Maternal adverse childhood experiences and their association with preterm birth: secondary analysis of data from universal health visiting.

BACKGROUND: Being born before full gestation can have short-term and life-long health implications, yet it remains difficult to determine the risk of preterm birth among expectant mothers. Across different health settings, increasing attention is given to the health and behavioural consequences of adverse childhood experiences (ACEs) such as child abuse or neglect, or exposure to harmful household environments (e.g. in which caregivers abuse alcohol), and the potential value of understanding these hidden harms when supporting individuals and families. A large international evidence base describes the association between childhood adversity and early years outcomes for mothers and children. However, the relationship between maternal ACEs and preterm birth has received far less attention. METHODS: Secondary analysis was carried out on anonymised cross-sectional data from health visiting services in south and west Wales that had previously captured information on mothers' ACEs during routine contacts. Demographic data and information on mothers' health were extracted from the Healthy Child Wales Programme. RESULTS: Half of all mothers sampled had experienced at least one ACE, with a history of ACEs more common among younger, white British mothers and those residing in deprived areas. Preterm birth was significantly independently associated with retrospective reports of childhood sexual abuse (adjusted odds ratio [AOR] = 3.83, 95% confidence interval [CI] = 1.19-12.32, p = 0.025), neglect (AOR = 7.60, 95%CI = 1.81-31.97, p = 0.006) and overall ACE exposure (AOR = 2.67, 95%CI = 1.14-6.23, p = 0.024), with one in ten mothers (10.0%) who experienced ≥4 ACEs having preterm birth. Sub-analyses revealed a more pronounced relationship among mothers with no known chronic health conditions, with those with ≥4 ACEs and no known chronic condition four times more likely to give birth preterm (AOR = 3.89, 95%CI = 1.40-10.80, p = 0.009). CONCLUSIONS: Findings highlight the importance of the entire maternal experience. The experience of childhood adversity can have a lasting impact into and beyond the prenatal period, potentially increasing the risk of preterm birth, even among otherwise healthy women. Increasing our understanding of the potential perinatal outcomes associated with ACEs can help to inform how maternity services and partners offer trauma-sensitive support to mitigate some of the risks of early parturition, as well as target intergenerational cycles of adversity and poor health.

Association Between Adverse Childhood Experiences and Adverse Pregnancy Outcomes.

OBJECTIVE: To examine the association between adverse childhood experiences and adverse pregnancy outcomes. METHODS: This cohort study included individuals who enrolled in a perinatal collaborative mental health care program (COMPASS [the Collaborative Care Model for Perinatal Depression Support Services]) between 2017 and 2021. Participants completed psychosocial self-assessments, including an adverse childhood experiences screen. The primary exposure was adverse childhood experiences measured by the ACE (adverse childhood experience) score, which was evaluated as a dichotomized variable, with a high ACE score defined as greater than three. Secondary analyses used the ACE score as a continuous variable. Adverse pregnancy outcomes including gestational diabetes, hypertensive disorders of pregnancy, preterm birth, and small-for-gestational-age (SGA) births were abstracted from the electronic health record. Bivariable and multivariable analyses were performed, including mediation analyses. RESULTS: Of the 1,274 women with a completed adverse childhood experiences screen, 904 (71%) reported one or more adverse childhood experiences, and 290 (23%) reported a high ACE score (more than three adverse childhood experiences). Adverse childhood experience scores were not associated with gestational diabetes or SGA births. After controlling for potential confounders, individuals with high ACE score had 1.55-fold (95% CI 1.06-2.26) increased odds of having hypertensive disorders of pregnancy and 2.03-fold (95% CI 1.38-2.99) increased odds of preterm birth. Each point increase in ACE score was not associated with a statistically increased odds of hypertensive disorders of pregnancy (adjusted odds ratio [aOR] 1.07, 95% CI 0.99-1.15); however, each additional point on the adverse childhood experiences screen was associated with increased odds of preterm birth (aOR 1.13, 95% CI 1.05-1.22). Mediation analyses demonstrated tobacco use, chronic medical problems, and obesity each partially mediated the observed association between high ACE scores and hypertensive disorders of pregnancy. Having chronic medical comorbidities partially mediated the observed association between high ACE scores and preterm birth. CONCLUSION: One in four individuals referred to a perinatal mental health program who were pregnant or postpartum had a high ACE score. Having a high ACE score was associated with an increased risk of hypertensive disorders of pregnancy and preterm birth. These results underscore how remote events may reverberate through the life course.

Prevalence, Correlates, and Treatment of Suicidal Behavior in US Military Veterans: Results From the 2019-2020 National Health and Resilience in Veterans Study.

Objective: US military veterans have high rates of suicide relative to civilians. However, little is known about the prevalence and correlates of suicidal behaviors in the general US veteran population.Methods: Data were from the National Health and Resilience in Veterans Study, a representative survey of US veterans conducted in 2019-2020 (n = 4,069). Analyses (1) estimated the prevalence of current suicidal ideation, lifetime suicide plans, and lifetime suicide attempts; (2) identified associated sociodemographic, military, DSM-5 psychiatric, and other risk correlates; and (3) examined mental health treatment utilization among veterans with suicidal ideation, suicide plans, or suicide attempts.Results: The prevalence of current suicidal ideation, lifetime suicide plans, and lifetime suicide attempts was 9.0%, 7.3%, and 3.9%, respectively. Suicidal behaviors were most prevalent among veterans aged 18-44 years, with 18.2%, 19.3%, and 11.1%, respectively, endorsing suicidal ideation, suicide plans, and suicide attempts. Major depressive disorder (MDD), age, posttraumatic stress disorder, and adverse childhood experiences (ACEs) emerged as the strongest correlates of suicidal ideation and suicide plans, while MDD, age, alcohol use disorder, and ACEs were the strongest correlates of suicide attempts. Only 35.5% of veterans with current suicidal ideation were engaged in mental health treatment, with veterans who used the US Veterans Administration (VA) as their primary source of health care more than twice as likely as VA non-users to be engaged in such treatment (54.7% vs 23.8%).Conclusions: Suicidal behaviors are highly prevalent among US veterans, particularly among young veterans. Results suggest that nearly two-thirds of veterans with current suicidal ideation are not engaged in mental health treatment, signaling the need for enhanced suicide prevention and outreach efforts.

Maternal filicide and mental illness: A descriptive study of 17 women hospitalized in a French secure unit over a 24-year period.

Maternal filicide is defined as the murder of a child by its mother. Many classifications have been elaborated based on underlying motives such as altruism, mental pathology, fatal maltreatment, spousal revenge, or an unwanted child. Pathological filicide refers to cases in which the perpetrator has a major psychiatric illness. Related literature is sparse. The present work proposes to identify the main characteristics of mentally ill filicidal mothers. This study was based on data gathered through a retrospective chart review of all filicidal women admitted to the Henri Colin secure unit (France) between 1996 and 2019 (N = 17). Most filicidal mothers had a dysfunctional childhood marked by emotional neglect, intrafamilial violence, or social isolation. They were often married, on average about 32 years old. We found a history of attempted filicide in 3 cases, and abuse or neglect in 3 other cases. The victim's average age was 6.2 years old, and in several cases, multiple siblings were murdered. Half of the filicidal mothers had a history of psychiatric disorders. Three different diagnoses were found in our study: bipolar or depressive disorders (41.2%); schizophrenia or other psychotic disorders (41.2%); personality disorders (17.6%). We identified two subgroups, as having different motivational profiles. In the first group, filicide is a defensive reaction to a perceived threat: The murder is committed under the influence of hallucinations or delusions. In the second group, filicide is linked to a context of separation, real or imagined. Several forensic and psychopathologic features associated with each profile are detailed.

The association between childhood trauma and lifetime suicide attempts among a sample of male prisoners: A pilot observational study.

BACKGROUND: Prisoners have higher rates of suicide attempts compared with general population. A history of childhood trauma (CT) is common among incarcerated subjects and it is a well-known risk factor for lifetime suicide attempts. Therefore, the purpose of the study was to investigate whether lifetime suicide attempts may be related to the exposition to CT among male prisoners. METHOD: We conducted a cross sectional study recruiting newly arrived inmates in an Italian jail, between January 2017 and June 2018. Prisoners were interviewed to collect socio-demographic and clinical information. Moreover, inmates completed the Childhood Trauma Questionnaire. We excluded prisoners unable to speak or read Italian, with learning disabilities or current severe psychiatric symptoms. RESULTS: A total of 215 consecutive male inmates were included. Fifty-one prisoners (23.7%) had a history of attempted suicide. The most reported CT was physical neglect. Multivariate logistic regression analysis showed that a history of childhood sexual abuse, emotional neglect and psychiatric diagnosis significantly increased the likelihood of lifetime suicide attempt. CONCLUSIONS: A previous history of suicide attempt is highly prevalent among inmates. In agreement with previous findings, lifetime suicide attempts seem to be associated with the presence of CT and psychiatric diagnosis. Therefore, CT should be considered as a relevant variable to improve the programs for the prevention of suicide in prison.

All adverse childhood experiences are not equal: The contribution of synergy to adverse childhood experience scores.

The operationalization of childhood trauma and adversity into checklists commonly known as adverse childhood experiences, or ACEs, has become the most widely adopted methodology linking traumatic childhoods to adult outcomes. As the number of self-reported ACEs increase from 0 to 4 or more (4+), most studies find a roughly stepwise progression in risk for a wide range of negative medical and mental health outcomes. A score of 4+ ACEs, has become a de facto cutpoint, increasingly used clinically to define "high risk" status for a myriad of outcomes. Comparisons across studies using a 4+ cutpoint, however, find considerable heterogeneity in the degree of risk for the same outcomes. In addition to sample and methodological differences, certain pairs of ACEs comprising the cumulative ACE score interact synergistically to significantly increase the overall risk beyond the sum (or product) of the contributions of each ACE to the outcome. This article reviews the empirical literature on synergistic ACEs including results from a general population adult and a mixed trauma, youth sample both sufficiently powered to examine over 20 different ACE pairings for possible synergy. Synergistic pairs of ACEs vary by gender and age group. About 30-40% of the variance in outcomes is accounted for by additive synergistic interactions between certain pairs of ACEs. Across studies, sexual abuse is the most synergistically reactive ACE. The article concludes with a discussion of the implications of synergistic ACE pairings for psychologists and other allied professionals across clinical practice, prevention, research, and policy. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

The Long-Term Impact of Adversity in Adolescence on Health in Middle and Older Adulthood: A Natural Experiment From the Chinese Send-Down Movement.

The 1950s-1970s Chinese send-down movement can be treated as a natural experiment to study the impact of adolescent exposure on subsequent health. This paper used data from the China Family Panel Studies 2010 to evaluate the long-term impact of the Chinese send-down movement on individual health later in life. Drawing from the life-course perspective, results from difference-in-differences models suggested that the send-down experience had a significant impact on worse self-rated health; the pathways from structural equation models showed that subsequent achievements-age of marriage and educational attainment-had mediating effects linking the send-down experience to worse self-rated health and better mental health, respectively. Taken together, our results highlight the roles of the send-down experience and post-send-down characteristics in shaping health outcomes later in life.

Prevalence of Traumas and PTSD Among Individuals Adjudicated Not Guilty by Reason of Insanity.

Trauma and posttraumatic stress disorder (PTSD) are common among psychiatric and criminal populations, yet there have been few studies among forensic psychiatric populations and no known studies have specifically examined insanity acquittees. This study aimed to identify the prevalence of trauma and to assess recognition of PTSD in forensic settings. Using a cross-sectional self-report survey methodology, we examined traumas, adverse childhood experiences (ACEs), and PTSD in insanity acquittees (n = 107). Most insanity acquittees experienced trauma (86%, averaging 11 events) and ACEs (76%, averaging 3 types). The most commonly experienced traumas were sudden death of a loved one, witnessed death or serious injury, adult physical assault, and motor vehicle accident. Women were significantly more likely to experience any ACE (especially witnessing domestic violence, household members with mental illness, emotional abuse, and emotional neglect) and adult sexual assault. PTSD prevalence was 25 percent, with 97 percent of cases being previously undiagnosed. Sexual traumas and younger age were significantly associated with PTSD. These results suggest that insanity acquittees have high levels of trauma, ACEs, and PTSD. While PTSD was about seven times more common than in previous findings in the general population, it frequently goes undiagnosed in forensic settings. Potential explanations and implications of our findings are discussed.

Childhhood Trauma in Schizophrenia Spectrum Disorders: Dissociative, Psychotic Symptoms, and Suicide Behavior.

Current evidence suggests a high prevalence of childhood trauma (CT) among adult patients diagnosed with schizophrenia spectrum disorders. Exposure to CT might lead to clinical differences eventually observed in these patients. We present a cross-sectional study with 54 patients with schizophrenia spectrum disorder (schizophrenia and schizoaffective disorder). We obtained sociodemographic data, as well as data on CT, dissociation, suicide history, and intensity of positive and negative psychotic symptoms. More than 75% of the patients reported a history of CT. We observed a link between CT and suicidal behavior. Patients showed high rates of dissociation. Dissociative experiences were related to CT, both in terms of intensity of trauma and number of traumas experienced. All CT forms except emotional neglect showed direct correlations with dissociative experiences. We found no correlation between intensity of CT and intensity of positive psychotic symptoms, yet we observed a moderate inverse correlation with negative psychotic symptoms.

Association of Adverse Childhood Experiences With Cardiovascular Disease Later in Life: A Review.

Importance: Adverse childhood experiences (ACEs) are potentially harmful events that occur during childhood, spanning neglect, physical or sexual abuse, parental separation, or death, among others. At least 50% of the US adult population has experienced 1 or more ACEs before the age of 18 years, but in clinical practice, ACEs remain underrecognized. Adults who have experienced ACEs are at increased risk of developing health risk behaviors and, ultimately, cardiovascular disease (CVD). This review summarizes the evidence regarding the association of ACEs with CVD and the accompanying diagnostic and therapeutic approaches in the adult population. Observations: ACEs are commonly classified into 3 domains: abuse (psychological, physical, or sexual), household dysfunction (eg, substance use by household members, mental illness, parental separation), and neglect. These experiences elicit chronic activation of the stress response system, leading to autonomic, neuroendocrine, and inflammatory dysfunction. The subsequent development of traditional risk factors, such as diabetes, hypertension, smoking, and obesity, results in the onset of CVD and premature mortality. Adults with 4 or more ACEs compared with those with none have a more than 2-fold higher risk of developing CVD and an almost 2-fold higher risk of premature mortality. Conclusions and Relevance: Identifying methods of mitigating the health consequences of ACEs may lead to better cardiovascular outcomes. Inquiry into ACE exposure during clinical encounters and subsequent referral to psychological services when appropriate may be helpful, but strategies aimed at CVD prevention via management of ACEs in adults continue to lack adequate evidence.

Health, stress, and well-being in Swiss adult survivors of child welfare practices and child labor: Investigating the mediating role of socio-economic factors.

BACKGROUND: With widespread deprivation in the education of minors affected by child welfare practices (CWP) in the last century, affected individuals often continued a life dominated by socio-economic disadvantage. According to life course theories, the impact of socio-economic disadvantage can accumulate across the life span, leading to worse health in later life. However, the scientific examination of health correlates of CWP in later life and the mediating role of socio-economic factors (SEF) has previously been neglected. OBJECTIVE: This study examined whether Swiss survivors of CWP, including former Verdingkinder, have poorer health in later life compared to controls, and whether this association is mediated by socio-economic factors: education, income, satisfaction with financial situation, socio-economic status. PARTICIPANTS AND SETTING: Two face-to-face interviews were conducted with N = 257 participants (risk group, RG, n = 132, MAGE = 70.83 years, 58 % male; control group, CG, n = 125, MAGE = 70.6 years, 49 % male). METHODS: A broad set of physical health outcomes, stress, well-being, and SEF were assessed with psychometric instruments. RESULTS: The RG reported more physical illnesses, vascular risk factors, health symptoms, stress, and lower well-being, compared to the CG. Mediation analyses revealed that SEF were relevant mediators for the significant health and stress disparities between groups. CONCLUSIONS: Results suggest that SEF can play a crucial role in mitigating the negative effects and health impairments in individuals formerly affected by CWP. Public health services and policies that target these SEF could improve current welfare practices by providing opportunities to overcome early-life disadvantage and facilitating healthier life trajectories.

Childhood severe acute malnutrition is associated with metabolic changes in adulthood.

BACKGROUNDSevere acute malnutrition (SAM) is a major contributor to global mortality in children under 5 years. Mortality has decreased; however, the long-term cardiometabolic consequences of SAM and its subtypes, severe wasting (SW) and edematous malnutrition (EM), are not well understood. We evaluated the metabolic profiles of adult SAM survivors using targeted metabolomic analyses.METHODSThis cohort study of 122 adult SAM survivors (SW = 69, EM = 53) and 90 age-, sex-, and BMI-matched community participants (CPs) quantified serum metabolites using direct flow injection mass spectrometry combined with reverse-phase liquid chromatography. Univariate and sparse partial least square discriminant analyses (sPLS-DAs) assessed differences in metabolic profiles and identified the most discriminative metabolites.RESULTSSeventy-seven metabolite variables were significant in distinguishing between SAM survivors (28.4 ± 8.8 years, 24.0 ± 6.1 kg/m2) and CPs (28.4 ± 8.9 years, 23.3 ± 4.4 kg/m2) (mean ± SDs) in univariate and sPLS-DA models. Compared with CPs, SAM survivors had less liver fat; higher branched-chain amino acids (BCAAs), urea cycle metabolites, and kynurenine/tryptophan (KT) ratio (P < 0.001); and lower ß-hydroxybutyric acid and acylcarnitine/free carnitine ratio (P < 0.001), which were both associated with hepatic steatosis (P < 0.001). SW and EM survivors had similar metabolic profiles as did stunted and nonstunted SAM survivors.CONCLUSIONAdult SAM survivors have distinct metabolic profiles that suggest reduced ß-oxidation and greater risk of type 2 diabetes (BCAAs, KT ratio, urea cycle metabolites) compared with CPs. This indicates that early childhood SAM exposure has long-term metabolic consequences that may worsen with age and require targeted clinical management.FUNDINGHealth Research Council of New Zealand, Caribbean Public Health Agency, Centre for Global Child Health at the Hospital for Sick Children. DST is an Academic Fellow and a Restracomp Fellow at the Centre for Global Child Health. GBG is a postdoctoral fellow of the Research Foundation Flanders.

Childhood trauma as a predictor of changes in sleep quality in American Indian adults during the COVID-19 pandemic.

BACKGROUND: Early life adversity associates with poor sleep in adulthood and is believed to sensitize individuals to later stressors. Infectious disease outbreaks increase psychological stress, and life events impact sleep quality. American Indians have been disproportionately affected by the COVID-19 pandemic. OBJECTIVE: Investigate whether childhood trauma predicts changes in sleep quality following onset of the pandemic and test whether pandemic stress contributes to changes in sleep. METHODS: In a sample of 210 American Indian adults (Age M (SD) = 55.09 (13.10), 59.5% female) demographics, childhood trauma and sleep quality were measured at Time 1. One month following the onset of the pandemic, psychological stress specific to the pandemic and sleep quality were measured. RESULTS: Using linear regression controlling for age, sex, income, and sleep quality at Time 1, childhood adversity predicted both psychological stress specific to the pandemic and changes in sleep quality from Time 1 to Time 2 (ß = 0.33, t(205) = 4.88, P < .001, ΔR2 = 0.10) and (ß = 0.24, t(204) = 3.48, P < .001, ΔR2 = 0.05), respectively. Mediation analyses indicated a significant indirect effect between childhood adversity and changes in sleep quality through COVID-19 stress (indirect effect [standard error, SE] = (0.03[0.01], 95% confidence interval = [0.003, 0.03]). CONCLUSIONS: In American Indians childhood trauma predicts greater declines in sleep quality associated with the onset of the COVID-19 pandemic, in part because greater psychological stress related to COVID-19. Future work should identify factors which alleviate stress related to life events for individuals who experienced childhood trauma in order to improve health behaviors and health.

Impacts of the 1918 flu on survivors' nutritional status: A double quasi-natural experiment.

Robust empirical evidence supports the idea that embryonic and, more generally, intrauterine disruptions induced by the 1918-flu pandemic had long-term consequences on adult health status and other conditions. In this paper we assess the 1918-flu long-term effects not just of in utero exposure but also during infancy and early childhood. A unique set of events that took place in Puerto Rico during 1918-1919 generated conditions of a "double quasi-natural experiment". We exploit these conditions to empirically identify effects of exposure to the 1918 flu pandemic and those of the devastation left by an earthquake-tsunami that struck the island in 1918. Because the earthquake-tsunami affected mostly the Western coast of the island whereas early (in utero and postnatal) exposure to the flu was restricted to those born in the interval 1917-1920, we use geographic variation to identify the effects of the quake and timing of birth variation to identify those of the flu. We benefit from availability of information on markers of nutritional status in a nationally representative sample of individuals aged 75 and older in 2002. We make two contributions. First, unlike most fetal-origins research that singles out early nutritional status as a determinant of adult health, we hypothesize that the 1918 flu damaged the nutritional status of adult survivors who, at the time of the flu, were in utero or infants. Second, we target markers of nutritional status largely set when the adult survivors were infants and young children. Estimates of effects of the pandemic are quite large mostly among females and those who were exposed to the earthquake-tsunami. Impacts of the flu in areas less affected by the earthquake are smaller but do vary by area flu severity. These findings constitute empirical evidence supporting the conjecture that effects of the 1918 flu and/or the earthquake are associated not just with disruption experienced during the fetal period but also postnatally.

Combinations of adverse childhood events and risk of postpartum depression among mothers enrolled in a home visiting program.

PURPOSE: The purpose of this study was to examine how combinations of adverse childhood events (ACEs) contribute to the risk of postpartum depression and the mediating role of prenatal social support. METHODS: The Adverse Childhood Experiences Scale Questionnaire and the Edinburgh Postnatal Depression Scale Questionnaire were used to measure the study's exposure and outcome. Among a cohort of 419 mothers enrolled in a home visiting (HV) program, latent class analyses were used to identify classes of ACEs exposure. General linear models assessed the risk of postpartum depression, and prenatal social support was examined as a mediator. RESULTS: Four distinct classes of ACE exposure were identified. On the Edinburgh Postnatal Depression scale, mothers who were classified in Classes 1-3 scored higher by 2.6-4.4 points compared with women in Class 0. ACE class was found to be indirectly associated with postpartum depression scores through prenatal social support. CONCLUSIONS: Identifying combinations of ACEs in an HV program has the potential to improve the characterization of ACEs among low-income perinatal women in the United States. Elucidating how these combinations contribute to the risk of postpartum depression has the potential to identify women at increased risk, which can help HV programs prioritize prevention efforts.

Breastfeeding Among Mothers Who Have Experienced Childhood Maltreatment: A Review.

BACKGROUND: Current breastfeeding recommendations focus on the physical benefits of breastfeeding but do not take into account the influence of a history of childhood maltreatment on mothers' experiences breastfeeding. A better understanding of this relationship is important to be able to better support mothers during this critical time. RESEARCH AIM: To review current research that examined how women's personal experiences of childhood maltreatment has affected their breastfeeding outcomes and experiences. METHODS: A scoping review was conducted to evaluate current literature on breastfeeding and childhood maltreatment. We screened 275 articles, of which eight met the sample selection criteria and were included in this review. These articles were analyzed based on common themes that emerged: Breastfeeding intention, initiation, duration, and exclusivity; medical conditions associated with breastfeeding; and participants' experiences related to breastfeeding. RESULTS: History of childhood maltreatment was associated with decreased and shorter duration of breastfeeding. Participants' experiences of breastfeeding varied: Some found it empowering, and others experienced great distress while breastfeeding. Challenges during this period included managing touch, struggling with the power differential between providers and participants, and coping with trauma symptoms (e.g., dissociation). CONCLUSIONS: For some participants, it was possible to breastfeed successfully after childhood maltreatment, but others found the experience extremely difficult, even traumatizing. There is a need for a trauma-informed approach to lactation care for women with a childhood maltreatment history.

Anxiety and Adverse Life Events in Professional Creative and Early Psychosis Populations.

Objective: The association between creativity and psychopathology has intrigued researchers and recent studies have affirmed genetic and epidemiological links. In particular, epidemiological research highlights the need to study what aspects of the creative individual protect or provide risk for transition to psychosis. Two factors, associated with transition to psychosis, will be investigated, namely anxiety and adverse life events. Method: A diverse sample of 110 participants (18-35 years) was examined, including early psychosis (EP), creative professionals who are clinically vulnerable or "at-risk" (ARCC), those with no psychotic symptoms (CC), and non-creative (NCC) participants. Measures of anxiety (DASS) and adverse life events (ALE) were administered to the participants to determine whether these factors were positively or negatively associated with creativity and whether they were able to differentiate the EP from ARCC, CC and NCC participants. Results: Creative cognition and achievement were positively correlated with anxiety. The EP and ARCC groups were more closely aligned than expected on measures of anxiety and adverse life events. Childhood sexual/physical assault were the only variables that differentiated these two groups. Conclusions: These results provide further support for the association between creative professionals and those with early psychosis. It provides corroborating evidence of the vulnerability of creative individuals who appear to be aligned with the early psychosis group on anxiety, aspects of paranoia and overall trauma. The results provide possible innovative avenues for intervention in EP and ARCC.

Adult survivors of childhood trauma: Complex trauma, complex needs.

BACKGROUND: Childhood trauma is common and can have profound consequences throughout a person's life. Adult survivors of childhood abuse pose a number of challenges for general practitioners (GPs). The diagnosis of their medical and psychiatric illnesses is complex; the therapeutic relationship can be both delicate and critical to recovery; and the treatments are varied, often expensive and frequently inaccessible. OBJECTIVE: The aim of this article is to provide a conceptual framework for the assessment and management of an adult survivor of childhood adversity. DISCUSSION: GPs can be effective and facilitate recovery-orientated, trauma-focused care, even when local services are limited. This model considers the person's presenting symptoms and the consultation interaction, and it is applicable regardless of diagnosis. Key principles include listening and engaging to understand why the person is presenting in this way, and approaching care in a targeted and collaborative manner. This can alleviate emotional distress for the patient, GP and care team.

Childhood trauma and bipolar spectrum: a population-based sample of young adults.

Introduction Childhood trauma has been suggested to be involved in susceptibility to bipolar disorder (BP). However, it remains unclear whether the occurrence of childhood trauma is differently distributed in subthreshold bipolar disorder (SBP). Objective To assess childhood trauma in young adults with SBP, as compared to young adults with BP and population controls (PC). Method This was a cross-sectional, population-based study. The Mini International Neuropsychiatric Interview (MINI) was used to define the groups with BP (subjects with a lifetime or current manic episode or lifetime or current hypomania with a history of a depressive episode), SBP (subjects with a history of hypomanic episode without lifetime or current depressive episode), and subjects without mood disorders (PC). Childhood trauma was assessed using de Childhood Trauma Questionnaire (CTQ). We investigated differences regarding childhood trauma across the three groups (BP, SBP and PC). Result Except for sexual abuse, all subtypes of childhood trauma remained associated with the BP group as compared to PC. Additionally, when we compared SBP and BP, significant differences were found only for emotional abuse. No significant differences were found in relation to childhood trauma between the SBP and PC groups after adjusting for confounding factors. Conclusion These findings suggest that investigating childhood trauma, with a particular focus on emotional abuse, could be considered a preventive measure and potentially improve the prognosis.