An abundance of research has implicated socioeconomic disadvantage as a major risk factor for increased rates of morbidity and mortality worldwide. While advances in science, medicine, and technology have enabled a positive trend in health outcomes over the previous two decades, individuals of lower socioeconomic status have experienced negligible improvements in health and longevity. Furthermore, individuals of lower socioeconomic status face higher risks of mental health disorders than their higher socioeconomic status counterparts. In order to improve methods of intervention, it is important to understand how the roots of these issues are cultivated during childhood. Socioeconomic status is operationalized in multiple ways, including objective measures at both the household and neighborhood levels such as income, education, occupation, employment status, and single-parent status, as well as subjective measures such as perceived social status. This work explores the relationships between exposure to childhood socioeconomic disadvantage and the development of psychopathology. It reviews the literature for impacts of lower socioeconomic status during childhood on both internalizing (mood and anxiety) and externalizing (behavioral and substance use) disorders. Overall, mental health disorders constitute a significant proportion of the worldwide health burden, affecting one in four adults across the global population, including one in five adults and one in two adolescents in the United States. These staggering prevalence rates illuminate the importance of better understanding the mechanisms by which mental health illnesses emerge. Childhood exposure to socioeconomic deprivation has been identified as a robust contributing factor to the increased risk of psychopathology development. Exposure to socioeconomic disadvantage increases the risk for mood disorders such as major depressive disorder, dysthymic disorder, bipolar I and II disorder, cyclothymic disorder; anxiety disorders such as generalized anxiety disorder, panic disorder, social anxiety disorder, and specific phobias; behavioral disorders such as oppositional defiant disorder, conduct disorder, antisocial personality disorder, and attention-deficit/hyperactivity disorder; and substance use disorders such as alcohol and tobacco use. These conditions can disrupt normal growth and development; cause significant impairment in social, academic, and occupational environments; and create tremendous distress in important areas of daily functioning. An ecobiodevelopmental model reveals how the interplay of biological factors, such as genetic inheritance and physiological adaptations/disruptions, with ecological factors, such as the social and physical environment, occurs continuously across the entire life span from the prenatal period through infancy, childhood, adolescence, and adulthood to drive development and the evolution of individual health and disease. Application of this approach helps to explain how genetic predispositions interact with exposure to poverty to cultivate an environment more prone to adverse childhood experiences. Adverse childhood experiences are stressors occurring prior to the age of 18 that can be threatening or harmful emotionally or physically, which can include traumatic or potentially traumatic experiences such as neglect and abuse. Examples include socioeconomic hardship, racial/ethnic discrimination, parental death, separation from parents, divorce, neighborhood violence, parental mental illness, abuse, neglect, parental substance abuse, violence and criminality in the home, and life-threatening physical illness. Adverse childhood experiences promote toxic stress, which occurs from distressing situations high in magnitude, duration, or frequency without protective, buffering adult relationships to help the child cope. Toxic stress is characterized by an overloading of the body’s normal physiologic response mechanisms, which can have adverse long-term consequences through brain circuitry alterations and physiologic disruptions of the hypothalamic-pituitary-adrenocortical axis occurring during sensitive, critical periods of development. Toxic stress-induced alterations can occur in brain regions such as the hippocampus, amygdala, and prefrontal cortex, which are important in mood control, anxiety, stress coping, decision-making, and self-regulation. Self-regulation is a critical mediator in the link between childhood deprivation and subsequent psychopathology, as deficits in self-regulation increases the risk of both internalizing and externalizing disorders. In summation, the ecobiodevelopmental model is a multi-disciplinary approach that integrates developmental science constructs of toxic stress and self-regulation with ecology, neuroscience, and life course sciences to supply promising explanations for the underlying mechanisms linking childhood poverty to mental illnesses.

Within the past two decades, research on adverse childhood experiences (ACEs) spurred by the seminal Felitti (1998) study has gained significant momentum. Research has shown that childhood adversity impacts development across the lifespan, and it has been linked to heightened risk for both physical and mental health difficulties. Depression symptoms is one such outcome that has been associated with ACE exposure. In examining the pathways through which ACEs impact later development, the literature indicates emotion regulation may be a potential mediator between ACEs and depression outcomes. While understanding etiology of depression and risk factors that contribute to symptomology is important, it is also important to investigate factors which may buffer against depression and build resilience. Social support may be a protective environmental factor that could mitigate heightened risk within populations of individuals with ACE exposure. The primary aim of this study is to investigate the role of social support as a protective factor against depression in those who have experienced ACEs nested within the model where emotion regulation acts as a mediator between ACE exposure and later depressive symptoms. In this study, undergraduate participants (N = 766) at a southeastern university completed self-report questionnaires which evaluated ACEs, emotion regulation difficulties, perceived social support, and depressive symptoms. In the current study, it is hypothesized that difficulties in emotion regulation will mediate the link between ACEs and later depressive symptoms (model 1), social support will act as a protective factor against depression in the pathway between difficulties in emotion regulation and depression (model 2), and social support will have a greater buffering effect in individuals who have greater severity of ACE exposure (model 3). Mediation (model 1) and moderated mediation (model 2) analyses will be conducted using Hayes PROCESS macro. For all PROCESS models, bootstrapping frequencies will be set at 5,000 and used to generate a 95% confidence interval. The PROCESS bootstrapping methods entail a statistical process of extracting, resampling, and replacement of cases within a dataset. Additional follow-up moderated moderation analyses (model 3) will be conducted using Hayes PROCESS macro if the moderated mediation model is found to be significant.

Adverse Childhood Experiences, also known as ACEs, are a major public health concern. ACEs are defined as stressful or traumatic events in early life that range from parental separation to all forms of abuse and neglect, as well as household dysfunction (e.g., living in a home with substance misuse). The current body of scholarly literature shows that ACEs have long lasting effects on both physical and mental health through a person’s life. Research also illustrates a dose-response relationship between the number of ACEs and the number of risk behaviors, such as substance misuse, that a person may exhibit. Quality of life refers to a person’s self-perceived well-being and includes mental, emotional, physical, and sexual health. Quality of life, synonymous with well-being is associated with numerous health benefits including reduced risk of disease, better immune function, and increased life expectancy. This study seeks to determine if quality of life is a protective factor against substance misuse in adults who report ACEs. In line with the current body of knowledge, we hypothesize that adults within the study sample with a higher number of ACEs will exhibit higher rates of tobacco use, alcohol use, and drug use. We also hypothesize that participants with ACEs who rate a higher quality of life score will be less likely to use alcohol, tobacco, or drugs; as compared to those who rate a lower quality of life. Participants (N=766, age 18-55) were recruited through the REACH (Religion, Emotions, and Current Health) survey study. Data on ACEs will be collected from the Adverse Childhood Experiences (ACEs) Questionnaire which measures the number of traumatic experiences during the first eighteen years of life. Data on substance use will be collected via the Tobacco Questionnaire dichotomously (yes or no), the AUDIT scale on alcohol use which measures the frequency and quantity of consumption, and the Drug Abuse Screening Test (DAST) which measures drug use in the last twelve months. Quality of Life will be measured using the World Health Organization Quality of Life WHOQOL-BREF. Quality of life will also be examined using two subscales, overall quality of life and perceived social support. All data was collected via self-reporting. Bivariate and multivariate analyses will be conducted using SPSS. To examine the potential moderating effect of quality of life, a hierarchical multiple regression will be conducted, specifically the simple moderation from the PROCESS macro for SPSS. We predict that those who perceive a higher quality of life, despite early life adversity, will report less frequency in alcohol, tobacco, and drug consumption. Conversely, we predict that those who perceive a lower quality of life will exhibit higher rates of health-related risk behaviors, specifically substance misuse.

Exposure to violence and dysfunction in childhood is a major public health concern. The Adverse Childhood Experiences (ACEs) study demonstrated that childhood maltreatment and family dysfunction impact adult health, contributing to risk behaviors, infectious and chronic disease, and premature death. South Africa (SA) has one of the highest rates of violence and family dysfunction globally, and those living in townships are suspected to be disproportionately affected. Munsieville, the oldest undeveloped township in SA, has reported high rates of violence in the community. This study aimed evaluate the association between a history of childhood sexual abuse and various forms of risky sexual behavior. Data were collected by a team of researchers from the College of Public Health as part of a pilot study of ACEs in Munsieville. Self-report of sexual abuse before age 18 was used to compute the independent variable, which ranged from 0-1, with 0 implying the absence of any type of childhood sexual abuse and 1 implying one or more forms of childhood sexual abuse. Age and gender were deemed potential confounders. Two binary l outcomes representing forms of risky sexual behavior were considered, self-report of transactional sex and substance use before sexual activity. Descriptive analysis examined the frequency of childhood sexual abuse by each category of the study outcomes. Two multiple logistic regression models were individually constructed to examine the association between childhood sexual abuse and transactional sex, and substance use before sexual activity. Odds ratios and corresponding 95% confidence intervals were reported. Findings of the descriptive analysis indicated that 8.83% (43) of the sample reported participating in transactional sex, 22.4% (101) reported using either drugs or alcohol before sex. Moreover, 21.6% (103) reported experiencing one or more forms of childhood sexual abuse. A positive statistically significant association between self-reported childhood sexual abuse and transactional sex was identified (OR: 3.45; 95% CI: 1.71 – 6.98), illustrating that those who experienced any type of child sexual abuse had a 3.5 times as likely to report transactional sex compared to those who did not experience sexual abuse during childhood. Childhood sexual abuse was also significantly associated with substance use before sexual activity (OR: 1.93; 95% CI: 1.11 – 3.34). The study findings suggests a need for further research to understand the long term effects of child sexual abuse. Further, future public health interventions aimed at reducing sexual abuse and violence inflicted on South African children should be employed as means to improve their wellbeing in adulthood.

Adverse Childhood Experiences (ACEs) affect numerous outcomes in adulthood, but relatively few studies examine their implications for adolescents. Understanding the effects of ACEs is important since adolescent behaviors affect subsequent life course milestones and transitions. One area of the ACEs research that is deficient involves adolescent substance use. In addition, there is a paucity of studies addressing whether the association between ACEs and substance use differs by race/ethnicity. Using data from the Fragile Families and Child Wellbeing Study, this study aims to fill these gaps by (a) examining whether adolescents who experience more ACEs tend to be at higher risk of alcohol and marijuana use; and (b) whether the association between ACEs and these forms of substance use differs among White, Black, and other racial/ethnic youth. The results show that, among Black youth, ACEs tend to affect alcohol and marijuana use at high levels (four or more). Among White youth, this association is limited to marijuana use. Nonetheless, age and peer substance use appear to have more consequential effects on the odds of alcohol and marijuana. The findings suggest that additional research is warranted, but that ACEs should be a focus of research on adolescent substance use.

The therapeutic alliance is a core element of successful treatment in therapy. Recent literature has explored variables that predict the alliance at various time points during therapy, but few studies have explored how the alliance develops over time and the factors that influence its rate of change. The current study addresses these questions by estimating latent growth-curve models to analyze how male and female partners' alliance scores develop over time and how adverse childhood experiences (ACEs) impact the development of the alliance during the first six sessions of therapy. Results from these analyses show that neither men nor women's ACEs had a significant effect on the rate of change in the alliance. A discussion of the attachment implications of these findings, as well as the limitations of this study and potential directions for future research are then presented.

Background: A 1998 seminal study catapulted adverse childhood experiences (ACEs) into the zeitgeist and shaped assessment of these experiences and long-term health consequences via The ACEs Study Questionnaire (ACE-SQ). However, the ACE-SQ's childhood sexual abuse (CSA) item requires the perpetrator have been 5-years or older than the survivor for endorsement. This may not adequately capture CSA and limit the questionnaire's ability to detect survivors. Objective: This study assessed whether CSA survivors were missed by this 5-year modifier, whether service access was restricted, and whether those missed were at elevated risk for adverse outcomes. Participants and setting: A sample of 974 women (M age = 30.46) completed an online survey. Methods: Histories of CSA were assessed using the original ACE-SQ and an alternative version without the 5-year modifier. Participants were grouped by endorsement (Modifier, No Modifier, No CSA) and compared across numerous physical and mental health outcomes using MANOVA, ANOVA, and logistic regression. Results: Numerous CSA survivors are presently missed by the 5-year modifier (n = 118 of N = 249). This group demonstrated the same elevated depression (t = 3.44, p = .002, d = 0.34), heightened somatic symptom burden (t = 3.34, p = .003, d = 0.35), and poorer subjective health (t = -2.86, p = .012, d = 0.27) as those captured by the modifier. Conclusions: Recommendations for research, practice, and policy include removing the 5-year modifier from CSA assessment, creating an empirically informed CSA definition, and eliminating or adjusting requisite cut-scores for accessing services.

Offenders and persons with serious mental illness experience disproportionate exposure to Adverse Childhood Experiences (ACEs). This study examines prevalence, distribution, and correlates of ACEs in 182 male and female forensic psychiatric inpatients in secure care. Descriptive statistics, chi-squares analysis, ANOVA, and logistic regression were used to describe ACEs by race and gender and to identify associations between ACEs and onset of aggression, arrest, and psychiatric hospitalization. Participants evidenced significant exposure to ACEs, with significant differences by race and gender. ACE score, race, and foster care or investigations of child abuse were significant predictors of outcomes related to aggression and criminality.

Introduction: A culturally competent survey currently does not exist to characterize the burden of Adverse Childhood Experiences (ACEs) among a HIV/AIDS population receiving care at a local Center of Excellence (COE). Methods: A qualitative study was conducted including 11 interviews involving opinions on national surveillance questions to develop a culturally competent survey. Purposive sampling, reactive probing, and analysis of transcribed interviews were completed using structured coding to determine which questions were kept, modified, or removed in the final survey. Results: The final 55-question survey contained more generalized ACE questions, topics pertaining to barriers to HIV care, and a list that patients could select from to indicate what they need to improve their HIV care. Conclusion: The final survey provided the opportunity to characterize the burden of ACEs at a COE. Future directions involve piloting the survey as a quality improvement tool with the goal of increasing retention rates through more individualized HIV care.

El texto completo de este trabajo no está disponible en el Repositorio Académico UPC por restricciones de la casa editorial donde ha sido publicado. / Objective: The objective of this study was to evaluate the association between (1) different types of ACEs and migraine, and (2) the number of ACEs and migraine among adolescent mothers in Lima, Peru. Methods: Our cross-sectional study included 787 adolescent mothers (14- to 18-years of age) in Peru. In-person interviews were conducted postpartum, in hospital, within 2-days of delivery. Nine types of ACEs were assessed, including exposure to three categories of abuse, two categories of neglect, and four categories of household dysfunction. Multivariable logistic regression procedures were used to estimate odds ratios (ORs) and 95% confidence intervals (95% CI) for the association between ACEs and migraine while adjusting for putative confounders. Results: Approximately 75% of adolescent mothers reported having experienced at least one type of ACE. Adolescent mothers who reported any childhood abuse had 1.49-fold increased odds of migraine (aOR = 1.49; 95% CI 1.03–2.18) compared to those with no history of childhood abuse. Adolescent mothers who reported experiencing household dysfunction had 1.56-fold increase odds of migraine (aOR = 1.56; 95% CI 1.09–2.24). Compared to participants who reported no ACE, those who experienced four or more ACEs had 3.09-fold (aOR = 3.09; 95% CI 1.80–5.40) increased odds of migraine (ptrend < 0.001). Conclusion: Exposure to ACEs is highly prevalent in adolescent-aged mothers postpartum and is associated with increased odds of migraine. These findings support the importance of screening for ACEs and migraine among adolescent mothers; and the need for providing culturally appropriate, trauma-informed headache care. / National Institutes of Health / Revisión por pares