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ACEs Research Corner — February 2021


[Editor's note: Dr. Harise Stein at Stanford University edits a web site — — that focuses on the health effects of abuse, and includes research articles on ACEs. Every month, she posts  the summaries of the abstracts and links to research articles that address only ACEs. Thank you, Harise!! -- Jane Stevens]

Walker CS, Walker BH, Brown DC, Buttross S, Sarver DE.
Defining the role of exposure to ACEs in ADHD: Examination in a national sample of US children. Child Abuse Negl. 2021 Feb;112:104884. PMID: 33360863
From a large national survey with parents reporting a diagnosis of ADHD, “The ACE most strongly associated with the odds of ADHD was having lived with someone with mental illness closely followed by parent/guardian incarceration.”

Mo X, Gai RT, Tachibana Y, Bolt T, Takahashi Y, Nakayama T.
The burden of disease and the cost of illness attributable to child maltreatment in Japan: long-term health consequences largely matter. BMC Public Health. 2020 Aug 27;20(1):1296. PMID: 32854682
Per authors, of the Japanese population living in 2016, the overall future lifetime economic burden (direct and indirect medical costs and burden of disease) of those experiencing childhood abuse is $50.24 billion US dollars, 7-8 times higher than prior estimates.

Clemens V, Berthold O, Witt A, et. al.
Lifespan risks of growing up in a family with mental illness or substance abuse. Sci Rep. 2020 Sep 22;10(1):15453. PMID: 32963257
From a survey of 2531 German adults, “The risk of child maltreatment was 5 to 5.6 times higher if mental illness and 4.9 to 6.9 times higher if substance abuse of a family member was reported. Furthermore, the risk of health problems, including obesity, decreased life satisfaction, lower income, low educational achievement, unemployment and living without a partner was increased if participants grew up in a family affected by mental health problems or substance abuse.”

Ho FK, Celis-Morales C, Gray SR, et. al.
Child maltreatment and cardiovascular disease: quantifying mediation pathways using UK Biobank. BMC Med. 2020 Jun 12;18(1):143. PMID: 32527275
“Child maltreatment is associated with incident CVD [cardiovascular disease] through a combination of mental health, lifestyle, and biological pathways.” From a study of 152,040 UK adults, 1/3 reported at least one type of child maltreatment. There was a dose-response relationship between the number of maltreatment types and incident CVD, and each additional type of child maltreatment was associated with an 11% increased risk of CVD. The majority (56.2%) of the association was related to depressive symptoms, followed by smoking, high-density lipoprotein cholesterol, and sleep duration.”

Rafiq T, O'Leary DD, Dempster KS, Cairney J, Wade TJ.
Adverse Childhood Experiences (ACEs) Predict Increased Arterial Stiffness from Childhood to Early Adulthood: Pilot Analysis of the Niagara Longitudinal Heart Study. J Child Adolesc Trauma. 2020 May 30;13(4):505-514. PMID: 33269049
“An association among adults between adverse childhood experiences (ACEs) and arterial stiffness and between arterial stiffness and cardiovascular disease has been established.“ As part of a small study over time of 76 young adults, those with 4+ ACEs had a greater increase in arterial stiffness starting in childhood, similar for males and females.

Kapoor E, Okuno M, Miller VM, et. al.
Association of adverse childhood experiences with menopausal symptoms: Results from the Data Registry on Experiences of Aging, Menopause and Sexuality (DREAMS). Maturitas. 2021 Jan;143:209-215. PMID: 33308631
Of 1670 women seen at a menopause clinic, even after adjusting for multiple factors, there was a significant association between childhood adversity and self-reported menopausal symptoms. “These associations highlight the importance of screening women with bothersome menopausal symptoms for childhood adversity, and of offering appropriate management and counseling when indicated.”

Williamson V, Greenberg N, Murphy D.
Predictors of moral injury in UK treatment seeking veterans. Child Abuse Negl. 2021 Feb;112:104889. PMID: 33360537
Of 177 UK veterans seeking psychological treatment, there was a significant association between ACEs and veteran expressions of moral injury.

Komesu YM, Petersen TR, Krantz TE, et. al.
Adverse Childhood Experiences in Women With Overactive Bladder or Interstitial Cystitis/Bladder Pain Syndrome. Female Pelvic Med Reconstr Surg. 2021 Jan 1;27(1):e208-e214. PMID: 33369968
For 322 women seen at a university urogynecology clinic, women with overactive bladder syndrome (OAB) were more than twice as likely as controls to have 4+ ACEs, and those with interstitial cystitis/bladder pain syndrome (IC/BPS) were 7 times more likely to have 4+ ACEs. “Recognition of increased childhood adversity in OAB and IC/BPS has important treatment and health implications.”

Feldman CH, Malspeis S, Leatherwood C, et. al.
Association of Childhood Abuse with Incident Systemic Lupus Erythematosus in Adulthood in a Longitudinal Cohort of Women. J Rheumatol. 2019 Dec;46(12):1589-1596. PMID: 31092723
Using data from the Nurses’ Health Study, among women who had experienced childhood physical and emotional abuse compared with women who had not, risk for SLE (lupus) was increased by 2.57 times, partly explained by depression and PTSD.

Carr MJ, Steeg S, Mok PLH, et. al.
Adverse Childhood Experiences and Risk of Subsequently Engaging in Self-Harm and Violence towards Other People-"Dual Harm". Int J Environ Res Public Health. 2020 Dec 15;17(24):E9409. PMID: 33334020
Using linked Danish registries covering 58,409 individuals, experiencing five or more ACEs was more prevalent among individuals with dual-harm history (physical harm to self and to others). “Growing up in environments that are characterized by poverty, violence, and substance misuse, and experiencing multiple adversities in childhood, appear to be especially strongly linked with elevated dual-harm risk.”

Chokshi B, Skjoldager K.
Adolescent Patient Perspectives on Addressing Childhood Adversity in the Primary Care Setting. Clin Pediatr (Phila). 2020 Oct;59(11):1014-1018. PMID: 32468888
Interviews with 16 adolescents on their thoughts on receiving ACE screening in primary care clinic revealed four main themes: all adolescents felt the primary care setting was suitable for discussing ACEs; participants suggested using a nonjudgmental attitude, establishing a trusting relationship, offering choice to engage in discussion, and educating about why the discussion is occurring; participants overwhelmingly noted that trauma could lead to mental health problems, but none knew about physical health effects; participants suggested community programs to spread information about ACEs, their impact on well-being, and on the ACEs screen itself, in addition to offering classes to teach skills for limiting the negative consequences of ACEs exposure.

Angelakis I, Austin JL, Gooding P.
Association of Childhood Maltreatment With Suicide Behaviors Among Young People: A Systematic Review and Meta-analysis. JAMA Netw Open. 2020 Aug 3;3(8):e2012563. PMID: 32756929
From a research review of 79 studies encompassing 337,185 adolescents, various types of childhood abuse were associated with increased risk of suicide attempts – childhood sexual abuse 3.41 times increased odds, physical abuse 2.18, emotional abuse 2.21, emotional neglect 1.93, physical neglect 1.79, and combined abuse 3.38.

Graf GH, Chihuri S, Blow M, Li G.
Adverse Childhood Experiences and Justice System Contact. Pediatrics. 2021 Jan;147(1):e2020021030. PMID: 33328338
In a research review, ACEs were positively associated with justice system contact in a dose-response fashion, across multiple types of justice system contacts and across geographic regions.

McCabe SE, Hughes TL, West BT, et. al.
Sexual Orientation, Adverse Childhood Experiences, and Comorbid DSM-5 Substance Use and Mental Health Disorders. J Clin Psychiatry. 2020 Dec 1;81(6):20m13291. PMID: 33264820
From a large US survey that did not include data on transsexual individuals, “Sexual minorities (gay, lesbian, bisexual), especially bisexual women, reported the highest prevalence of ACEs and comorbid substance use and mental health disorders. Approximately 43.8% of bisexual women reported 4 or more ACEs, and 38.0% of bisexual women reported comorbid substance use and mental health disorders.

Grest CV, Finno-Velasquez M, Cederbaum JA, Unger JB.
Adverse Childhood Experiences Among 3 Generations of Latinx Youth. Am J Prev Med. 2021 Jan;60(1):20-28. PMID: 33341179
For 1003 Latinx individuals followed over 5 time points, compared with third generation young adults, first and second generation youth were approximately half as likely to report household dysfunction, especially living with an alcohol or drug user. In contrast, first generation youth were two times more likely to report sexual abuse compared to third generation.

Behnke A, Rojas R, Karabatsiakis A, Kolassa IT.
Childhood maltreatment compromises resilience against occupational trauma exposure: A retrospective study among emergency medical service personnel. Child Abuse Negl. 2020 Jan;99:104248. PMID: 31731138
In this study of 103 German EMS personnel, those who reported higher exposure to childhood maltreatment experienced more severe depressive, PTSD and body symptoms with occupational trauma exposure. “Childhood maltreatment could increase the EMS personnel's vulnerability to the detrimental consequences of critical incidents on duty.”

Not Specifically ACEs but of Interest

Kalia V, Knauft K, Hayatbini N.
Cognitive flexibility and perceived threat from COVID-19 mediate the relationship between childhood maltreatment and state anxiety. PLoS One. 2020 Dec 11;15(12):e0243881. PMID: 33306748
“Our data indicate that experience with early life adversity in the form of maltreatment is associated with increased perceived threat from COVID-19, which results in higher anxiety levels for the individual.”

McGuire K, London K.
A retrospective approach to examining child abuse disclosure. Child Abuse Negl. 2020 Jan;99:104263. PMID: 31734635
From an online survey of adult college students who had experienced childhood abuse, 80% indicated any lifetime disclosure of childhood sexual abuse, with 50% disclosing during childhood, and only 16% coming to the attention of authorities. For childhood physical abuse, 52% reported any lifetime disclosure, with 32% disclosing during childhood, and only 8% being reported to authorities.

McPhillips K, Salter M, Roberts-Pedersen E, Kezelman C.
Understanding trauma as a system of psycho-social harm: Contributions from the Australian royal commission into child sex abuse. Child Abuse Negl. 2020 Jan;99:104232. PMID: 31710962
Authors discuss the Australian Royal Commission report Institutional Responses to Child Sexual Abuse and its successful investigatory process “by developing approaches to trauma as a system of harm with complex impacts on families, communities and indeed the nation…an interdisciplinary relational approach to the study of trauma is a key principle in the emergence of a trauma-informed culture.”

Roberts AL, Kubzansky LD, Chibnik LB, Rimm EB, Koenen KC.
Association of Posttraumatic Stress and Depressive Symptoms With Mortality in Women. JAMA Netw Open. 2020 Dec 1;3(12):e2027935. PMID: 33275156
From the Nurses Health Study II, of 51,000 mostly White mid-life nurses followed for nine years, and controlling for multiple variables, women with PTSD and depression symptoms were 2-4 times more likely to die during the follow-up period, in a dose-response fashion with increasing mental health symptoms. Highest causes of death for these women, compared to a control group without PTSD and depression, were cardiovascular disease, diabetes, unintentional injury, suicide, and other. Per interview with author, “These findings provide further evidence that mental health is fundamental to physical health…We ignore our emotional well-being at our peril.” A commentator added that it is “critical to appreciate the physical health consequences in individuals who have experienced trauma. This study adds to a growing literature demonstrating that the impact extends far beyond emotional health.”

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