Adverse Childhood Experiences and Suicidal Behaviors Among Youth: The Buffering Influence of Family Communication and School Connectedness

PurposeThe main objectives of this study were to determine (1) whether family communication and school connectedness offer protection against suicidal behaviors in the presence of adverse childhood experiences (ACEs; direct protective effect) and (2) whether family communication or school connectedness buffer the association between ACEs and suicidal behaviors (interacting protective effect) on the multiplicative and additive scales.MethodsData were obtained from a western state's 2019 Youth Risk Behavior Survey that included 5,341 middle school and 4,980 high school participants. Generalized linear models were used to estimate whether family communication and school connectedness offered direct protection against suicidal behaviors or buffered the association between ACEs and suicidal behaviors using adjusted prevalence ratios and corresponding 95% confidence intervals.ResultsFamily communication and school connectedness offered direct protection against suicidal behaviors in the presence of ACEs (a 1-unit higher score was associated with a 32%–42% lower prevalence of suicidal behaviors for middle school youth and a 27%–39% lower prevalence of suicidal behaviors for high school youth). There was evidence that family communication and school connectedness buffered the association between ACEs and suicidal behaviors on the multiplicative scale.ConclusionsThe findings provide support for the development and implementation of interventions that build family communication and school connectedness to reduce suicidal behaviors. Furthermore, screening for trauma and suicidal behaviors is warranted.     

Adverse Childhood Experiences Among Hawai‘i Adults: Findings from the 2010 Behavioral Risk Factor Survey

The prevalence of adverse childhood experiences (ACEs) among Hawai‘i adults and their impact on the health of affected individuals are unknown. Aiming to provide Hawai‘i State baseline information on ACEs and their associations with health conditions and risk behaviors, the 2010 Hawai‘i Behavioral Risk Factor Surveillance System (BRFSS) included the ACE module. Using 5,928 survey respondents who completed the module, demographic attributes were estimated and multivariate logistic regression analysis was performed to examine the association between ACEs and sixteen selected health indicators. In 2010, approximately 57.8% of Hawai‘i adults reported experiencing at least one ACE. Native Hawaiians had the highest prevalence followed by Whites. Adults aged ≥ 65 years had the lowest prevalence on all ACEs. The prevalence of ACEs was inversely related to education and household income levels. Compared to those without ACEs, adults with ACEs had higher odds for a number of health conditions and risk behaviors. Moreover, as the number of ACEs increased, the odds for these health conditions and risk behaviors increased. Hawai‘i adults with ACEs were more likely to report dissatisfaction with life compared to those without ACEs. Men were more likely to report having a family member in prison, while women were more likely to report experiencing sexual abuse. Recommendations include further research on the unbiased contributions of ACEs to diseases and risk behaviors, and the development of culturally-appropriate interventions to reduce the prevalence of ACEs in Hawai‘i.     

Distinct Contributions of Adverse Childhood Experiences and Resilience Resources: A Cohort Analysis of Adult Physical and Mental Health

Although evidence is rapidly amassing as to the damaging potential of early life adversities on physical and mental health, as yet few investigations provide comparative snapshots of these patterns across adulthood. This population-based study addresses this gap, examining the relationship of adverse childhood experiences (ACEs) to physical and mental health within a representative sample (n = 19,333) of adults, comparing the prevalence and explanatory strength of ACEs among four birth cohorts spanning ages 18–79. This assessment accounts for demographic and socioeconomic factors, as well as both direct and moderating effects of resilience resources (social/emotional support, life satisfaction, and sleep quality). Findings demonstrate (1) increasing trends of reported ACEs across younger cohorts, including time period shifts such as more prevalent family incarceration, substance abuse, and divorce, (2) significant bivariate as well as independent associations of ACEs with poor health within every cohort, controlling for multiple covariates (increasing trends in older age for physical health), and (3) robust patterns wherein resilience resources moderated ACEs, indicating buffering pathways that sustained into old age. Theoretical and practice implications for health professionals are discussed.     

Rural-Urban Differences in Adverse Childhood Experiences Across a National Sample of Children

Purpose : The purpose of this study was to examine the prevalence of adverse childhood experiences (ACEs) exposure in 34 states and the District of Columbia, and whether exposure differs between rural and urban residents. Methods : This cross-sectional study used data from the 2016 National Survey of Children's Health (NSCH), restricted to states in which rural versus urban residence was indicated in the public use data (n = 25,977 respondents). Bivariate analyses were used to estimate unadjusted associations. Multivariable regression models were run to examine the association between residence (rural or urban) and ACE counts of 4 or more. Findings : Compared to urban children, rural children had higher rates of exposure to the majority of the ACEs examined: parental separation/divorce, parental death, household incarceration, household violence, household mental illness, household substance abuse, and economic hardship. In adjusted analysis, there was no significant difference for rural children compared to urban children. The odds of 4 or more ACEs decrease as poverty levels decline, with children residing 0%-99% below the federal poverty line more likely to have reported 4 or more ACEs, compared to children residing 400% or above the federal poverty line (aOR 4.02; CI: 2.65-6.11). Conclusions : Our findings suggest that poverty is a key policy lever that may mitigate the burden of ACE exposure. The findings of this study may be instructive for policymakers and program planners as they develop interventions to stop, reduce, or mitigate ACE exposure and the long-term impact of ACEs among children in rural America.     

Adverse Childhood Experiences,Family Functioning,and Resilience in Military Families: A Pattern‐Based Approach

Linkages between adverse childhood experiences and long‐term consequences in servicemen and servicewomen were examined in relation to family‐level resiliency processes predicted to mitigate this link. Using a pattern‐based, multi‐informant approach, resilience was explored through a systemic lens in relation to family‐level processes. Latent family profiles were identified using diverse dimensions of family functioning guided by the circumplex model. Data were collected from parents and their adolescents, age 11 to 18, living in the continental United States (N = 273 military families). Variations in adverse childhood experiences among servicemembers and their partners were related to heterogeneous family functioning typologies (profiles). One adaptive family functioning typology illustrated that a select group of families with higher levels of early adverse experiences evinced adaptive functioning outcomes in multiple domains in adulthood. Implications for examining individual resilience via a family‐level process and applications to educational and clinical contexts are discussed in relation to military and nonmilitary families.     

Developmental Assets: Profile of Youth in a Juvenile Justice Facility

BACKGROUND: Possessing high numbers of developmental assets greatly reduces the likelihood of a young person engaging in health-risk behaviors. Since youth in the juvenile justice system seem to exhibit many high-risk behaviors, the purpose of this study was to assess the presence of external, internal, and social context areas of developmental assets in at-risk youth attending a northeast Missouri juvenile justice center. METHODS: Male and female middle and high school students moved to a residential juvenile justice center voluntarily completed the Developmental Assets Profile (DAP) instrument during a regularly scheduled “intake” session. RESULTS: Most respondents reported lacking risk-protective factors in the internal and social context areas. Respondents noted their lack of community involvement in the social context area and their overinvolvement with negative influences in the internal context area. Specifically in the internal and external context areas, most respondents reported having trouble with substance abuse and not having positive peer or parental support. In the social context area, many noted that they wanted to do well in activities and were encouraged to do well; however, they scored service to others and involvement in religious groups or activities as low. CONCLUSIONS: Students who lack protective qualities, especially those who do not feel committed to their community, are more likely to be involved in substance abuse and risky behaviors. School-community partnerships may provide the targeted health protective factors that encourage more community involvement and more positive health behaviors in these youth.     

Examining Associations between Adverse Childhood Experiences and Posttraumatic Stress Disorder Symptoms among Young Survivors of Urban Violence

Our study examines the association between Adverse Childhood Experience (ACE) exposure and posttraumatic stress disorder (PTSD) symptoms among survivors of violence. In this cross-sectional study, an ACE questionnaire and PTSD Checklist for DSM-5 (PCL-5) were completed by 147 participants ≤ 3 months after presenting to a Philadelphia, PA emergency department between 2014 and 2019 with a violent injury. This study treated ACEs, both separate and cumulative, as exposures and PTSD symptom severity as the outcome. Most participants (63.3%) met criteria for provisional PTSD, 90% reported experiencing ≥ 1 ACE, and 39% reported experiencing ≥ 6 ACEs. Specific ACEs were associated with increasing PCL-5 scores and increased risk for provisional PTSD. Additionally, as participants’ cumulative ACE scores increased, their PCL-5 scores worsened (b = 0.16; p < 0.05), and incremental ACE score increases predicted increased odds for a positive provisional PTSD screen. Results provide further evidence that ACEs exacerbate the development of PTSD in young survivors of violence. Future research should explore targeted interventions to treat PTSD among survivors of interpersonal violence.Supplementary InformationThe online version contains supplementary material available at 10.1007/s11524-022-00628-4.     

Childhood Maltreatment and Unprotected Sex among Female Juvenile Offenders: Evidence of Mediation by Substance Abuse and Psychological Distress

PurposeResearch has shown that childhood maltreatment is associated with sexual risk taking among female juvenile offenders; however, the mechanisms by which maltreatment influences sexual risk remain poorly understood. We assessed whether substance abuse, psychological distress, and dating violence mediate the relationship between childhood maltreatment and unprotected sex.MethodsSexually active female juvenile offenders (13–17 years of age) completed audio computer-assisted self-interviews (n = 232). Logistic regression with a risk decrement approach, the Sobel test, and the Goodman I test were used to evaluate mediation.ResultsMaltreatment before sixth grade was common in our sample, including physical abuse (48.7%), sexual abuse (14.7%), supervision neglect (57.3%), and physical neglect (18.5%). Cumulative childhood maltreatment was also high with 42.2% reporting two or more types. In the fully adjusted model, cumulative childhood maltreatment remained associated with unprotected sex (odds ratio, 2.43; 95% confidence interval, 1.27, 4.65). The percent of the total effect in the relationship between childhood maltreatment and unprotected sex that was mediated by substance abuse was 16.4% (Sobel = 2.54 [p = .01]; Goodman I = 2.49 [p = .01]) and psychological distress accounted for 23.7% (Sobel = 2.55 [p = .01]; Goodman I = 2.51 [p = .01]). Dating violence was not a significant mediator in our analyses.ConclusionWe found a strong relationship between childhood maltreatment and unprotected sex among female juvenile offenders that was partially mediated through substance abuse and psychological distress. These findings can be used to develop public health strategies to increase condom use among female juvenile offenders. Trauma-informed approaches to sexual health promotion that address substance abuse and psychological distress are warranted.     

Coming Out Experiences and Psychological Distress of Chinese Homosexual Men in Hong Kong

This study adopted a cognitive-behavioral conceptual framework based on the Theory of Reasoned Action (TRA) in understanding coming out experiences and psychological distress of 187 Chinese gay men. Results showed that participants' coming out experiences were characterized by same-sex sexual fantasy at teenage years, followed by awareness of homosexual tendency, same-sex sexual contact, and then self-identification and disclosure of homosexual orientation in young adulthood. Regarding targets of disclosure, participants tended to disclose their sexual orientation to their gay friends first, followed by heterosexual friends, siblings, parents, and coworkers. This study also supported the extension of the TRA conceptual framework to Chinese societies. Results showed that a low level of psychological distress in Chinese gay men was linked to their coming out experiences, which were in turn related to TRA components of involvement and identification with gay communities and positive attitudes toward coming out. Limitations and implications were also discussed.     

Complex Health Needs in the Youth Justice System: A Survey of Community-Based and Custodial Offenders

PurposeEstimate the prevalence and annual frequency of health risk indicators in young people serving community-based orders (CBOs) and custodial orders in the state of Victoria, Australia.MethodsCross-sectional survey of 242 young people serving CBOs and 273 serving custodial orders in Victoria in 2002–2003. Validated measures included the Composite International Diagnostic Interview for substance dependence, Short Mood and Feelings Questionnaire for depression, and Psychosis Screening Questionnaire for psychosis symptoms. Prevalence estimates were adjusted for sampling bias and age- and sex-adjusted for between-group comparisons. Prevalence estimates were applied to 2010–2011 Victorian youth justice data to estimate annual frequencies at the state level.ResultsThe prevalence of substance dependence, poor mental health, and risky sexual behavior was high in both groups. Age- and sex-adjusted prevalence estimates were generally higher among those serving custodial orders; however, extrapolating prevalence estimates to statewide youth justice data generally resulted in higher estimated annual frequencies among CBOs. For example, the estimated prevalence of any substance dependence was 66% (95% confidence interval [CI], 60–72) in those serving custodial orders and 34% (95% CI, 26–42) in CBOs, but the estimated frequency of substance dependence in CBOs in 2010–2011 was 970 (95% CI, 750–1,180), compared with 490 (95% CI, 450–530) in those serving a custodial order.ConclusionsThere is a compelling case for scaling up health services for young offenders in custody and in the community, and for routinely monitoring the health of young offenders serving custodial and community orders.     

The Mediating and Moderating Effects of Workplace Social Capital on the Associations between Adverse Work Characteristics and Psychological Distress among Japanese Workers

Our current study investigated how workplace social capital (WSC) mediates and moderates the associations between adverse work characteristics and psychological distress among Japanese workers. We collected cross-sectional data (N=9,350) from a baseline survey of an occupational Japanese cohort study. We focused on individual WSC and considered job demands/control, effort/reward, and two types (i.e., procedural and interactional) of organizational justice as work-characteristic variables. We defined psychological distress as a score of ≥5 on the Kessler Psychological Distress Scale (K6 scale). Multivariate logistic regression analyses predicted a binary variable of psychological distress by individual WSC and adverse work characteristics, adjusting for individual-level covariates. Individual WSC mediated the associations between adverse work characteristics and psychological distress in almost all model specifications. Additionally, individual WSC moderated the associations of psychological distress with high job demands, high effort, and low interactional justice when we used a high WSC cutoff point. In contrast, individual WSC did not moderate such interactions with low job control, reward, or procedural justice. We concluded that individual WSC mediated the associations between adverse work characteristics and psychological distress among Japanese workers while selectively moderating their associations at high levels of WSC.     

南昌市高中生童年期不良经历与自杀相关行为的研究

目的 了解高中生自杀意念、自杀计划现状及童年期不良经历,探索童年期不良经历与自杀意念、自杀计划的关系,掌握童年期不良经历对自杀意念、自杀计划的累积效应。方法 2015年5月,采取分层整群随机抽样方法,将南昌市城区34所高中按中考录取分数线由高到低排序随机抽取5个学校,共调查高中生884名。结果 884名高中生中125人（14.14%）有自杀意念,55人（6.22%）有自杀计划。logistic分析表明,躯体虐待(OR=3.002,P<0.001),家庭成员有精神异常者(OR=3.465,P<0.001)与自杀意念呈正性相关;性虐待(OR=3.105,P=0.008)、躯体虐待(OR=3.439,P<0.001),家庭成员有精神异常者(OR=5.295,P<0.001)与自杀计划呈正性相关。累积效应分析发现,随着童年期不良经历数目的增加,自杀意念、自杀计划发生的风险增加,有三种及以上不良经历者产生自杀意念OR=10.836,产生自杀计划OR=22.660。结论 童年期不良经历是高中生自杀意念、自杀计划发生的危险因素,加强对有童年期不良经历青少年的干预可有效防控高中生自杀相关行为。     

The effects of protective factors and adverse childhood experiences on behavioral health services use: Findings from a population-based sample

ABSTRACT

Adverse childhood experiences (ACEs) are linked to later life health problems such as behavioral health (BH) service use but less is known about how to counter this association. Using a population based sample of 807 adults, we examined the effects of protective factors in countering this association. ACEs were associated with increased BH service use while protective factors were associated with decreased BH service use. However, no significant interaction effect was found. Research is needed to develop a better measure of protective factors. Social workers need to be aware of ACE prevalence among clients and can foster protective factors.     

A Complex Negotiation: Women's Experiences of Naming and Not Naming Premenstrual Distress in Couple Relationships

ABSTRACT

Recent research has demonstrated the importance of family relationships in women's experience of premenstrual changes, their construction of these changes as “PMS.” However, the discursive process by which women take up the subject position of “PMS” sufferer through the explicit naming of “PMS” to an intimate partner has received little research attention. Drawing on 60 individual interviews with Australian women, conducted between 2004 and 2006, we examined accounts of naming “PMS” in intimate relationships, women's explanations for naming or not naming, their experiences of their partner naming them as premenstrual. The analysis process identified an overarching theme of naming “PMS,” which was made up of three themes: naming to explain; “PMS” becoming the only explanation for distress; “PMS” as not a legitimate explanation for distress. The findings suggest that clinicians need to be aware of women's complex, often ambivalent, experiences of naming “PMS” within their relationships, when working with women, couples, seeking treatment or support for premenstrual distress.     

Double whammy: Adverse childhood events and pain reflect symptomology and quality of life in women in substance abuse treatment

Background. This study examined the profiles of symptoms and health-related quality of life (QOL) of women in substance abuse treatment, comparing those with higher versus lower histories of adverse childhood events (ACE), and those with versus without current pain. Methods. Adult women in outpatient substance abuse treatment (n = 30) completed questionnaires (cross-sectional study) on topics including drug use, adverse childhood events (ACE), QOL, functional ability, current pain, and depression. Results. Women with pain indicated significant differences in emotional (p < 0.05), and functional ability (p < 0.01); but no significant differences were found between women with high versus low levels of ACE. Yet, radar plots of women with both current pain and high levels of ACE, versus those without, portrayed a distinctive profile indicating high levels of anxiety and depression. Conclusions. Rather than a checklist, visual composites of symptoms experienced by women in substance abuse treatment illustrates areas of concern in the overall status of women in substance abuse treatment.     

A Lifecourse Perspective on Socio-economic Inequalities in Health: The Influence of Childhood Socio-economic Conditions and Selection Processes

In this article a lifecourse perspective on socio-economic inequalities in health is presented. In a lifecourse perspective, cumulation of adverse socio-economic circumstances and selection are important mechanisms, which successively may cause a downward spiral. A conceptual model is examined with empirical data. Three processes in the explanation of socio-economic health inequalities are emphasised: the contribution of childhood socio-economic conditions, the contribution of childhood health and the contribution of health selection. Data were used from the longitudinal Study of Socio-Economic Health Differences (LS-SEHD) in the Netherlands.
It was found that the relation between adult socio-economic status and adult health is influenced by childhood socio-economic conditions. An independent effect of childhood socio-economic conditions on adult health was partly explained by unhealthy behaviour and personality characteristics and cultural factors. Also, childhood health was found to play a role in the explanation of socio-economic health differences in early adult life. Health selection in childhood seems the most important mechanism in this process. With respect to health selection in adult life no effect of health problems on downward social mobility was apparent. Our results indicate that the occurrence of a downward spiral is likely to be significant during the period of childhood and youth.     

Youth with Learning Disabilities in the Juvenile Justice System: A Training Needs Assessment of Detention and Court Services Personnel

This study examines the training needs of juvenile justice personnel regarding their work with youth who have disabilities, particularly learning disabilities. Proportionate stratified cluster sampling was used to survey juvenile detention and court services personnel statewide about previous training and confidence of knowledge in these areas. Findings indicate that less than two-thirds (62%) of respondents had received training about persons with disabilities and less than half (47%) had received training about persons with learning disabilities. Some myths about learning disabilities continue to persist more than others. Knowledge about learning disabilities is considered to be important and training is desired. Suggestions for planning future training events are offered.The study was supported by a grant provided by the Virginia Department of Criminal Justice Services, JAIBG Pooled Funds Grant 98-JB-VX-0051 and was previously submitted as part of a report to the Virginia Department of Criminal Justice Services, Juvenile Accountability Incentive Block Grant Program.