The association between adverse childhood experiences and common mental disorders and suicidality: an umbrella review of systematic reviews and meta-analyses

Schickedanz A.B., Escarce J.J., Halfon N., Sastry N., Chung P.J.

Adverse childhood experiences are associated with higher risk of common chronic mental and physical illnesses in adulthood, but little evidence exists on whether this influences medical costs or expenses. This study estimated increases in household medical expenses associated with adults' reported adverse childhood experience scores.Household out-of-pocket medical cost and adverse childhood experience information was collected in the 2011 and 2013 waves of the Panel Study of Income Dynamics and its linked 2014-2015 Panel Study of Income Dynamics Childhood Retrospective Circumstances Study supplement and analyzed in 2017. Generalized linear regression models estimated adjusted annual household out-of-pocket medical cost differences by retrospective adverse childhood experience count and compared costs by family type and size. Logistic models estimated odds of out-of-pocket costs that were >10% of household income or >100% of savings, as well as odds of household debt.Adverse childhood experience scores were associated with higher out-of-pocket costs. Annual household total out-of-pocket medical costs were $184 (95% CI=$90, $278) or 1.18-fold higher when respondents reported one to two adverse childhood experiences and $311 (95% CI=$196, $426) or 1.30-fold higher when three or more adverse childhood experiences were reported by an adult in the household. Odds of household medical costs >10% of income, >100% of savings, and the presence of household medical debt were 2.48-fold (95% CI=1.40, 4.38), 2.25-fold (95% CI=1.69, 2.99), and 2.29-fold (95% CI=1.56, 3.34) higher when an adult in the household reported three or more adverse childhood experiences compared with none.Greater exposure to adverse childhood experiences is associated with higher household out-of-pocket medical costs and financial burden in adulthood.

Marie-Mitchell A., Kostolansky R.

The purpose of this systematic literature review was to summarize current evidence from RCTs for the efficacy of interventions involving pediatric health care to prevent poor outcomes associated with adverse childhood experiences measured in childhood (C-ACEs).On January 18, 2018, investigators searched PubMed, PsycInfo, SocIndex, Web of Science, Cochrane, and reference lists for English language RCTs involving pediatric health care and published between January 1, 1990, and December 31, 2017. Studies were included if they were (1) an RCT, (2) on a pediatric population, and (3) recruited or screened based on exposure to C-ACEs. Investigators extracted data about the study sample and recruitment strategy, C-ACEs, intervention and control conditions, intermediate and child outcomes, and significant associations reported.A total of 22 articles describing results of 20 RCTs were included. Parent mental illness/depression was the most common C-ACE measured, followed by parent alcohol or drug abuse, and domestic violence. Most interventions combined parenting education, social service referrals, and social support for families of children aged 0-5years. Five of six studies that directly involved pediatric primary care practices improved outcomes, including three trials that involved screening for C-ACEs. Eight of 15 studies that measured child health outcomes, and 15 of 17 studies that assessed the parent-child relationship, demonstrated improvement.Multicomponent interventions that utilize professionals to provide parenting education, mental health counseling, social service referrals, or social support can reduce the impact of C-ACEs on child behavioral/mental health problems and improve the parent-child relationship for children aged 0-5years.

Fassel M., Grieve B., Hosseini S., Oral R., Galet C., Ryan C., Kazis L., Pengsheng N., Wibbenmeyer L.A.

Abstract Adverse childhood experiences (ACEs), including child maltreatment and household dysfunction, define adverse events that occur before 18 years of age. National and state data show that between 12.5 and 14.5% of the adult population report ≥4 ACEs (HIGH-ACE), respectively. HIGH-ACEs are associated with more chronic health problems. To date, the interaction between ACEs and burn injuries has not been studied. Herein, we sought to define the ACE exposure in our burn patients and its impact on early outcomes. Inpatient and outpatient adult burn survivors (≥18 years of age) were enrolled. Subjects completed surveys assessing adverse experiences (ACEs-18), needs, strengths, and resiliency at consent, and pain, depression, post-traumatic stress disorder (PTSD), and social participation surveys at 2 weeks to 3 months postinjury. Demographics, burn, and hospital course data were also collected. Chi-square and student’s t-tests were used for descriptive analysis and to compare the groups (HIGH-ACE vs LOW-ACE). The HIGH-ACE group (n = 24; 45.3%) reported more depressive symptoms (P < .04) than the LOW-ACE group (n = 29, 54.7%). HIGH-ACE patients were less resilient when facing stressful events (P ≤ .02) and more likely to screen positive for probable PTSD (P = .01) and to score lower on the Life Impact Burn Recovery Evaluation Profile (LIBRE Profile), which assesses for social participation, in the domain of Family and Friends (P = .015). Our exploratory study suggests that ACE screening may help detect burn patients at risk for a more complicated recovery, thereby promoting personalized assistance in recovery.

Yap M.B.

Calati R., Ferrari C., Brittner M., Oasi O., Olié E., Carvalho A.F., Courtet P.

Social isolation is one of the main risk factors associated with suicidal outcomes. The aim of this narrative review was to provide an overview on the link between social isolation and suicidal thoughts and behaviors.We used the PubMed database to identify relevant articles published until April 13, 2018. We focused on: (a) systematic reviews, meta-analyses, and narrative reviews; (b) original observational studies with large samples (N ≥ 500); and (c) qualitative studies. We included all relevant suicidal outcomes: suicidal ideation (SI), suicidal planning, non-suicidal self-injury, deliberate self-harm, suicide attempt (SA), and suicide.The main social constructs associated with suicidal outcomes were marital status (being single, separated, divorced, or widowed) and living alone, social isolation, loneliness, alienation, and belongingness. We included 40 original observational studies, the majority of them performed on adolescents and/or young adults (k = 23, 57.5%). Both the objective condition (e.g., living alone) and the subjective feeling of being alone (i.e., loneliness) were strongly associated with suicidal outcomes, in particular with SA and SI. However, loneliness, which was investigated in most studies (k = 24, 60%), had a major impact on both SI and SA. These associations were transculturally consistent.Confounding factors can limit the weight of the results obtained in observational studies.Data from the observational studies suggest that both objective social isolation and the subjective feeling of loneliness should be incorporated in the risk assessment of suicide. Interventional studies targeting social isolation for suicide prevention are needed.

Brown S.M., Rienks S., McCrae J.S., Watamura S.E.

Children investigated for maltreatment are particularly vulnerable to experiencing multiple adversities. Few studies have examined the extent to which experiences of adversity and different types of maltreatment co-occur in this most vulnerable population of children. Understanding the complex nature of childhood adversity may inform the enhanced tailoring of practices to better meet the needs of maltreated children. Using cross-sectional data from the National Survey of Child and Adolescent Well-Being II ( N = 5870), this study employed latent class analysis to identify subgroups of children who had experienced multiple forms of maltreatment and associated adversities among four developmental stages: birth to 23 months (infants), 2–5 (preschool age), 6–10 (school age), and 11–18 years-old (adolescents). Three latent classes were identified for infants, preschool-aged children, and adolescents, and four latent classes were identified for school-aged children. Among infants, the groups were characterized by experiences of (1) physical neglect/emotional abuse/caregiver treated violently, (2) physical neglect/household dysfunction, and (3) caregiver divorce. For preschool-aged children, the groups included (1) physical neglect/emotional abuse/caregiver treated violently, (2) physical neglect/household dysfunction, and (3) emotional abuse. Children in the school-age group clustered based on experiencing (1) physical neglect/emotional neglect and abuse/caregiver treated violently, (2) physical neglect/household dysfunction, (3) emotional abuse, and (4) emotional abuse/caregiver divorce. Finally, adolescents were grouped based on (1) physical neglect/emotional abuse/household dysfunction, (2) physical abuse/emotional abuse/household dysfunction, and (3) emotional abuse/caregiver divorce. The results indicate distinct classes of adversity experienced among children investigated for child maltreatment, with both stability across developmental periods and unique age-related vulnerabilities. Implications for practice and future research are discussed.

Lawrence P.J., Murayama K., Creswell C.

Objective We conducted meta-analyses to assess risk for anxiety disorders among offspring of parents with anxiety disorders, and to establish whether there is evidence of specificity of risk for anxiety disorders as opposed to depression in offspring, and whether particular parent anxiety disorders confer risks for particular child anxiety disorders. We also examined whether risk was moderated by offspring age, gender, temperament, and the presence of depressive disorders in parents. Method We searched PsycINFO, PubMed, and Web of Science in June, 2016, and July, 2017 (PROSPERO CRD42016048814). Study inclusion criteria were as follows: published in peer-reviewed journals; contained at least one group of parents with anxiety disorders and at least one comparison group of parents who did not have anxiety disorders; reported rates of anxiety disorders in offspring; and used validated diagnostic tools to ascertain diagnoses. We used random and mixed-effects models and evaluated study quality. Results We included 25 studies (7,285 offspring). Where parents had an anxiety disorder, offspring were significantly more likely to have anxiety (risk ratio [RR] = 1.76, 95% CI = 1.58−1.96) and depressive disorders (RR = 1.31, 95% CI = 1.13−1.52) than offspring of parents without anxiety disorders. Parent panic disorder and generalized anxiety disorder appeared to confer particular risk. Risk was greater for offspring anxiety than for depressive disorders (RR = 2.50, 95% CI = 1.50−4.16), and specifically for offspring generalized anxiety disorder, separation anxiety disorder and specific phobia, but there was no evidence that children of parents with particular anxiety disorders were at increased risk for the same particular anxiety disorders. Moderation analyses were possible only for offspring age, sex, and parental depressive disorder; none were significant. Conclusion Parent anxiety disorders pose specific risks of anxiety disorders to offspring. However, there is limited support for transmission of the same particular anxiety disorder. These results support the potential for targeted prevention of anxiety disorders.

von Werthern M., Robjant K., Chui Z., Schon R., Ottisova L., Mason C., Katona C.

The number of asylum seekers, refugees and internally displaced people worldwide has increased dramatically over the past 5 years. Many countries are continuing to resort to detaining asylum seekers and other migrants, despite concerns that this may be harmful. In light of the considerable body of recent research, this review aims to update and expand on a 2009 systematic review on the mental health consequences of detention on adult, adolescent and child immigration detainees, which found (on the basis on 9 studies) that there was consistent evidence that immigration detention had adverse effects on mental health. Three databases were searched using key terms relating to immigration detention and mental health. Electronic searches were supplemented by reference screening. Studies were included if they were quantitative, included individuals detained for immigration purposes, reported on mental health problems and were published in peer-reviewed journals. Two reviewers independently screened papers for eligibility, and a further two reviewers completed quality appraisals for included studies. Twenty- six studies (21 of which were not included in the 2009 review) reporting on a total of 2099 participants were included in the review. Overall, these studies indicated that adults, adolescents and children experienced high levels of mental health problems. Anxiety, depression and post-traumatic stress disorder were most commonly reported both during and following detention. Higher symptom scores were found in detained compared to non-detained refugees. In addition (and more clearly than was evident in 2009), detention duration was positively associated with severity of mental symptoms. Greater trauma exposure prior to detention was also associated with symptom severity. The literature base reviewed in this paper consistently demonstrated severe mental health consequences amongst detainees across a wide range of settings and jurisdictions. There is a pressing need for the proper consideration of mental health and consequent risk of detention-related harm in decisions surrounding detention as well as for improved care for individuals within detention facilities. Recommendations based on these findings are presented, including increased focus on the identification of vulnerability and on minimising the duration of detention.

Lovato K., Lopez C., Karimli L., Abrams L.S.

Shifts in U.S. immigration policy over the past two decades have resulted in increased deportations of unauthorized persons residing in the United States. Given the current political climate concerning unauthorized immigrants, social workers must understand the influence of parental deportation on youth/adolescent psychosocial and academic wellbeing. This study reviews relevant empirical literature on the impact of forced family separations on child and youth wellbeing from 2000 to the present. Overall, these studies showed that family separation due to immigration enforcement had negative effects on child and youth well-being, specifically, mental health, psychosocial and academic outcomes. These findings, which have implications for both research and practice, suggest that more culturally-based interventions are needed to better serve the psychosocial and educational needs of youth who have experienced a forced family separation due to deportation.

Karatekin C., Hill M.

We report two studies examining psychometric properties of an expanded measure of adverse childhood experiences (ACEs) that combined the original ACEs items with items from the Juvenile Victimization Questionnaire. In Study 1, we examined its factorial structure, internal consistency, and concurrent validity in undergraduates (N = 1479). In Study 2, we also examined replicability of frequencies of ACEs, test-retest reliability, and convergent and predictive validity. Results suggested a model with four inter-related factors: maltreatment, household dysfunction, community dysfunction, and peer dysfunction/property victimization. Internal consistency, test-retest reliability, concurrent and convergent validity were acceptable, and findings were replicated across samples. We suggest that this expanded measure is assessing early experiences of victimization and helplessness in the face of perceived intentional emotional and physical threats or actual harm by others, and that although they may not all be “traumatic,” their cumulative impact is associated with poor mental health in young adults.

Williams J., Bucci S., Berry K., Varese F.

This is the first review to identify, summarise and critically evaluate studies that examined psychological mediators of the relationship between childhood adversities and psychosis.A database search (PsychINFO, MEDLINE, Web of Science, CINAHL) was conducted to identify eligible studies published between January 1980 and September 2017. A narrative synthesis and appraisal of methodological quality and statistical appropriateness of the primary studies was conducted.We identified 37 papers, comprising 9057participants with psychotic disorders and 63,059 non-clinical participants. Despite great variation in the mediators considered and the methodological and analytic quality of the primary studies, our synthesis suggests that the relationship between childhood adversity and psychosis is mediated by several "families" of mediating variables including post-traumatic sequelae (e.g. dissociation, PTSD symptoms), affective dysfunction and dysregulation, and maladaptive cognitive factors (e.g. self-esteem and beliefs and concepts about the self and others). More tentative evidence was observed for the role played by appraisals of subsequent circumstantial factors (e.g. "life hassles"). Substance misuse was not found to be a prominent mediator of the relationship between childhood adversity and psychotic experiences, but further high quality corroborative studies are required.The importance of the five different (but not independent or mutually exclusive) families of mediators considered by the present evidence synthesis should be examined by future research employing appropriate modelling methods to better disentangle the contribution of these different processes. Nonetheless, they represent potentially valuable intervention targets that clinicians should consider whilst developing treatment plans for trauma survivors with distressing psychotic symptoms.

Merrick M.T., Ford D.C., Ports K.A., Guinn A.S.

Early adversity is associated with leading causes of adult morbidity and mortality and effects on life opportunities.To provide an updated prevalence estimate of adverse childhood experiences (ACEs) in the United States using a large, diverse, and representative sample of adults in 23 states.Data were collected through the Behavioral Risk Factor Surveillance System (BRFSS), an annual, nationally representative telephone survey on health-related behaviors, health conditions, and use of preventive services, from January 1, 2011, through December 31, 2014. Twenty-three states included the ACE assessment in their BRFSS. Respondents included 248 934 noninstitutionalized adults older than 18 years. Data were analyzed from March 15 to April 25, 2017.The ACE module consists of 11 questions collapsed into the following 8 categories: physical abuse, emotional abuse, sexual abuse, household mental illness, household substance use, household domestic violence, incarcerated household member, and parental separation or divorce. Lifetime ACE prevalence estimates within each subdomain were calculated (range, 1.00-8.00, with higher scores indicating greater exposure) and stratified by sex, age group, race/ethnicity, annual household income, educational attainment, employment status, sexual orientation, and geographic region.Of the 214 157 respondents included in the sample (51.51% female), 61.55% had at least 1 and 24.64% reported 3 or more ACEs. Significantly higher ACE exposures were reported by participants who identified as black (mean score, 1.69; 95% CI, 1.62-1.76), Hispanic (mean score, 1.80; 95% CI, 1.70-1.91), or multiracial (mean score, 2.52; 95% CI, 2.36-2.67), those with less than a high school education (mean score, 1.97; 95% CI, 1.88-2.05), those with income of less than $15 000 per year (mean score, 2.16; 95% CI, 2.09-2.23), those who were unemployed (mean score, 2.30; 95% CI, 2.21-2.38) or unable to work (mean score, 2.33; 95% CI, 2.25-2.42), and those identifying as gay/lesbian (mean score 2.19; 95% CI, 1.95-2.43) or bisexual (mean score, 3.14; 95% CI, 2.82-3.46) compared with those identifying as white, those completing high school or more education, those in all other income brackets, those who were employed, and those identifying as straight, respectively. Emotional abuse was the most prevalent ACE (34.42%; 95% CI, 33.81%-35.03%), followed by parental separation or divorce (27.63%; 95% CI, 27.02%-28.24%) and household substance abuse (27.56%; 95% CI, 27.00%-28.14%).This report demonstrates the burden of ACEs among the US adult population using the largest and most diverse sample to date. These findings highlight that childhood adversity is common across sociodemographic characteristics, but some individuals are at higher risk of experiencing ACEs than others. Although identifying and treating ACE exposure is important, prioritizing primary prevention of ACEs is critical to improve health and life outcomes throughout the lifespan and across generations.

Hoffmann R., Kaiser J., Kersting A.

Due to the unique importance of parental and sibling relationships and concurrently existing developmental challenges, the loss of a parent or sibling due to cancer is a highly stressful event for children and adolescents. This is the first systematic review that integrates findings on psychosocial outcomes after parental or sibling cancer bereavement.A systematic search of Web of Science, PubMed, PsycINFO, and PubPsych was conducted, last in December 2017. Quantitative studies on psychosocial outcomes of children and adolescents who lost a parent or sibling due to cancer were included.Twenty-four studies (N = 10 parental and N = 14 sibling bereavement), based on 13 projects, were included. Ten projects had cross-sectional designs. Only 2 projects used large, population-based samples and nonbereaved comparison groups. Outcomes were partially measured by single-item questions. Bereaved children and adolescents showed similar levels of depression and anxiety compared with nonbereaved or norms. Severe behavioral problems were found rarely. However, in 2 large, population-based studies, about half of the bereaved individuals reported unresolved grief. Bereaved adolescents had a higher risk for self-injury compared with the general population in one large, population-based study. Communication with health-care professionals, family, and other people; social support; distress during illness; age; gender; and time because loss were associated with psychosocial bereavement outcomes.Results indicate a high level of adjustment in cancer-bereaved children and adolescents. A modifiable risk factor for adverse psychosocial consequences is poor communication. Prospective designs, representative samples, and validated instruments, eg, for prolonged grief, are suggested for future research.

Boch S.J., Ford J.L.

In the United States, parental incarceration (PI) has been increasingly recognized as an understudied adverse childhood experience. In response, a rapidly expanding body of research has begun to investigate the effects of PI on youth mental and physical health outcomes.The purpose of this integrative review was to synthesize recent quantitative evidence investigating the effects of PI on youths' mental and physical health outcomes.Electronic strategies were used to find relevant quantitative articles published between September 2006 and 2016 using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses-Equity guidelines. Articles in the review (N = 17) varied in study design and methodologic rigor, complicating the analysis.In general, U.S. youth exposed to PI are more likely than their unexposed peers to exhibit internalizing and externalizing behavioral difficulties. There is substantially less evidence on the associations between PI and the physical health of youth, in addition to the proposed linkages between exposure to PI and poor health. Overall, there is limited inclusion of contextual specifics of PI (e.g., type and duration of incarceration, relationship quality), which hampers generalizability.Future research could investigate the biological and social linkages between PI and health outcomes. Forensic nurses could help build supportive environments and meaningful behavioral health interventions to assist the health of those youth with a parent incarcerated.

Chng G.S., Li D., Chu C.M., Ong T., Lim F.

Children who enter the child protection system often have complex family problems and have experienced early adverse experiences. Using latent class analysis, this study aimed to identify family classes of child protection cases in Singapore, to ascertain the prevalence of these family classes, and to test the association of family class membership to subsequent recurrence of harm. A sample of 440 cases who entered the Child Protective Service in Singapore was analyzed based on eight familial factors on the household and caregiver levels. A four-class solution was found to demonstrate the best fit: (a) the large household group was intergenerational and majority lived with extended family members, (b) the harsh parenting group showed high levels of parenting problems and the caregiver justifying his abuse/neglect, (c) the high criminality group had high levels of caregiver substance abuse and caregiver arrest and incarceration history, and (d) the low disadvantage group rated low on all the familial factors. A Cox Regression revealed that in comparison to the low disadvantage group, the harsh parenting group was twice as likely to have recurrence of harm. There were also differences across family classes with regard to age at entry into child protection, gender composition and abuse types. The findings and practice implications are discussed.

Curtis A., Luchetti M., Prendergast C., Ahern E., Creaven A., Kirwan E., Graham E.K., O’Súilleabháin P.S.

Dosanjh L.H., Lauby S., Fuentes J., Castro Y., Conway F., Champagne F.A., Franklin C., Goosby B.

Templeton J.M., Dixon W.E., Williams S., Morelen D., Driggers-Jones L., Robertson C.

Suh G., Chow A., Ou T., Lin H.

Dominguez D., Pérez‐Testor C., Benedico‐Peydró P., Casarramona A., Aznar‐Martínez B.

ABSTRACTThe main objective of this study is to examine the psychological effects of childhood abuse in adulthood, focusing on personality traits, resilience and attachment style within a large sample specifically centred on the Spanish context. A total of 700 adults participated, of whom 24.4% reported experiencing some form of childhood abuse. The results indicate that individuals who reported experiencing childhood abuse exhibit lower levels of responsibility, agreeableness, extraversion and resilience, as well as a greater tendency to develop an insecure attachment style compared to those without a history of abuse. Furthermore, findings suggest that both attachment style and specific personality traits (extraversion, agreeableness and responsibility) partially mediate the relationship between childhood maltreatment and resilience. These results highlight the critical need for a comprehensive approach to prevent childhood abuse and neglect, emphasising the importance of early interventions to foster adaptive personality development, resilience and secure attachment in adulthood.

Cao A., Melvin G.A., Wu L., Cardamone-Breen M.C., Salvaris C.A., Olivier P., Jorm A.F., Yap M.B.

Background Suicidal ideation and behaviours are common among adolescents, posing significant challenges. Parents have a protective role in mitigating this risk, yet they often feel ill-equipped to support their adolescents, and their specific support needs are not well understood. Aims To explore the lived experiences of parents with suicidal adolescents and identify their support needs in the context of a therapist-assisted online parenting programme. Method Semi-structured interviews were conducted with three stakeholder groups based in Australia: nine parents with lived experience caring for a suicidal adolescent, five young people who experienced suicidality during adolescence and five clinical/research experts in youth mental health/suicide prevention. Inductive thematic analysis was used to analyse and interpret findings. Results Three key themes highlight the experience of parenting a suicidal adolescent: the traumatising emotional experience, uncertainty and parent empowerment. Six themes described parents’ support needs: validation and support, practical and tailored strategies, rebuilding the parent–adolescent relationship, parental self-care, flexible and accessible modes of delivery, and understanding non-suicidal self-injury. Conclusions Findings highlight key themes of parenting a suicidal adolescent and parental support needs. An online parenting programme could offer parents flexible access to evidence-based parenting strategies. Yet, a purely digital approach may not address the complexities of the parent-adolescent dynamic and provide adequate tailoring. As such, a hybrid approach incorporating therapist support can provide parents with both the compassionate support and practical guidance they seek.

Samaey C., Lambrechts S., Lecei A., Achterhof R., Hagemann N., Hermans K.S., Hiekkaranta A.P., Kirtley O.J., Reininghaus U., Boets B., Myin-Germeys I., van Winkel R.

Torino G., Rignanese M., Salmè E., Madeddu F., Courtet P., Jelena F., Attali D., Larissa K., Carolina B., Lopez-Castroman J., Fornaro M., Calatib R.

Chia A.Y., Hartanto A., Wan T.S., Teo S.S., Sim L., Kasturiratna K.T.

Al-Rousan A.H., Ayasrah M.N., Khasawneh M.A., Gharaibeh M.

Goltser-Dubner T., Benarroch F., Lavon M., Amer R., Canetti L., Giesser R., Kianski E., Martin J., Pevzner D., Blum Weinberg P., Ben-Ari A., Bar-Nitsan M., Alon S., Yshai S., Lotan A., et. al.

Abstract Rising adolescent suicide rates present a growing unmet need. Childhood trauma (CT) has been associated with altered cortisol dynamics and immune cell glucocorticoid reactivity, yet their additive longer-term contributions to later suicide outcomes are less clear. The current study compared CT scores, resting salivary free cortisol and mononuclear cell gene expression levels of the nuclear receptor, subfamily 3, member 1 (NR3C1) coding the glucocorticoid receptor, and its co-chaperons FKBP prolyl isomerase 5 (FKBP5) and KIT Ligand (KITLG), between a cohort of adolescents presenting with a suicidal crisis requiring hospital treatment, and matched healthy controls. Childhood trauma scores and glucocorticoid measures were significantly altered among suicidal adolescents, and CT scores correlated with mononuclear cell glucocorticoid transcripts. Both CT scores and glucocorticoid measures explained substantial additive portions of the variance in adolescent suicidality. Long-term perturbations in cortisol dynamics and immune cell glucocorticoid response elements denote dysregulated immune stress reactivity, and may possess value in prediction and point to modifiable-risk factors in prevention of clinically significant suicidality during the brittle period of adolescence, years after childhood trauma exposure.

Yunus A., Rusmiyati S.N., Shafie A.A., Baharudin D.F.

This chapter examines Adverse Childhood Experiences (ACEs), Protective and Compensatory Experiences (PACEs), and their management in school counseling. Research highlights ACEs' detrimental effects on development, emphasizing the need for PACEs to mitigate these impacts. School counselors play a vital role during the 0-18 developmental period, primarily shaped by home and school environments. Integrating technology into counseling addresses gaps like fragmented records across educational phases and enhances ACEs and PACEs identification and intervention. The chapter serves as a guide for counselors, educators, parents, and communities to collaboratively support schools in providing counseling services attuned to ACEs and PACEs.

Flach V.I., Cariola L.A.

Hughes K., Bellis M.A., Ford K., A Sharp C., Hopkins J., Hill R., Cresswell K.

Abstract Background Adverse childhood experiences (ACEs) increase individuals’ risks of poor health across the life course. For children that suffer household-based ACEs, experiences in other settings such as schools have the potential to exacerbate or mitigate risks of poor health. However, few studies have examined such effects. This study aimed to examine relationships between household-based ACEs, school experiences and adult health outcomes. Methods A national cross-sectional household survey (N = 1,868 aged 18+) was undertaken in Wales using random quota sampling (November 2022 to March 2023). Measures included nine household-based ACEs; two measures of childhood school experience (having been bullied, sense of school belonging); and adult health outcomes (smoking, binge drinking, low mental wellbeing, mental illness, violence). Associations between ACEs, school experience and health outcomes were examined using chi squared tests and binary logistic regression. Results The proportion reporting both having been bullied and lower school belonging increased with ACE count (0 ACEs 6%, 4 + ACEs 51%). Higher ACE count was independently associated with increased risk of all adult health outcomes except binge drinking, while poorer school experience (having been bullied, lower school belonging) was associated with increased risk of low mental wellbeing, mental illness and violence victimisation. For example, adjusted odds of current mental illness rose to 3.98 in those reporting 4 + ACEs (vs. 0 ACEs) and 3.37 in those reporting both having been bullied and lower school belonging (vs. not bullied, higher school belonging). In individuals with 4 + ACEs, adjusted prevalence of current mental illness reduced from 44% in those reporting both having been bullied and lower school belonging to 19% in those reporting not having been bullied and higher school belonging. Conclusions For children who grow up in adverse home environments, exposure to further adversity at school may amplify risks of poorer health and life outcomes. However, schools are opportune settings for children who lack safety and support at home to recover from stress, develop resilience and access support. Trauma-informed approaches in schools that recognise the impacts of adversity and support children to overcome it have the potential to improve educational and health outcomes. Further research is needed to identify effective approaches.

Nilsen S.A., Radlick R.L., Askeland K.G.

Abstract Purpose Adverse childhood experiences (ACEs) are a possible pathway through which poor family finances influences adolescents’ behavioral and mental health problems. However, the interrelationship between family finances, ACEs, and behavioral and mental health outcomes in adolescence has received little attention. We aimed to (1) document exposure to family-based ACEs by perceived family finances (PFF), (2) examine how PFF relates to cumulative and pattern-based approaches to ACEs, and (3) assess the direct and interactive associations between PFF and ACEs in relation with behavioral and mental health problems. Methods Data stem from the 2017–2019 nationwide Ungdata surveys of adolescents aged 13–15 (n = 12,560). Family-based ACEs were measured by 6 items covering parental alcohol use and intoxication, and intra-familial violence and fighting. The family-based ACEs were used both as a cumulative index score and examined through latent class analysis (LCA) to identify patterns of exposures. Cluster robust linear regression analyses were used to examine additive and interactive associations between PFF, family-based ACEs, and behavioral and depressive symptoms. Results Poor (compared to not poor) PFF was significantly associated with more depressive symptoms and behavioral problems. Cumulative and pattern based approaches to family-based ACEs partially and similarly attenuated the association between PFF and mental health outcomes. Mainly, however, PFF and family-based ACEs were independently associated with mental health outcomes and did not interact. Conclusions Poor family finances and family-based ACEs co-occur, and both have strong associations with depressive symptoms and behavioral problems in adolescence.