Adverse Childhood Experiences: Associations with a Blunted Cortisol Stress Response During Pregnancy.

INTRODUCTION: Adverse Childhood Experiences (ACEs) are associated with a range of negative physical and mental health outcomes, yet there is limited research focused on the effect of ACEs on stress responses during pregnancy. Expectant mothers experience an increase in cortisol levels as pregnancy progresses, with this increase having important implications for fetal and early infant development. Little is known about the impact of ACEs on maternal cortisol levels. This study explored the relationship between maternal ACEs and cortisol response among expectant mothers nearing or in the third trimester of pregnancy. METHODS: 39 expectant mothers were exposed to a Baby Cry Protocol via an infant simulator, with salivary cortisol collected at five points in time (N = 181). Stepwise, multilevel model creation resulted in a random intercept and random slope model with an interaction term for total number of ACEs and week of pregnancy. RESULTS: The repeated measures data showed that cortisol levels decreased across collection times, from arrival at the lab, through the Baby Cry Protocol, to recovery. Predictive margins for the interaction term showed that while exposure to a greater number of ACEs was associated with higher cortisol levels early in the third trimester, the expected increase in cortisol late in pregnancy was blunted for expectant mothers who were exposed to a greater number of ACEs. DISCUSSION: These findings findings suggest the importance of ACEs screening and intervention efforts as part of prenatal care.

Associations between Allostatic Load and Posttraumatic Stress Disorder: A Scoping Review.

Traumatic events may lead to the development of PTSD or PTSD symptomology that can negatively impact health outcomes. Allostatic load, which represents the cumulative biological wear and tear of exposure to stress, can be employed to better understand the physiological etiology of PTSD. A scoping review, informed by the PRISMA Extension for Scoping Reviews, was completed to identify published and unpublished empirical studies that explored the relationship of allostatic load and PTSD. Eight databases were searched yielding four studies, with the results summarized narratively and in tabular form. Findings were mixed as to the association between allostatic load and PTSD. Allostatic load was positively associated with PTSD diagnosis; however, studies measuring only PTSD symptomatology found no relationship. Few PTSD researchers have tested the relationship of a comprehensive measure of allostatic load to PTSD. Among those who have, studies show that allostatic load can be a beneficial tool and applicable theoretical framework for understanding the biological changes associated with PTSD. Future research should focus on standardizing measures of both allostatic load and PTSD and identifying potential confounders. A better understanding of the physiological changes associated with PTSD could lead to more effective prevention and treatment efforts.

Allostatic load and mental health: a latent class analysis of physiological dysregulation.

This study explored the associations between specific profiles of biological dysregulation and mental health outcomes in a national, community sample of healthy adults in the United States. A latent class analysis of data from the Midlife Development in the United States study (n = 1,757) was conducted to determine classes of biological dysregulation. Multinomial logistic regressions of class membership were employed to determine associations with measures related to depression, including whether or not individuals had sought treatment, Center for Epidemiological Studies Depression Scale, and both the generalized distress and anhedonia subscales of the Mood and Anxiety Symptoms Questionnaire. Four classes of dysregulation emerged: baseline/low dysregulation, metabolic and inflammatory dysregulation, parasympathetic dysregulation, and SAM pathway dysregulation. Individuals who met the criteria for depression measures were more likely to be in the metabolic and immune dysregulation and parasympathetic dysregulation groups as compared to the baseline group. The results suggest that mental health outcomes, such as depression, are differentially associated with specific profiles of biological dysregulation. A more nuanced approach to profiles of dysregulation could better inform treatment decisions.Lay summaryHigher levels of allostatic load, which represents the cumulative wear and tear of exposure to stress, are associated with increased rates of depression and anhedonia. Specifically, parasympathetic dysregulation and immunometabolic dysregulation are associated with negative mental health outcomes.

Neighborhood social integration as a predictor of neighborhood perceptions.

A growing body of literature has established a relationship between neighborhood perceptions and both physical and mental health outcomes, yet there remains a need to further explicate possible psychosocial factors that are predictive of neighborhood perceptions. This study hypothesized that an increase in social integration would result in more positive neighborhood perceptions. Propensity score matching on social integration was employed to strengthen the ability to draw a causal inference about the effect on neighborhood perceptions. When controlling for a range of sociodemographic covariates-including area deprivation index as a measure of objective neighborhood conditions-high social integration accounted for more than a 7% increase in neighborhood perceptions. The findings indicate the role of social integration as a predictor of neighborhood perceptions, revealing the potential importance of interventions and mechanisms aimed at improving neighborhood perceptions via social integration for the purposes of improving physical health and mental wellbeing.

Collective action among US veterans: Understanding the importance of self-efficacy, collective efficacy, and social support.

The purpose of this study was to examine the relationship between collective action, collective efficacy, self-efficacy, and social support among US veterans who formally volunteered in their communities upon their return from military service. The participants were 323 post-9/11/01-era veterans who completed a national nonprofit administered civic service program. Results from the structural equation model indicate that appraisal social support is negatively, directly associated with collective action, while belonging social support is positively, directly associated with collective action. In addition, appraisal social support is positively, indirectly associated with collective action via self-efficacy and collective efficacy. About 44% of the relationship between self-efficacy and collective action is associated via collective efficacy. The model accounts 19.9% of the variance in self-efficacy, 16.5% of the variance in collective efficacy, and 23.7% of the variance in collective action. The role of social support in the model provides additional evidence for the importance of strong social ties in facilitating collective action as veterans gather to volunteer in programs across the country. Results have implications for how national, nonprofit, and community volunteering programs may want to engage veterans and community members in collective action efforts.

Child and Adolescent Suicidal Ideation and Suicide Attempts: Evidence from the Healthcare Cost and Utilization Project.

OBJECTIVES: To examine the trends associated with child and adolescent suicidal ideation and suicide attempts and to compare these trends to those among the adult population. STUDY DESIGN: A nationally representative sample of administrative billing data was used for the analysis, which included descriptive statistics, trend data, and logistic regression. RESULTS: There were 874 872 (95% CI, 810 574-939 169) children and adolescents and 5 561 197 (95% CI, 5 271 426-5 850 968) adults admitted to an emergency department who experienced suicidal ideation or suicide attempts between 2010 and 2014, representing 1.20% of admissions for children (95% CI, 1.13-1.37) and adolescents and 1.09% of admissions for adults (95% CI, 1.05-1.13). Children and adolescents were more likely to be female (aOR, 1.74; 95% CI, 1.71-1.78) and to have private insurance (aOR, 1.75; 95% CI, 1.68-1.83) as compared with adults. Although the percentage of admissions increased for adults 25 and older (18.95%) the greatest increases were found among children and adolescents (5-11 years of age, 37.87%; 12-14 years of age, 82.03%; 15-17 years of age, 51.59%; and 18-24 years of age, 26.77%). There is a seasonal trend for children and adolescents such that higher rates are associated with the school year, which is not present for adults. CONCLUSION: Practitioners should be cognizant of the fact that suicidal ideation and suicide attempts for youth present differently than they do for the greater population and they should be vigilant in identifying risk factors, especially during seasons where risk of self-harm increases.

Posttraumatic Stress Disorder Among Low-Income Adolescents Experiencing Family-Neighborhood Income Disparities.

Certain neighborhood factors may increase the risk of exposure to trauma, therefore increasing the risk of posttraumatic stress disorder (PTSD). Other aspects of neighborhoods can be protective, such as neighborhood-based social relationships, which provide social support that buffers the risk of developing PTSD. The strength of these social relationships may not be as dependent on neighborhood conditions as much as they are contingent on socioeconomic similarities between neighborhood residents. Using a nationally representative sample of hospital emergency department admissions in the United States (N = 13,669,251), this study hypothesized that an interaction between family-level income and neighborhood-level income would be associated with adolescent PTSD. The results show that female adolescents who resided in the highest income areas were 1.39 times more likely, 95% CI [1.09, 1.77], to be diagnosed with PTSD than those who lived in the lowest income areas. This association was not statistically significant for male adolescents. Additionally, low-income female youth were nearly one-third more likely than their non-low-income counterparts to be diagnosed, odds ratio (OR) = 1.29, 95% CI [1.12, 1.48], whereas low-income male youth were nearly twice as likely than their non-low-income counterparts to be diagnosed, OR = 1.95, 95% CI [1.62, 2.34]. Furthermore, there was an interaction among both male and female adolescents such that lower-income adolescents living in higher-income areas had higher odds of a PTSD diagnosis compared to their higher-income peers in areas that were in the same median household income quartile.

Spanish Abstracts by Asociación Chilena de Estrés Traumático (ACET) Trastorno de Estrés Postraumático entre Adolescentes de Bajos Ingresos que Experimentan Disparidades de Ingresos en el Vecindario Familiar FACTORES DEL VECINDARIO Y TEPT EN ADOLESCENTES Ciertos factores del vecindario pueden incrementar el riesgo de exposición al trauma, por tanto, incrementan el riesgo de trastorno de estrés postraumático (TEPT). Otros aspectos del vecindario pueden ser protectores, como las relaciones sociales basadas en la vecindad, lo que provee apoyo social que amortigua el riesgo de desarrollar TEPT. La fuerza de estas relaciones sociales puede no depender tanto de las condiciones del vecindario como depender de las similitudes socioeconómicas entre los residentes del vecindario. Usando una muestra representativa a nivel nacional del departamento de admisiones del hospital de emergencia en los Estados Unidos (N = 13,669,251), este estudio hipotetizó que la interacción entre el nivel de ingreso familiar y el nivel de ingreso del vecindario estaría asociada con el TEPT en adolescentes. Los resultados muestran que adolescentes femeninas que residían en áreas con niveles de ingreso más altos tenian 1.39 veces más probabilidad, 95% IC [1.09-1.77] de ser diagnosticadas con TEPT de las que vivían en áreas con un nivel socioeconómico más bajo. Esta asociación no fue estadísticamente significativa para adolescentes masculinos. Adicionalmente, el nivel de ingreso bajo en jóvenes femeninas tuvo casi un tercio más de probabilidades de ser diagnosticadas que sus contrapartes de ingresos no bajos, odds ratio (OR) = 1.29, IC 95% [1.12, 1.48], mientras que los jóvenes varones de bajos ingresos tenían casi el doble de probabilidades de ser diagnosticados que sus contrapartes que no tenían ingresos bajos, OR = 1.95, 95% IC [1.62, 2.34]. Además, hubo una interacción entre los adolescentes masculinos y femeninos, de tal manera que los adolescentes de bajos ingresos que viven en áreas de mayores ingresos tenían mayores probabilidades de un diagnóstico de TEPT en comparación con sus pares de mayores ingresos en áreas que tenían el mismo ingreso medio familiar.

Arthropod Bites and Stings Treated in Emergency Departments: Recent Trends and Correlates.

INTRODUCTION: Despite increasing health effects of arthropod bites and associated costs, research on their frequency is limited, especially at the population level. The aim of this study was to estimate the prevalence, correlates, and recent trends in visits to US emergency departments related to arthropod bites and stings. METHODS: The prevalence of arthropod bites, including information regarding location of the bite, was calculated for years 2010 through 2014 using data from the Healthcare Cost and Utilization Project Nationwide Emergency Department Sample. Sex- and age-stratified multivariate logistic regression analyses were conducted with "arthropod bite" as the dependent variable and patient and hospital characteristics as independent variables. RESULTS: Overall, there were significant increases in bites over the study period with higher rates of bites in the summer months (June-August), especially among children. Individuals who seek treatment for arthropod bites in the emergency department are more likely to reside in zip codes with lower median household income and to be without insurance coverage or with Medicaid rather than private insurance. The cost of care related to arthropod bites increased approximately 40% over the study period. CONCLUSIONS: These results provide updated surveillance on the prevalence and correlates of arthropod bites and stings in the US population.

Neighborhood collective efficacy and collective action: The role of civic engagement.

Theory suggests that by strengthening collective efficacy among neighbors, neighborhoods can more effectively engage in collective action. The research linking the two components of collective efficacy-social cohesion and social control-with collective action is limited. This study uses structural equation modeling with a nationally representative sample from the United States Census Bureau's American Housing Survey (N = 22,106) to analyze these relationships. This analysis finds that neither component of collective efficacy is directly associated with collective action. Instead, social cohesion is negatively, directly associated with civic engagement, social control is positively directly associated with civic engagement, and civic engagement is positively associated with collective action. Social cohesion and social control are indirectly associated with collective action when including civic engagement. Understanding the associations between collective efficacy, civic engagement, and collective action is informative for understanding effective and efficient community participation to facilitate change.

Transit Crime as a Barrier to Qualitative Urban Health Research with Older Adults.

This paper reports how transit crime and perception of crime have been barriers to an area-focused and person-based ethnographic urban health and wellbeing research study in St. Louis. This study has experienced two primary challenges. First, respondent concerns about crime have impeded the ability of the study to follow best practices to strengthen ethnographic and qualitative research. Second, these concerns have impeded sampling and respondent participation in a way that decreases the voice and perspectives of older adults.

Biomarker Profiles of Depression During Young Adulthood: Results From the National Health and Nutrition Examination Survey.

PURPOSE: Cumulative "wear and tear" on physiological systems (allostatic load) may contribute to risk for depression, but there is limited research on allostatic load during young adulthood, which is a peak developmental period for depression onset. This study evaluates profiles of allostatic load and their association with depression in young adults. METHODS: Biomarker and depression data were extracted for 18-24-year-olds (928 females, 932 males) in the National Health and Nutrition Examination Survey from 2015 to 2020. Latent class analysis was used to identify biomarker profiles. Multivariate logistic regression analyses were used to predict depression based on profile membership, controlling for sociodemographic characteristics. RESULTS: Three allostatic load profiles were identified in both females and males-high inflammatory and moderate metabolic dysregulation (immunometabolic dysregulation), high metabolic and moderate inflammatory dysregulation (metaboimmune dysregulation), or low dysregulation. Metaboimmune or immunometabolic dysregulation profiles in females, and metaboimmune dysregulation in males, were associated with 3-3.5 times greater odds of depression compared to low dysregulation profiles. DISCUSSION: Profiles of immune and metabolic dysregulation can be observed during young adulthood. Elevated immunometabolic and metaboimmune profiles were associated with depression risk in young adult females, while elevated metaboimmune profiles were associated with depression risk in young adult males. Detection of depression-related physiological dysregulation in young adults could be used to identify depression phenotypes and apply early interventions.

An evaluation of the All of Us Research Program database to examine cumulative stress.

OBJECTIVES: To evaluate the NIH All of Us Research Program database as a potential data source for studying allostatic load and stress among adults in the United States (US). MATERIALS AND METHODS: We evaluated the All of Us database to determine sample size significance for original-10 allostatic load biomarkers, Allostatic Load Index-5 (ALI-5), Allostatic Load Five, and Cohen's Perceived Stress Scale (PSS). We conducted a priori, post hoc, and sensitivity power analyses to determine sample sizes for conducting null hypothesis significance tests. RESULTS: The maximum number of responses available for each measure is 21 participants for the original-10 allostatic load biomarkers, 150 for the ALI-5, 22 476 for Allostatic Load Five, and n = 90 583 for the PSS. DISCUSSION: The NIH All of Us Research Program is well-suited for studying allostatic load using the Allostatic Load Five and psychological stress using PSS. CONCLUSION: Improving biomarker data collection in All of Us will facilitate more nuanced examinations of allostatic load among US adults.

Lower Socioeconomic Status, Psychological Distress, and Self-reported Hypertension: A Longitudinal Moderated Mediation Analysis.

BACKGROUND: Lower socioeconomic status (SES) has been associated with hypertension; however, the mediators and moderators of this association remain understudied. We examined the mediation effect of psychological distress on the link between lower SES and self-reported hypertension and the racial and sex moderation effects. METHODS: We analyzed the data collected from 2009 to 2019 among adults from the Panel Study of Income Dynamics (PSID). Lower SES was defined as one of 3 indicators: education ≤12 years, unemployed, or individual annual income <$27,800. Psychological distress was assessed using the Kessler K6 scale. Cox proportional hazard regression was conducted. Mediation analyses were performed using the PROCESS macro. RESULTS: In the sample of heads of family who did not have self-reported hypertension in 2009 (N = 6,214), the mean age was 41 years, 30.6% were female, 32.9% were African American. The cumulative incidence of self-reported hypertension was 29.8% between 2009 and 2019. Cox proportional hazard regression analysis showed that after controlling for covariates, lower SES (score > 0 vs. score = 0) was associated with self-reported hypertension (hazard ratio = 1.27, 95% confidence interval = 1.14-1.42). SES had indirect effect on self-reported hypertension through psychological distress and the indirect effect (0.02 in females, 0.01 in males, P < 0.05) was moderated by sex but not by race. CONCLUSIONS: The association of SES and self-reported hypertension was mediated by psychological distress and sex moderated the mediation effect. Interventions focused on reducing contributors to SES and psychological stress should be considered to reduce hypertension risk.

Sleep disorders and relative risk of suicidal ideation and suicide attempts in youth presenting to emergency departments.

OBJECTIVE: Sleep problems predict suicide, which is a leading cause of death in adolescents and young adults, but the relative risk of suicidality in youth with sleep disorders has not been established in nationally representative samples. This study evaluated the relative risk of suicidal ideation and attempt in youth ages 6-24 who presented to United States emergency departments between 2015 and 2017. METHODS: Youths' diagnoses of sleep and psychiatric disorders, and emergency department encounters with suicide attempt and suicidal ideation, were extracted from the Health Care Cost Utilization Project's Nationwide Emergency Department Sample (N = 65,230,478). Relative risk of suicidal ideation and suicide attempt were evaluated through logistic regression and predicted rate ratios after adjustment for history of self-harm and demographic characteristics. RESULTS: Youth with at least 1 sleep disorder had 3 times greater odds of an emergency department encounter involving suicidal ideation compared to those without a sleep disorder (aOR = 3.22, 95% CI: 2.61, 3.98). The predicted probability of suicidal ideation was 46.03% higher in youth with a mood disorder and a sleep disorder, and 47.04% higher in youth with a psychotic disorder and sleep disorder, compared to youth without a sleep disorder. Only 0.32% of youth presenting to emergency departments were diagnosed with a sleep disorder. CONCLUSIONS: Sleep disorders are associated with increased risk for suicidal ideation in youth presenting to emergency departments. Sleep disorders are also underdiagnosed in youth presenting to emergency departments relative to their estimated prevalence in epidemiologic surveys. Research and public health campaigns to prevent suicide in youth should incorporate assessment and intervention for sleep disorders.

Latent profiles of biological dysregulation and risk of mortality: time-to-event analysis using the Midlife in the US longitudinal study.

BACKGROUND: There is a well-established relationship between high allostatic load (AL) and increased risk of mortality. This study expands on the literature by combined latent profile analysis (LPA) with survival data analysis techniques to assess the degree to which AL status is associated with time to death. METHODS: LPA was employed to identify underlying classes of biological dysregulation among a sample of 815 participants from the Midlife in the US study. Sex-stratified Cox proportional hazards regression models were used to estimate the association between class of biological dysregulation and time to death while controlling for sociodemographic covariates. RESULTS: The LPA resulted in three classes: low dysregulation, immunometabolic dysregulation and parasympathetic reactivity. Women in the immunometabolic dysregulation group had more than three times the risk of death as compared with women in the low dysregulation group (HR=3.25, 95% CI: 1.47 to 7.07), but that there was not a statistically significant difference between the parasympathetic reactivity group and the low dysregulation group (HR=1.80, 95% CI: 0.62 to 5.23). For men, the risk of death for those in the immunometabolic dysregulation (HR=1.79, 95% CI: 0.88 to 3.65) and parasympathetic reactivity (HR=0.90, 95% CI: 0.34 to 3.65) groups did not differ from the low dysregulation group. CONCLUSION: The findings are consistent with the previous research that demonstrates increased AL as a risk factor for mortality. Specifically, in women, that increased risk may be associated with immunometabolic dysregulation and not simply a generalised measure of cumulative risk as is typically employed in AL research.

Measuring allostatic load: Approaches and limitations to algorithm creation.

OBJECTIVE: Allostatic load literature has proliferated over the past three decades, and a growing body of research demonstrates that higher levels of allostatic load are associated with a wide range of negative physical and mental health outcomes. However, there remain significant challenges with operationalization of the concept. A scoping review of the methods employed to create an allostatic load algorithm was conducted and recommendations for future research with an orientation towards advancing clinical application of the theory are discussed. METHODS: A search of seven electronic databases (PubMed, PsycINFO, Social Work Abstracts, Social Service Abstracts, Social Sciences Citation Index (Web of Science), Sociological Abstracts, Scopus) was completed with the search term "allostatic load." Studies were reviewed, and if they met the inclusion criteria, data was extracted, complied, and presented in the narrative, table, and figures. RESULTS: The initial searches yielded 5280 results with the final sample of 395 non-duplicate articles that met the inclusion criteria. More than half (52.5%) of all included publications employed biomarker cutoffs based on the high-risk quartiles of the sample distribution, 11.1% employed the sum of at-risk clinical scores, and the remainder of studies utilized a range of different algorithms. CONCLUSION: Allostatic load literature has grown at an exponential rate in recent years, but researchers continue to operationalize the concept via algorithms that may have limited utility moving forward. More nuanced statistical approaches are emerging and should be considered, as should a shift towards an approach that can provide additional clinical utility.

Housing Unit Type and Perceived Social Isolation Among Senior Housing Community Residents.

BACKGROUND AND OBJECTIVES: Social isolation, and its associated health implications, is an important issue for older adults in the United States. To date, there has been limited study of the pathways that connect these 2 factors. The present study expands on previous models by linking factors related to the built environment-in the form of housing unit type-to perceived social isolation among those living independently in dedicated senior housing. RESEARCH DESIGN AND METHODS: The causal inference technique of inverse probability weighting with regression adjustment was employed to assess the impact of living in a townhome-style unit, as opposed to in an apartment building, on self-reported perceived social isolation (N = 1,160). RESULTS: Individuals who lived in townhome-style housing reported a 10.4% lower probability of experiencing social isolation as a result of living in a townhome-style unit as opposed to an apartment building-style unit. DISCUSSION AND IMPLICATIONS: The findings provide evidence for the conceptual model that characteristics specific to a given housing unit type may create conditions that exacerbate or buffer individuals from experiencing social isolation. This, in turn, has important implications for the targeting of interventions for social isolation. Policy considerations related to the type of affordable senior housing being built should also be informed by these findings. Additionally, future research should better explicate the role of housing unit type on mental and emotional health outcomes.

Emergency Department Admissions for Physical Child Abuse: Evidence from the 2006-2017 Nationwide Emergency Department Sample.

Physical child abuse continues to be a serious public health issue in the United States. This study expands on previous research by exploring trends in physical child abuse diagnoses among children admitted to emergency departments (EDs) across the United States. The analysis aimed to explicate the association between physical child abuse and both sociodemographic and behavioral health covariates to better inform and identify risk factors associated with ED admissions for abuse. The study also explicated differences between confirmed and suspected physical child abuse cases. The study utilized a nationally representative sample of hospital-owned EDs that included 319,676,625 ED admissions between 2006 and 2017 for children under 18-years-old. The analysis included a trend analysis, bivariate descriptive statistics, and multivariate logistic regression models were employed. Children with a physical child abuse diagnosis were less likely to be from higher income communities (aOR = 0.61, 95% CI [0.53, 0.71]), less likely to be female (aOR = 0.93, 95% CI [0.90, 0.96]), and more likely to be uninsured (aOR = 1.65, 95% CI [1.48, 1.84]). Children with attention-deficit hyperactivity disorder (aOR = 1.36, 95% CI [1.14, 1.62]) and a conduct disorder (aOR = 1.28, 95% CI [1.04, 1.58]) were more likely to have a physical abuse diagnosis. The sex-stratified analyses found that the higher rates of physical abuse among children with attention-deficit hyperactivity disorder were driven by the male subsample, while higher rates of abuse for those with conduct disorders were the result of the female subsample. A supplemental analysis of suspected versus confirmed physical child abuse for the fourth quarter of 2015 through 2017 also revealed sociodemographic and behavioral health differences. This study supports the need to consider sociodemographic and behavioral risk factors associated with physical child abuse to inform treatment and potential reoccurrence of abuse.

Childhood adversity, suicidality, and non-suicidal self-injury among children and adolescents admitted to emergency departments.

PURPOSE: This population-based study explored the associations between childhood adversity and admission to emergency departments (EDs) with non-suicidal self-injury (NSSI) and with a suicide attempt. METHODS: A nationally representative cross-sectional sample of 5-17-year-olds admitted to EDs (N = 143,113,677) from 2006 to 2015 was utilized to assess the associations between childhood adversities, NSSIs, and suicide attempts. RESULTS: ED admissions with NSSI and admissions with a suicide attempt were associated with greater odds of exposure to individual childhood adversities (aORs: 1.34 to 5.86; aORs: 2.37 to 15.69, respectively). ED admissions with a suicide attempt were associated with greater odds of exposure to childhood adversities that might be perceived as less extreme or harmful (separation or divorce aOR: 15.69) than other adversities (death of a family member aOR: 13.38; history of physical abuse aOR: 9.56) as well as greater odds of exposure to three or more childhood adversities (aOR: 20.98). CONCLUSION: Early detection of childhood adversities is important for identifying potential risk factors for self-harm. ED admission data can provide population-level surveillance to aid in these efforts and lead to more targeted and effective interventions aimed at reducing the negative effects of toxic stress that can result from exposure to childhood adversities.

Coding of Sexual Assault by Emergency Physicians: A Nationally Representative Study.

INTRODUCTION: Sexual assault is a public health problem that affects many Americans and has multiple long-lasting effects on victims. Medical evaluation after sexual assault frequently occurs in the emergency department, and documentation of the visit plays a significant role in decisions regarding prosecution and outcomes of legal cases against perpetrators. The American College of Emergency Physicians recommends coding such visits as sexual assault rather than adding modifiers such as "alleged." METHODS: This study reviews factors associated with coding of visits as sexual assault compared to suspected sexual assault using the 2016 Nationwide Emergency Department Sample. RESULTS: Younger age, female gender, a larger number of procedure codes, urban hospital location, and lack of concurrent alcohol use are associated with coding for confirmed sexual assault. CONCLUSION: Implications of this coding are discussed.