PMID: 36589638
Author reviews the research linking increased menopausal symptoms and increased rates of gynecologic surgeries with increased ACE scores, possible physiological explanations/mechanisms, and calls for increased education of medical professionals about this link “so that women can be screened for ACEs in the relevant clinical situations and be offered appropriate counseling, support, and mental health resources” to make more informed choices about treatment, including having surgery.
Legendre M, Sabourin S, Bégin C.
Childhood sexual abuse and food addiction severity in a clinical sample of individuals with overweight or obesity. Eat Weight Disord. 2022 Dec;27(8):3737-3742. PMID: 35994206
Of 187 adults presenting with eating and weight disorders, of all of the interpersonal traumas, childhood sexual abuse was associated with the highest risk (about 2 times higher) of food addiction. In addition, “The relationship with the abuser, the type of sexual abuse, and the number of abuses are relevant factors” in food addiction.
Korgaonkar MS, Breukelaar IA, Felmingham K, et al.
Association of Neural Connectome With Early Experiences of Abuse in Adults. JAMA network open. 2023;6(1):e2253082. PMID: 36701155
647 Australian adults, mean age 33.3 years, who had experienced childhood abuse, received brain MRIs evaluating how different parts of the brain worked together. The experience of childhood abuse was found to be associated with physiologic changes in brain connectivity (the “connectome”) affecting the functioning of systems responsible for perceptual processing (the process of selecting, organizing, and interpreting information) and attention. This finding was independent of psychopathology/mood disorder.
Joshi D, Gonzalez A, Lin D, Raina P.
The association between ACEs and epigenetic age acceleration in the Canadian longitudinal study on aging. Aging Cell. 2023:e13779. PMID: 36650913
For 1445 Canadian study participants aged 45-85 years, cumulative ACE score, childhood exposure to parental separation or divorce, and emotional abuse were each associated with higher “DNAm GrimAge” which estimates risk of accelerated mortality, after adjusting for other adversities and covariates.
Kivimäki M, Bartolomucci A, Kawachi I.
The multiple roles of life stress in metabolic disorders. Nat Rev Endocrinol. 2023 Jan;19(1):10-27. PMID: 36224493
“We review current evidence from basic sciences and epidemiology linking stress to the development and progression of metabolic disorders throughout life…stressors in the home, workplace and neighbourhood are associated with accelerated ageing and metabolic and immune alterations, both directly and indirectly via behavioural risks. The likelihood of developing clinical conditions, such as diabetes mellitus is increased in individuals with adverse childhood experiences or long-term (years) of severe stress at work or in private life. The increased risk of metabolic disorders is often associated with other stress-related conditions, such as mental health disorders, cardiovascular disease, and increased susceptibility to infections. Equally, stress can worsen prognosis in metabolic diseases.” Excellent review with helpful tables and diagrams.
Swedo EA, D'Angelo DV, Fasula AM, Clayton HB, Ports KA.
Associations of ACEs With Pregnancy and Infant Health. Am J Prev Med. 2023 Jan 23:S0749-3797(22)00539-6. PMID: 36697281
“The study used 2016-2018 Pregnancy Risk Assessment Monitoring System population-based data from 5 states…Over 50% of respondents reported at least 1 adverse childhood experience and 13%-31% reported ≥3 adverse childhood experiences, depending on the state. Significant associations were identified in all adjusted models between adverse childhood experiences and unwanted pregnancy, smoking, physical abuse, and depression during pregnancy.”
Zhang L, Mersky JP, Lee CP.
Intergenerational Pathways Linking Mothers' ACEs and Children's Social-Emotional Problems. Child Maltreat. 2023 Feb;28(1):107-118. PMID: 35068215
“An analysis of data from a longitudinal investigation of low-income women in Wisconsin confirmed the connection between a mother’s exposure to childhood adversity and social-emotional problems in her offspring. Results showed that mothers’ mental health problems, experiences of adult adversity, and perceptions of father involvement fully mediated [was responsible for] the relationship between mothers’ ACEs and children’s social-emotional problems.”
Tschampl CA, Canuto M, De Jesús D, et al.
Adverse childhood experiences are associated with increased overdose risk in predominately Latinx adults seeking treatment for substance use disorders. Front Psychiatry. 2022 Dec 15;13:987085. PMID: 36590627
Of 148 primarily Latinx adults seeking treatment for substance use disorders, “ACE scores were high with 58% having experienced 4+ ACEs. Female gender was associated with a 24% higher ACE score than male gender…each additional ACE was associated with 1.3 times greater odds of overdose. Those reporting heroin use had 8.8 times greater odds of reporting overdose compared to those reporting no heroin use.”
Adolescents
Grossberg A, Rice T.
Depression and Suicidal Behavior in Adolescents. Med Clin North Am. 2023 Jan;107(1):169-182. PMID: 36402497
“Depression commonly onsets in adolescence, affecting approximately 1 in 4 female adolescents and 1 in 10 males in the United States. Adolescent depression is a significant risk factor for suicide, the cause of over a third of all American adolescent deaths. Adolescent depression is introduced with a focus on important risk factors, including nonsuicidal self-injury, ACEs, and substance abuse. Protective factors and contemporary special topics of the COVID-19 pandemic and social media use are reviewed. Therapeutic options and clinical barriers are highlighted.”
Test Offer S, Alexander E, Barbara K, et al.
The association between childhood trauma and overweight and obesity in young adults: the mediating role of food addiction. Eat Weight Disord. 2022 Dec;27(8):3257-3266. PMID: 35907144
Of 512 UK young adults, “experiences of childhood trauma are associated with the development of overweight and obesity during early adulthood and up to half of this relationship can be attributed to food addiction, which is likely used as a maladaptive coping mechanism in response to trauma. Young adults living with overweight and obesity who report experiences of childhood trauma may benefit from the support of clinical and counselling psychologists to improve their understanding of the underlying psychosocial factors that influence their eating behaviours.”
Ochi S, Dwivedi Y.
Dissecting early life stress-induced adolescent depression through epigenomic approach. Mol Psychiatry. 2023 Jan;28(1):141-153. PMID: 36517640
Authors discuss the evidence for common epigenetic changes caused by early life stress, including DNA methylation, histone modification, and the regulation of noncoding RNAs; the commonalities and differences in epigenetic profiling between adolescents and adults; the changes that are sex-dependent as well as by type of early life stress; and the subsequent impact on adolescent psychiatric disorders.
Brown C, Beardslee J, Frick PJ, Steinberg LD, Cauffman E.
Perceived sleep quality predicts aggressive offending in adolescence and young adulthood. J Child Psychol Psychiatry. 2023;64(2):320-8. PMID: 35665505
Of 1216 justice-involved male youth followed between ages 13-24, “Increases in sleep problems are associated with increases in offending, particularly aggressive/person-related offenses, for both adolescents and young adults. This holds true even after controlling for time-varying anxiety, substance use, and violence exposure…Improving sleep quality may be critical for reducing aggressive behavior in at-risk adolescents and young adults. Interventions that address sleep quality, and not just quantity, may be particularly beneficial.”
Robin M, Schupak T, Bonnardel L, et al.
Clinical Stakes of Sexual Abuse in Adolescent Psychiatry. Int J Environ Res Public Health. 2023;20(2). PMID: 36673831
Of French adolescent patients aged 13-17 years with psychiatric hospitalization over a 4-year period, in 28.5% sexual assault was mentioned in the medical record and was associated with a five-times longer hospital stay, increased suicide attempts with higher number of abuse experiences, and increased medical severity when the named aggressor was an adult. “The number of hospitalizations is positively correlated with the number of reported abuses, as well as with the intrafamilial and adult status of the perpetrator. An early age of onset, repeated abuse, and the intrafamilial nature of the abuse are associated with a longer time to disclosure.”
Domestic Violence – Effects on Children
Gower T, Jouriles EN, Rosenfield D, McDonald R.
Physical and psychological IPV: Relations with child threat appraisals and internalizing and externalizing symptoms. J Fam Psychol. 2022 Oct;36(7):1106-1116. PMID: 35771501
Of 531 children aged 7-10 years and their mothers, “physical and psychological IPV had additive effects on child threat appraisals [perceived potential degree of harm, and perceived vulnerability] and child reports of disruptive behavior problems…Notably, psychological IPV was also associated with child threat appraisals, anxiety symptoms, and disruptive behavior problems even in the absence of physical IPV.”
Winfield A, Hilton NZ, Poon J, Straatman AL, Jaffe PG.
Coping Strategies in Women and Children Living with Domestic Violence: Staying Alive. J Fam Violence. 2023:1-13. PMID: 36685751
Interviews with 30 Canadian mothers who experienced severe or potentially life-threatening domestic violence and 5 adults who experienced domestic violence in childhood revealed five major themes: ongoing communication, appeasing the abuser, soothing activities, exposure reduction, and fostering independence. “Mothers and their children worked together to reassure each other, keep each other safe, and made plans to leave their abuser. Safety planning for the mother-child dyad could build on children's existing coping strategies and recognize and support children's desire to protect their mother and themselves effectively and safely according to their developmental stage.”
Hornor G.
Intimate Partner Violence and Children: Essentials for the Pediatric Nurse Practitioner. J Pediatr Health Care. 2023 Jan 20:S0891-5245(22)00356-X. PMID: 36682969
“This continuing education article will discuss IPV and its impact on children from conception to adolescence while exploring implications for practice.”
Kahovec AE, Haselschwerdt ML.
Legal System Disclosure Experiences of Young Adult Children Exposed to Domestic Violence. J Interpers Violence. 2023 Jan;38(1-2):NP1343-NP1366. PMID: 35466757
Of 25 young adults exposed to father-mother-perpetrated DV during their childhood, half of the participants had no legal system disclosure. “Escalation of violence was a key factor that drove legal system disclosure, but other factors including how the young adults and their communities perceived their fathers, the match between the youth's goals for disclosure and the outcomes upon disclosing, along with family privacy norms and family boundaries were influential in guiding decision making over time…our findings unpack the conditions under which youth choose to (not) disclose, the factors influencing these decisions, and how the responses and reactions from legal support systems inform future disclosure decisions.”
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