A research report Submitted to the School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, in partial fulfilment of the requirements for the degree of Masters of Science in Epidemiology and Biostatistics 15 June 2017, Johannesburg, South Africa / Introduction: Worldwide, cardiovascular diseases are the number one cause of death with a three-quarter of cardiovascular disease deaths occurring in low-middle income countries. Childhood social adversity as a proxy of psychosocial stress has been found to be associated with later adult risk of cardiovascular diseases, with studies investigating the mechanisms linking early exposure to social adversity and later risk of cardiovascular diseases. CRP has been a biomarker that is found to be associated with the risk of cardiovascular diseases in adults, however, the association between CRP levels in adolescence and social adversity in children (prenatal and postnatal periods) is not well documented. Assessing the association between childhood social adversity and CRP levels in late adolescent period will encourage further studies to explore whether high levels of CRP tracks from adolescence to adulthood and ultimately increase the risk of cardiovascular diseases in the South African context. Aim: This study aims to determine the association between social adversity from the prenatal period to two years of age and the level of CRP in the same cohort at the age of 18 (from 1990 to 2008) Methods: The study was a secondary data analysis of the Birth to Twenty longitudinal study which recruited 3273 singleton children. Four measures (prenatal and postnatal (0-2 years)) of social adversity in children (which are maternal prenatal stress, maternal prenatal general feeling, maternal postnatal depression and household socioeconomic status) were used. The high-sensitivity C-reactive protein was grouped into tertiles (1st tertile: hs-CRP<0.48 mg/l, 2nd tertile: 0.48<hs-CRP<1.16, 3rd tertile: hs-CRP>1.16) and multinomial logistic regressions were therefore used to assess the association between childhood social adversities and tertiles of high sensitivity C-reactive protein. Results: The primary Birth to Twenty longitudinal study had more than 35% loss to follow-up at 18 years. No statistically significant difference (p>0.05) was found on demographic variables of those included in the analysis compared to those not included (due to current study criteria and loss to follow-up). A unit increase in maternal marital stress score during pregnancy was associated with an increase by 2.23 (p=0.03) in the relative risk of the youth being in the 2nd high sensitivity C-reactive protein tertile in comparison to being in the 1st high sensitivity C-reactive protein tertile. For a unit increase in maternal family stress score, the relative risk of the youth being in the 3rd high sensitivity C-reactive protein is 1.61 (p=0.04) times greater in comparison to being in the 1st high sensitivity C-reactive protein tertile. No statistically significant associations were observed among the other categories of social adversity (p>0.05) and high sensitivity C-reactive proteins. Low social support to mothers during pregnancy was associated with elevated high-sensitivity C-reactive protein in adolescents. Conclusion: A positive association was observed between a prenatal measure of social adversity and elevated high-sensitivity C-reactive protein; In particular, increased levels of family and relationship-related prenatal stress during pregnancy is a predictor of elevated high-sensitivity C-reactive protein in children. This study contributes to the empirical evidence from studies done in animals suggesting that early development of adult health complication starts during the intrauterine period. The findings of this study will further guide intervention research to target conditions during intrauterine period in preventing adult health complications. / MT2017

The purpose of this study is to discuss the current situations, differences and related situations of adversity quotient and campus crisis management for the educators in elementary schools. Based on the results of this research, we provided suggestions for the educational administration institutions, the elementary schools and the educators in elementary schools, and the related following researches could take those as reference material. In order to complete this study, the study starts with literature analysis, questionnaire survey, and collection and analysis of data. The questionnaire was performed on 400 elementary school educators in 39 elementary schools in Kaohsiung County. ¡§The questionnaire for adversity quotient¡¨ and ¡§The questionnaire for crisis management of elementary school¡¨ compiled by self were used as the tool for this study. We used software SPSS version 12 to run the statistically resultant such as t-test, one-way ANOVA, product-moment correlation and multiple regression analysis etc. According to the results of analyzed data, there are six conclusions shown below: 1.The adversity quotient of elementary school educators in Kaohsiung County is in the medium high range. However, it is easily effected other part of life due to the distress. 2.The elementary school educators in Kaohsiung County need to establish the conceptions of guidance and assistance for campus crisis management. 3.The elementary school educators in Kaohsiung County who are males, serve over 11 years, graduated from graduate school, administrative staffs, home-room teachers and had experience for handling crisis have higher adversity quotient. 4.The elementary school educators in Kaohsiung County who are males, serve over 6 years, graduated from graduate school, administrative staffs, home-room teachers and had experience for handling crisis perform much better in campus crisis management. 5.There is close relation between the level of adversity quotient and campus crisis management. 6.Adversity quotient can be the reference for projecting the ability of campus crisis management.

Adverse experiences have long-term consequences for biological, behavioral, and psychosocial adjustment. Adolescents may be particularly susceptible to these effects due to heightened sensitivity to environmental influences, the protracted development of the prefrontal cortex, and risk for psychopathology. We used a person-centered approach to characterize distinct profiles of adversity in early adolescence, and examined associations with later cognitive control and psychopathology. One hundred and sixty-seven adolescents (53% male) and their primary caregivers participated in a longitudinal study, with approximately one year in between each assessment. At Time 1 (Mage = 14.07 years), we collected reports on seven indicators of adversity: socioeconomic disadvantage, abuse, neglect, household chaos, parent substance use, parent depression, and negative life events. At Times 2, 3, and 4, adolescents' behavioral performance and blood-oxygenation-level-dependent response during a cognitive control task were measured. Two years later, at Time 5, adolescents and their caregiver reported on adolescent internalizing and externalizing symptomatology. Using latent profile analysis, we identified three distinct adversity subgroups: a low risk group, a low socioeconomic status (SES)/high parent substance use (SU) group, and a high risk group. Adolescents in the low SES/high parent SU group had the lowest levels of behavioral cognitive control. Furthermore, the low SES/high parent SU group and the high risk group both had significantly higher levels of psychopathology relative to the low risk group. There were no significant group differences with respect to neural cognitive control, and neither neural nor behavioral cognitive control predicted psychopathology. A cumulative risk approach using a mean score of adversity produced a similar general pattern of results, but obscured the unobserved heterogeneity in adverse experiences. These results highlight the utility of a person-centered approach to the characterization of adversity in adolescence and illustrate distinct developmental consequences for cognitive functioning and psychopathology. We expand upon prior empirical work by demonstrating that the co-occurrence of low SES and parent substance use may place adolescents at increased risk for deficits in behavioral cognitive control, which may be an important target for intervention and prevention efforts. / Doctor of Philosophy / During childhood and adolescence, most individuals are exposed to some form of adversity, such as abuse, neglect, poverty, or parent mental illness. These factors can have long-term effects on brain functioning and mental health. Adolescents may be especially affected by adversity because their brain is in an important stage of development and they are also more sensitive to social and environmental influences. The purpose of this study was to better understand if certain patterns of adversity experiences were associated with adolescents' self-regulation abilities and mental health outcomes. We recruited 167 adolescents and their primary caregivers from the community and asked them to report on adolescents' experiences of adversity at age 13-14. Specifically, we asked about socioeconomic status, abuse, neglect, household chaos, parent substance use, parent depression, and negative life events. Once each year for the next three years, adolescents completed a self-regulation task while they were in a Magnetic Resonance Imaging (MRI) machine. We examined their performance on the task as well as their brain activation. Two years later, at 18-19 years old, adolescents and their caregiver reported on the adolescent's mental health symptoms. Results indicated that there were three groups of adolescents with different combinations of adverse experiences: a low risk group, a low socioeconomic status (SES)/high parent substance use (SU) group, and a high risk group. Adolescents in the low SES/high parent SU group had the worst performance on the self-regulation task. Furthermore, both the low SES/high parent SU group and the high risk group had significantly higher mental health problems relative to the low risk group. There were group differences in terms of brain activation. Finally, neither performance nor brain activation during self-regulation was associated with mental health problems. We also tested these associations by using an average score of adversity, rather than dividing participants into subgroups. When we compared these approaches, the results were generally similar, but the subgroup approach provided more specific information about what types of experiences put adolescents at higher risk for self-regulation and mental health problems. Thus, the subgroup approach may be useful for better understanding the nuanced consequences of adversity. Our findings further show that the co-occurrence of low SES and parent substance use may place adolescents at increased risk for deficits in self-regulation, which may be an important target for intervention and prevention efforts.

The academic study of how people respond to adverse life experiences has been dominated by Western conceptualisations of distress, resilience and growth. The current literature base regarding responses to adversity has been criticised for focusing on one response trajectory (Post Traumatic Stress Disorder; PTSD). This criticism stems from the privileging of Western understandings of the self and for negating to consider sufficiently the role of context (the available social, cultural and political discourses). The significance of this void in the literature is that it has led to the development of models and theories which could be considered culturally insensitive, if applied outside of the context from which they have derived. This research addresses the highlighted gap in the literature by exploring how the context of Sierra Leone influences how people respond to the experience of Civil War and continuing adversity. Nine in-depth interviews were carried out within two ‘mental health’ organisations in Sierra Leone. The participants were nine individuals and one group, consisting of both ‘patients’ and staff members. The qualitative methodology of Narrative Analysis was used to analyse both the stories people told and the stories which may have remained unexpressed. A focus was placed during analysis on the role of context and the dialogic process. The main findings of the research indicated that the cultural resources within Sierra Leone both influenced and constrained the narratives which individuals were able to tell. ‘Stories of Survival’ seemed to be told through two dominant social narratives of ‘Bear it, and Forget’ and ‘Because of Almighty God, we Forgive’. ‘Stories of Resistance’ however, demonstrate what was implied but often left unsaid, this is characterised by two main unexpressed stories; ‘We Cannot Forget’ and ‘Why God?’. Furthermore, findings suggest that it is the relationship between the dominant social narratives and individual meaning-making which influences the trajectory of stories told. The implications of this research request a commitment to valuing the role of social context in conceptualisations of distress, resilience and growth following adversity. Finally, the need to establish ways of offering support to individuals and communities, which fully considers the role of social context, is emphasised. This paper concludes by exploring the relevance of social content for the planning of services, training programmes and continuing clinical practice.

Adverse childhood experiences (ACEs) play a role in the development of chronic mental and physical diseases in adulthood. These experiences include adversities such as: emotional/verbal abuse, sexual abuse, physical abuse, and household dysfunction. In this study, we hypothesize that forensic mental health offenders will have higher ACE scores than community participants. Secondly, we hypothesize that these participants will show higher rates of and earlier incidences of offending, arrest, incarceration, and hospitalization as a result of their ACE scores. Further, we hypothesize that males and females will be affected by ACEs differently. Using archival data from a secure forensic psychiatric facility in the Midwestern US, data were collected from 211 participants, of which 80% were males and 18% females. The ages of the participants ranged from 23 to 72 with a median age of 43. Using SPSS software, we were able to determine frequency of the ten categories of abuse, maltreatment, and familial dysfunction as included in the original ACE research. Correlations were run to determine the relationship between ACEs and criminal behavior. Statistical comparisons were also run to examine the differences between males and females. ACE score significantly correlated with age at first psychiatric admission. Males and females were significantly different with regard to ACE score. However, other variables were not significant and suggest that future research need to more deeply examine these differences, and additional variables that may determine criminal outcomes in high-risk samples.

abstract: Adverse childhood family environments have been found to have long-term effects on a child's well-being. Although no prior studies have examined the direct effects of childhood family adversities on nighttime blood pressure (BP) dip, parental death and divorce in childhood, have been associated with a variety of related psychological problems in adulthood. The current study examined the direct effects of parental death and divorce in childhood and quality of early family relationships on adult nighttime BP dip as well as the mediating role of three psychosocial factors (depression, hostility and social stress). One hundred and forty-three young adults were asked to complete self-reported measures of the three psychosocial factors and quality of family relationships. Study participants wore an ambulatory blood pressure (ABP) monitor over a 24-hr period in order to assess nocturnal BP dip. Although neither childhood family adversity nor quality of childhood family relationships directly predicted nighttime BP dipping, quality of early family relationships predicted all three psychosocial factors, and hostility was found to mediate the relationship between quality of childhood family relationships and nighttime systolic BP dip. Early family experiences play an important role in influencing nighttime cardiovascular functioning by influencing an individual's psychological functioning in young adulthood. Because nighttime non-dipping has been associated with increased risk for cardiovascular disease and other serious health conditions, the results of the present study have important clinical implications and provide specific psychosocial pathways that may be targeted in future programs designed to prevent and treat cardiovascular disease. / Dissertation/Thesis / M.A. Psychology 2012

Previous research suggests that adverse childhood experiences (ACEs) can greatly impact a child’s physical, mental, and emotional wellbeing later in life. ACE exposure has been associated with lower levels of empathy in the literature. Spirituality is often associated with a number of positive outcomes, including those associated with empathy, like prosocial behaviors. The present study examines spirituality as a buffer against reduced empathy in those with exposure to adverse events in childhood. Participants for this study were recruited through the SONA research platform at East Tennessee State University as part of a larger research project, the REACH (Religions, Emotions, and Current Health) study. Results of this study did not support the working hypotheses that we would find a negative correlation between ACEs and empathy, as well as a moderation relationship via spirituality between ACEs and empathy. However, we did find that empathy was positively associated with spirituality, and ACEs were negatively associated with spirituality. Future research should dig deeper into the relationship between ACEs and empathy, as well as search for other possible protective factors for the effects of ACEs.

Introduction: The effects of adverse childhood experiences (ACEs) have been long studied in various populations, but there has been limited research on how differential ACEs can lead to more uncommon outcomes in unique and high-risk populations, such as youth who have engaged in sexually abusive behaviors. These youth experience ACEs at higher rates and with greater comorbidity than those who have engaged in nonsexual crimes or without justice-system involvement. ACEs are associated with increased suicidal ideation and attempts, though little research has examined how different types of ACEs (i.e., direct maltreatment vs. indirect maltreatment/household dysfunction) may lead to differential outcomes. In the current study, I analyze relationships between experiences of direct abuse (i.e., physical abuse, sexual abuse, emotional abuse) and indirect abuse/household dysfunction (i.e., neglect, parental absence, caregiver substance misuse, caregiver mental illness, witnessing interpersonal violence) on suicidality outcomes in high-risk youth. I hypothesize that indirect maltreatment/household dysfunction will influence the relationships between adverse experiences and suicidality outcomes beyond the influence of direct maltreatment. Methods: Data were collected from archival records of male youth (n = 290) who had previously engaged in sexually abusive behaviors and received treatment from a private, nonprofit residential and outpatient treatment facility in Tennessee. Hierarchical linear and logistic regressions will be used to determine relationships between adverse experiences and various suicidality outcomes (e.g., presence of suicidal ideation or attempts, age at first suicidal ideation), first with direct maltreatment experiences and then indirect maltreatment/household dysfunction experiences. Results & discussion: Results will be discussed, along with implications for enhancing prevention and clinical intervention strategies for managing suicidality among high-risk youth.

Terror management theory (TMT) seeks to understand religious worldview adherence, positing that worldview beliefs can abate existential threats such as mortality salience. Most research on TMT has employed young samples, so influences on older adults' experiences of mortality salience are unclear. Simultaneously, research on death anxiety shows that older people may view their own death more favorably than younger individuals do. Guided by the lifespan development perspective, I investigated whether the range of life experiences and interpretation of them might account for perceptions of death in old age. A multi-phase content analysis of in-depth interview transcripts from 16 adults aged 65+ focused on narratives of life events, religious worldviews, and death. The findings suggested how lifespan adversity, such as the death of a loved one, promoted growth in self and religious belief that enhanced participants' reported relationship with the sacred. In turn, participants' views of and beliefs about death were without fear, indicating the influence of highly individualized and deeply spiritual religious worldview beliefs on the abatement of death fear. These findings support extension of TMT to older people by identifying the impact of lifespan experiences with trauma and adversity as contributing to less superficial, more individualized conceptions of religious worldviews. Such worldviews, contingent upon growth from adaptation to lifespan experiences, may indeed lead to less death anxiety and reduce the effects of mortality salience in old age. / Master of Science

The development of teacher resilience is important in improving teacher retention. This study identified reasons veteran teachers have remained in the classroom; individual and contextual factors of resilience; significant challenges the teachers have encountered; and strategies the teachers used for dealing with the challenging situations. This was a qualitative study that included interviews with 15 teachers in a rural school division in Central Virginia. Data analysis occurred through deductive coding of the transcribed interviews using qualitative data analysis software. The findings for this study identified seven factors that veteran teachers indicated were important in their decision to remain in the classroom. The study also identified 22 individual factors of resilience and 10 contextual factors presented through the experiences of the veteran teachers. The veteran teachers described four challenges that they have faced in their school division and the strategies they used to overcome those challenges. The study concludes with the discussion, implication, and conclusion of the findings. / Doctor of Education / The development of teacher resilience is important in improving teacher retention. This study identified reasons veteran teachers have remained in the classroom; individual and contextual factors of resilience; the most significant challenges the teachers have encountered; and strategies the teachers used for dealing with those challenging situations. This was a qualitative study that included interviews with 15 teachers in a rural school division in Central Virginia. The findings for this study provide practitioners with a framework to develop a resilient culture within their schools.