Childhood maltreatment and mental health problems in a 10-year follow-up study of adolescents in youth residential care: A latent transition analysis.

Childhood maltreatment and mental health problems are common among young people placed out-of-home. However, evidence on the impact of maltreatment on the course of mental health problems in at-risk populations is sparse. The aim of this longitudinal study is twofold: (a) describe the course of mental health problems and the shift in symptom patterns among adolescents in youth residential care into young adulthood and (b) assess how childhood maltreatment is related to the course of mental health problems. One hundred and sixty-six adolescents in Swiss youth residential care were followed up into young adulthood (36.1% women; MAge-Baseline = 16.1 years; MAge-Follow-Up = 26.4 years). Latent transition analysis was employed to analyze transitions of symptom patterns and their association with maltreatment exposure. We found three latent classes of mental health problems: a "multiproblem"-class (51.8% baseline; 33.7% follow-up), a "low symptom"-class (39.2% baseline; 60.2% follow-up), and an "externalizing"-class (9.0% baseline; 6.0% follow-up). Individuals in the "multiproblem"-class were likely to transition towards less-complex symptom patterns. Higher severity of self-reported childhood maltreatment was associated with more complex and persistent mental health problems. Our study underlines the need for collaboration between residential and psychiatric care systems within and after care placements, with a specialized focus on trauma-informed interventions and care.

Scoping review on trauma and recovery in youth after natural disasters: what Europe can learn from natural disasters around the world.

In the last decade, Europe has seen a rise in natural disasters. Due to climate change, an increase of such events is predicted for the future. While natural disasters have been a rare phenomenon in Europe so far, other regions of the world, such as Central and North America or Southeast Asia, have regularly been affected by Hurricanes and Tsunamis. The aim of the current study is to synthesize the literature on child development in immediate stress, prolonged reactions, trauma, and recovery after natural disasters with a special focus on trajectories of (mal-)adaptation. In a literature search using PubMed, Psychinfo and EBSCOhost, 15 studies reporting about 11 independent samples, including 11,519 participants aged 3-18 years, were identified. All studies identified resilience, recovery, and chronic trajectories. There was also evidence for delayed or relapsing trajectories. The proportions of participants within each trajectory varied across studies, but the more favorable trajectories such as resilient or recovering trajectory were the most prevalent. The results suggested a more dynamic development within the first 12 months post-disaster. Female gender, a higher trauma exposure, more life events, less social support, and negative coping emerged as risk factors. Based on the results, a stepped care approach seems useful for the treatment of victims of natural disasters. This may support victims in their recovery and strengthen their resilience. As mental health responses to disasters vary, a coordinated screening process is necessary, to plan interventions and to detect delayed or chronic trauma responses and initiate effective interventions.

[Framework for a Group Intervention Aiming at Coping with out-of-home Placement - Focus Groups in Residential Foster Homes]. / Potenzielle Inhalte und Rahmenbedingungen einer Gruppenintervention für Jugendliche zur Aufarbeitung der eigenen Fremdunterbringung.

Out-of-home placement is a critical life event for affected children and adolescents. We explored the potential content and conditions for a group intervention aiming at coping with this critical life event by the means of three focus groups with n = 13 participants. The participants reported feelings of guilt, uncertainty concerning their future, experiences of loss, and lack of confidence. So far, standardized programs for sharing the participants' out-of-home care experiences had not been established in their child welfare programs. Under certain circumstances, the participants were willing to take part in a group intervention for this purpose. The intervention should aim at the autobiographical integration of the out-of-home placement as well as the promotion of general protection factors. Further qualitative research is needed to adjust the intervention in order to fit the needs of the target population.

Female-Perpetrated Child Sexual Abuse: Prevalence Rates in Germany.

Research on female-perpetrated child sexual abuse, especially maternal sexual abuse, is scarce. Prevalences are assumed to be lower compared to male-perpetrated abuse; however, representative studies including female perpetrators are rare. Experiences of male- and female-perpetrated child sexual abuse were examined in a representative German sample. Questions included experiences of hands-on and penetrative sexual abuse. The perpetrator-victim relationship was assessed to calculate prevalences of maternal sexual abuse. A total of 2516 participants (54.53% female, 14-91 years) were questioned and prevalences, as well as group differences between victims of male perpetrators compared to female perpetrators, were calculated. Overall, 10.5% of all participants reported experiences of child sexual abuse. Female perpetrators were involved in 9.9% of the cases, i.e. 1.0% of all participants. Victims of female perpetrators were significantly more often male. A quarter of the adult female perpetrators were the mother figure of the child. The findings suggest that the share of female perpetrators in cases of child sexual abuse is rather small; concurrently, female perpetration is insufficiently recognized. Especially male victims seem to be at risk for sexual abuse by female perpetrators. Contacts for children especially within the professional support system need to be aware of the existence of female perpetrators.

Adverse Childhood Experiences and Avatar Preferences in Online Games.

This study investigates the relationship between adverse childhood experiences (ACEs), age, and sex with respect to their avatar preference in online games. The analyses comprise a subsample of n = 1817 adolescents and adults from 14 to 60 years within a representative German population-based study. Results indicate that 14 % of this sample uses avatars in online games, with significantly more males (22.6 %) than females (7.7 %) doing so. Persons with multiple ACEs (≥ 4) have a higher OR of 2.05 (95 % CI: 1.418-2.956) to use avatars in online games. Regarding avatar preference, females are more likely to play supporters than males, and males are more likely to choose damagers and mixed-type avatars than females. Participants with an experience of parental divorce during their childhood reported higher preference of playing supporter or mixed-type avatars in comparison with damager avatars. Moreover, participants with mental illness or suicide in the family show a higher preference of mixed-type avatars compared to damager, but not to supporter avatars. Knowledge about the use of avatars can be an interesting source of information for supporting psychotherapeutic treatment in a young age group.

Awareness of abusive head trauma in a German population-based sample: implications for prevention.

BACKGROUND: Despite efforts to reduce the incidence of abusive head trauma (AHT), incidence rates remain high. One cause is that prevention programs mostly aim to educate mothers of newborns on AHT and infant crying. However, mothers commonly have already a high knowledge and constitute only a minority among identified AHT perpetrators. The hypothesis was that there are great differences in AHT awareness in different subgroups. To assess awareness of AHT, a population-based study was performed. METHODS: A population-based representative sample of the German population aged >14 years (N = 2510) was assessed in a cross-sectional observational survey. The sample was selected in a random route approach between November 2017 and February 2018. RESULTS: Overall knowledge of AHT was higher in women (67.9%) than in men (48.8%, p < 0.001). Female gender, having children, higher age, and level of education were predictors for the awareness of AHT. A majority of participants reported to have heard about AHT from the media. CONCLUSIONS: Awareness of AHT differs significantly within the population. In groups at higher risk to perpetrate AHT, including men, young caregivers, and those with low educational level, awareness of AHT was low. These subgroups should be targeted by tailored education programs for prevention.

Do we get the message through? Difficulties in the prevention of abusive head trauma.

Many programs aim to prevent abusive head trauma throughout the USA, Europe, and in many other regions of the world. Most of these programs inform mothers shortly after delivery about the dangers of abusive head trauma. Effectiveness of these programs usually is measured by the increase of knowledge on abusive head trauma. Recent research showed, however that for effective primary prevention, a much broader approach might be necessary. But so far, there is no data that reports the knowledge on key messages on abusive head trauma in the general public as a baseline. We conducted a representative population-based survey on abusive head trauma knowledge in Germany. Whereas the dangers are generally well known, a majority might be ambivalent towards the recommendation to leave a crying infant alone for a few minutes when the caregiver becomes too stressed or frustrated. Furthermore, a majority prefers being informed on abusive head trauma before birth.Conclusion: Future preventive programs should focus on educating adolescents (potential baby sitters) and young adults when they do not yet have children of their own. What is known: • Most programs for primary prevention of abusive head trauma (AHT) focus on mothers shortly after delivery • There are no analyses so far of the quality of education programs in the general public, as educating mothers might not be sufficient to reduce incidence rates What is new: • Our study is the first population-based survey to measure the knowledge on AHT in a representative population sample and to provide the data base for targeted prevention programs. • The introduction of broader prevention programs might be necessary.

Longitudinal Associations Between Dysfunctional Maltreatment-Related Cognitions and Psychopathology in Children and Adolescents.

Dysfunctional posttraumatic cognitions seem to play an important role in adjustment after traumatic experiences. However, little research has been done on maltreated children and adolescents. Furthermore, possible causal associations between cognitions, posttraumatic stress symptoms, and internalizing and externalizing problems have rarely been investigated. In the current study, 263 maltreated children and adolescents (8-17 years of age) were assessed at baseline and again at time points 6 and either 12 or 18 months later. Cross-lagged panel analyses were used to gain a better understanding of the course of and associations among dysfunctional maltreatment-related cognitions, posttraumatic stress symptoms, and internalizing and externalizing problems. Ratings of all variables significantly decreased over time. Moderate to strong autoregressive paths emerged for all variables, denoting stability. Furthermore, the variables showed moderate to high correlations at every assessment. Posttraumatic stress symptoms moderately predicted dysfunctional maltreatment-related cognitions as well as internalizing and externalizing problems 6 months after baseline. Cross-lagged paths from the cognitions as well as from internalizing and externalizing problems to all other variables were not significant. Age, gender, and maltreatment characteristics did not play a relevant role in these cross-lagged associations when they were included as covariates. Our results underline the cognitive scar model, in which preceding posttraumatic stress symptoms adversely impact cognitions. Posttraumatic stress symptoms appear to be an important target for treatment as their reduction may help decrease internalizing and externalizing problems as well.

Spanish Abstracts by Asociación Chilena de Estrés Traumático (ACET) Asociaciones Longitudinales Entre Cogniciones Disfuncionales Relacionadas Con Maltrato Y Psicopatología En Niños Y Adolescentes COGNICIONES DISFUNCIONALES RELACIONADAS CON MALTRATATO Las cogniciones postraumáticas disfuncionales parecen jugar un papel importante en la adaptación después de experiencias traumáticas. Sin embargo, se ha realizado poca investigación en niños y adolescentes maltratados. Además, se ha investigado muy poco las posibles asociaciones causales entre cogniciones, síntomas de estrés postraumático y los problemas de internalización y externalización. En este estudio, 263 niños y adolescentes maltratados (de 8 a 17 años de edad) fueron evaluados al inicio y nuevamente en los períodos de 6 y 12 o 18 meses posteriores. Se utilizaron análisis de casos de cruce desfasado para obtener una mejor comprensión del curso y las asociaciones entre las cogniciones relacionadas con el maltrato disfuncional, los síntomas de estrés postraumático y problemas de internalización y externalización. Las calificaciones de todas las variables disminuyeron significativamente en el tiempo. Trayectorias autorregresivos moderadas a fuertes surgieron para todas las variables, denotando estabilidad. Además, las variables mostraron correlaciones moderadas a altas en cada evaluación. Los síntomas de estrés postraumático predijeron moderadamente cogniciones disfuncionales relacionados con maltrato como también los problemas de internalización y externalización 6 meses después de la evaluación inicial. Trayectorias de cruce desfasado de las cogniciones, como de los problemas de internalización y externalización a todas las demás variables no fueron significativas. Las características de edad, género y maltrato no jugaron un papel relevante en estas asociaciones de cruce desfasado cuando se incluyeron como covariables. Nuestros resultados destacan el modelo de cicatriz cognitiva, en el que los síntomas de estrés postraumático precedente afectan negativamente las cogniciones. Los síntomas de estrés postraumático parecen ser una un objetivo importante para el tratamiento, ya que su reducción puede también ayudar a disminuir los problemas de internalización y de externalización.

The Prevalence of Sexual Abuse in Institutions: Results From a Representative Population-Based Sample in Germany.

The lifetime prevalence of sexual abuse in institutional settings in Germany was examined in a sample representative of the general adult population (N = 2,437). Participants completed a survey on whether they had ever experienced such abuse, its nature (contact, noncontact, forced sexual, intercourse), the type of institution (e.g. school, club), and the relationship of perpetrator to victim (peer, caregiver, staff member). Overall, 3.1% of adult respondents (women: 4.8%, men: 0.8%) reported having experienced some type of sexual abuse in institutions. Adult women reported higher rates of all types than did men, with rates of 3.9% versus 0.8% for contact sexual abuse, 1.2% versus 0.3% for noncontact sexual abuse, and 1.7% versus 0.2% for forced sexual intercourse. We conclude that a remarkable proportion of the general population experiences sexual abuse in institutions, underscoring the need for development of protective strategies. Especially, schools seem to represent good starting points for primary prevention strategies.

[Improving child protection in healthcare: peer counseling, education, and research using the example of abusive head trauma]. / Kinderschutz im Gesundheitswesen verbessern: Fachberatung, Weiterbildung und Forschung am Beispiel des misshandlungsbedingten Kopftraumas.

Too often, diagnosis of maltreatment is missed by healthcare professionals - thus denying children in danger from necessary protection. Insufficient knowledge and insecurities towards professional confidentiality and how to approach child protection services may be the reasons for the failure to protect children effectively.In this article, we present how a comprehensive concept by the competence center of child protection in medicine of the state of Baden-Wurttemberg consisting of peer counseling, peer education, and research can add to the prevention of maltreatment. One component is peer counseling through a telephone helpline that is accessible 24/7, the medical child protection hotline. The requests to the helpline are analyzed and add to the generation of tailored content for the education of doctors, psychotherapists, nurses, and other healthcare professionals. As an example, we present the online course "Child protection in medicine - a basic course for all health professionals" (so far available only in German). One common issue when the child protection hotline is called for counseling is abusive head trauma. Research shows that sometimes a diagnosis of abusive head trauma might be missed. This condition is most prevalent in children under the age of 2 and represents one of the most severe forms of physical abuse with high mortality.Inquiries to the medical child protection hotline are constantly increasing, but making the service known nationwide to all healthcare professionals still poses a challenge. The online course is widely used and being constantly improved. The comprehensive concept of peer counseling, education, and research is an important contribution to the improvement of the prevention of child maltreatment.

[Experiences with an intercultural training for professionals from child-welfare services working with children and adolescents following child abuse and neglect]. / Erfahrungen mit einem kultur- und migrationsspezifischen Workshop für Fachkräfte der Kinder- und Jugend- hilfe in der Arbeit mit misshandelten Kindern und Jugendlichen.

Experiences with an intercultural training for professionals from child-welfare services working with children and adolescents following child abuse and neglect Abstract. Background: As part of a multicenter study evaluating measures to improve access to evidenced-based treatment for children and adolescents following child abuse and neglect, we introduced and evaluated migration-adapted services, including a one-day intercultural training. Key issues were the dissemination of information concerning migration and acculturation, trauma and mental health to immigrant families as well as the development of exercises on intercultural competence and culturally sensitive work. Method: Near the end of the research project we gathered experiences and opinions concerning the work with immigrant families using an online survey in a subgroup of case managers working in the project (professionals in child-welfare services). This article presents two case report illustrating the practical relevance of the training's content. Results: Overall, the training was rated positively. In the opinion of the case managers, especially language barriers and cultural diversity should be considered while working with immigrant families. The case reports show that the training sensitized and supported the case managers supported the case managers when dealing with differing illness concepts, differing illness concepts, culture-sensitive assessment, or work with language mediators. Conclusions: The case management work also demonstrated the limitations of the psychosocial care system; the further dissemination of intercultural knowledge is important.

The impact of child maltreatment on non-suicidal self-injury: data from a representative sample of the general population.

BACKGROUND: Child maltreatment is an identified risk factor for Non-Suicidal Self-Injury (NSSI). The aim of the current study was to investigate effects of different types of maltreatment, and mediating effects of depression and anxiety on NSSI in the general population. METHODS: A representative sample of the German population, comprising N = 2498 participants (mean age = 48.4 years (SD = 18.2), 53.3% female) participated in this study. Child maltreatment was assessed using the Childhood Trauma Questionnaire (CTQ),NSSI was assessed with a question on lifetime engagement in NSSI, depressive symptoms were assessed by the Patient Health Questionnaire (PHQ-2) and anxiety symptoms by the General Anxiety Disorder questionnaire (GAD-2). RESULTS: Lifetime prevalence of NSSI in this sample was 3.3, and 30.8% reported at least one type of child maltreatment. Participants in the NSSI group reported significantly more experiences of child maltreatment. Emotional abuse was endorsed by 72% of all participants with NSSI. A path analytic model demonstrated an unmediated direct effect of emotional neglect, a partially mediated effect of emotional abuse, and a fully mediated effect of sexual abuse and physical neglect by depression and anxiety on NSSI. CONCLUSIONS: Especially emotional neglect and abuse seem to play a role in the etiology of NSSI above and beyond depression and anxiety, while sexual and physical abuse seem to have a rather indirect effect.

Usual Care for Maltreatment-Related Pediatric Posttraumatic Stress Disorder in Germany.

Child maltreatment represents a major risk factor for the development of emotional and behavioral problems, especially posttraumatic stress disorder (PTSD). While effective trauma-focused treatments are available, little is known about the usual mental healthcare for abused youths in Germany. The present study compared the utilization of mental healthcare in abused youths who had developed a PTSD (N = 95) with a group presenting other mental disorders (N = 146). Semistructured interviews were used to assess maltreatment histories, current mental health, and healthcare utilization. In addition, potential child factors associated with access to mental healthcare (age and level of functioning) were examined. Results showed that 65 % of both diagnostic groups currently fail to use any mental healthcare service. Of the participants with PTSD, 43 (45 %) had never received any mental healthcare intervention. Investigations on potential barriers are necessary to close the huge gap between clinical services and evidence-based, trauma-focused interventions.

[Children and adolescents after child abuse and neglect: Do they receive appropriate treatment?]. / Kinder und Jugendliche mit Misshandlungserfahrungen: bekommen sie die Versorgung, die sie brauchen?

BACKGROUND: Child abuse and neglect (CAN) is a risk factor for the development of psychiatric disorders. Untreated, disorders can sustain into adulthood. OBJECTIVES: This study compares rates of psychiatric disorders to mental health care utilization in victims of CAN. METHODS: From three regions in Germany, 322 children and adolescents aged between 4 and 17 and a non-abusive caregiver were assessed for the child's history of CAN, mental health and mental health care utilization via semi-structured interviews. RESULTS: Approximately two thirds of the participants (present state 64.29 %; lifetime 69.57 %) suffered from a psychiatric disorder classifiable with ICD-10. Posttraumatic stress disorder (25.16 %), conduct disorders (21.34 %) and attention and hyperactivity disorders (16.15 %) were most frequently diagnosed. Merely 19.88 % were using mental health care at the time of the assessment. CONCLUSIONS: The provision of mental health care for victims of CAN is insufficient. To improve access to appropriate services for this vulnerable clientele, cooperation between psychiatrists and psychotherapists and the child welfare system is essential. The implementation and dissemination of evidence-based diagnostic methods and treatments must be further advanced.

[Validated Instruments for the Psychological Assessment of Unaccompanied Refugee Minors - a Systematic Review]. / Validierte Verfahren zur psychologischen Diagnostik unbegleiteter minderjähriger Flüchtlinge - eine systematische Übersicht.

The German care system faces a growing number of unaccompanied refugee minors (URM). URM show high levels of traumatization, a variety of psychological symptoms and lack important resilience factors. Therefore an early and valid psychological assessment is important for intervention and service planning. Yet, no systematic review on validated instruments for the assessment of this group exists. Literature search revealed one study about translators in the assessment of URM and five validated instruments for proxy and self-report. These instruments are available in several languages and showed good psychometric properties. It has to be critically stated that all instruments have been validated by a single work group within a single population. Especially with regards to changing definitions of Posttraumatic Stress Disorder within the new (and upcoming) classification systems ICD-11 and DSM-5, increased awareness for diagnostic procedures is necessary. Additionally, more validated instruments for specific psychological disorders in multiple languages are needed. Under an economic perspective the use of open access questionnaires that are available in different languages seems useful, even if they are not especially validated for URM.

[Improving Access to Evidence Based Interventions for Children and Adolescents with Mental Disorders After Child Abuse and Neglect]. / Verbesserter Zugang zu evidenzbasierten Therapien für psychisch kranke Kinder und Jugendliche nach Kindesmisshandlung und -missbrauch.

Victims of child abuse and neglect are more likely to develop emotional and behavioral problems than their non-abused peers. In many cases they do not receive evidence based treatments. Based on pilot studies and clinical experience, a structured and manualized case-management protocol was developed to provide child welfare professionals guidance, direction and support in helping these families find and engage in appropriate treatment. The protocol is described. A survey among child welfare workers indicates a lack of knowledge about mental disorders in victims of child abuse as well as an insufficient cooperation between the child welfare and the mental healthcare system. Child welfare workers who have applied the manual evaluate it positively. This study shows that the structured case-management can be implemented in a child welfare setting.

Distribution of sensory nerve endings around the human sinus tarsi: a cadaver study.

The aim of this study was to analyse the pattern of sensory nerve endings and blood vessels around the sinus tarsi. The superficial and deep parts of the fat pads at the inferior extensor retinaculum (IER) as well as the subtalar joint capsule inside the sinus tarsi from 13 cadaver feet were dissected. The distribution of the sensory nerve endings and blood vessels were analysed in the resected specimens as the number per cm(2) after staining with haematoxylin-eosin, S100 protein, low-affinity neurotrophin receptor p75, and protein gene product 9.5 using the classification of Freeman and Wyke. Free nerve endings were the predominant sensory ending (P < 0.001). Ruffini and Golgi-like endings were rarely found and no Pacini corpuscles were seen. Significantly more free nerve endings (P < 0.001) and blood vessels (P = 0.01) were observed in the subtalar joint capsule than in the superficial part of the fat pad at the IER. The deep part of the fat pad at the IER had significantly more blood vessels than the superficial part of the fat pad at the IER (P = 0.012). Significantly more blood vessels than free nerve endings were seen in all three groups (P < 0.001). No significant differences in distribution were seen in terms of right or left side, except for free nerve endings in the superficial part of the fat pad at the IER (P = 0.003). A greater number of free nerve endings correlated with a greater number of blood vessels. The presence of sensory nerve endings between individual fat cells supports the hypothesis that the fat pad has a proprioceptive role monitoring changes and that it is a source of pain in sinus tarsi syndrome due to the abundance of free nerve endings.

[Temperament and character-traits as protective factors among adolescents in juvenile residential facilities]. / Temperament und Charaktereigenschaften als protektive Faktoren bei Jugendlichen in stationären Jugendhilfeeinrichtungen.

Although adolescents in juvenile residential facilities are at high risk for mental disorders, not all of these adolescents develop psychiatric symptoms. The aim of our study was to define traits protecting these adolescents. A total of 314 adolescents of 20 juvenile residential facilities were examined using standardized assessment instruments (Child Behavior Checklist (CBCL), Junior Temperament and Character Inventory (JTCI)). Educators of the facilities filled out a sociodemographic questionnaire for each participant. Adolescents were divided into two groups (resilient vs. mental problems) by CBCL-Cut-off-Scores. Analyses were based on these two groups. Resilient youth differed from youth with psychiatric symptoms in temperament- and character-traits (e. g. self-directedness F = 28.4, p < .001, d = 0.64) with small to moderate effect sizes (d = 0.36 to 0.64). Resilient adolescents lived in larger facilities (U = 9080, p = .025). No associations were found between gender and resilience, as well as age at placement in the facility and duration of the stay in the facility and resilience. Significant differences in temperament- and character-traits between resilient adolescents and adolescents with mental problems were identified. Especially character-traits could be a basis for developing strategies for promoting mental health and further resilience factors, as social support.

Widening epidemiological data on the prevalence of child maltreatment: Validation of the German ICAST-R in a student sample and national household survey.

BACKGROUND: A number of instruments for measuring child maltreatment (CM) prevalence have repeatedly been used across different countries. Although they hold the potential for providing benchmarks to tackle the gap of lacking comparability of CM prevalence across countries, contextual information about the adverse experiences such as perpetrator, chronicity, frequency, or severity are rarely covered. The ISPCAN Child Abuse Screening Tool - Retrospective (ICAST-R) covers these important dimensions. The German version increases the number of available versions to 21 different languages. Spoken by about 120 million people, German is one of the 20 most prevalent languages around the world. Moreover, the ICAST-R is intended to be used with young adults. This study further aims at adding towards the gap of psychometrics in older age groups. METHODS: Analyses are based on both a sample of German students (n = 333) and a nationally representative household survey (n = 2515). The validation process covered six steps: (1) Analyses of missing data on single items, (2) calculation of descriptive statistics to estimate the prevalence CM as well as subjective severity and main perpetrators. (3) Structural validity of the four conceptualized subtypes of CM (neglect, physical abuse, emotional abuse and sexual abuse) was tested using confirmatory factor analyses (CFA). Next (4), equivalence testing by multigroup confirmatory factor analyses (MGCFA) on age groups was conducted within the representative sample; (5) reliability was tested by determining internal consistencies for each subscale via the McDonald's Omega, Kuder-Richardson 20 (KR-20), and Cronbach's alpha. Lastly (6), criterion validity was tested in regression models comparing depressive/anxious symptomatology for single victimization and polyvictimization. RESULTS: The German ICAST-R yielded low missing values items in both samples. 16 % of the participants in the national household survey reported neglect, 20.3 % physical abuse, 22.2 % emotional abuse, and 8.6 % sexual abuse. Polyvictimization was prevalent with 20.6 % of subjects reporting >2 types of CM. Students in the pilot-survey reported much higher prevalence estimates than participants in the nationally representative sample. The types of CM subjectively rated as most harmful were emotional abuse and sexual abuse. In both samples, structural validity was similarly confirmed as CFA was reproducing the four conceptualized subtypes of CM with adequate fit (household survey: CFI 0.919, TLI 0.907, RMSEA 0.017, SRMR 0.046). Internal consistency achieved acceptable and comparable values for all three types of coefficients; criterion validity was established with a significant dose-response effect of CM experiences on both anxiety and depressive symptoms/diagnoses. Age dependent analyses on structural validity (MGCFA) and reliability in the household survey revealed potential weaknesses of items. CONCLUSION: The German version of the ICAST-R both widens the possibility of international CM prevalence comparison and provides novel epidemiological data for Germany on subjective severity of CM and CM perpetrators. Even in the presence of a marked selection bias, the ICAST-R had similarly good psychometric properties in the student and nationally representative household sample. Except for issues with two items, equivalence testing was comparable across age groups.

Adverse childhood experiences increase the risk for low perceived social participation and health-related quality of life in a large-scale population-based study in Germany.

BACKGROUND: Adverse childhood experiences (ACEs) are highly prevalent and increase the risk for long-term adverse health outcomes. Next to well-known ACE-associated risks for morbidity, recent research is increasingly invested in exploring pathways towards health, overall functioning, and partaking in society following early adversity. OBJECTIVES: Thus, this study aims to assess the association between latent classes of ACEs with perceived social participation and health-related Quality of Life (QoL) in a large population-based sample and to explore potential moderators of these associations. METHOD: A representative sample of the German population (N = 2531; Mage = 48.7; 51 % women) was cross-sectionally investigated for ACEs, social participation (KsT-5), and health-related QoL (EuroQol-5D-5L). Latent Class Analysis (LCA) was performed to derive groups with similar ACE patterns. Multiple regression analyses were used to investigate the association of latent classes of ACEs with social participation and health-related QoL and to explore potential moderators. RESULTS: Four distinct latent classes of ACEs were identified; "no/low ACEs" (N = 1968, 77.8 %); "household-dysfunction" (N = 259, 10.2 %), "child abuse and neglect" (N = 188, 7.4 %), and "polyadversity" (N = 116, 4.6 %). Compared to participants in the no/low ACE class, those in the ACE-exposed classes showed overall lower levels of perceived social participation and health-related QoL. The polyadversity class showed lower levels of social participation compared to the two other ACE-exposed classes. Chronic stress, living with a partner, education, current job/educational involvement, and gender were found to moderate these associations in exploratory analyses. CONCLUSIONS: This study shows people exposed to ACEs to have a higher risk for lower perceived social participation and lower health-related QoL - an increased risk, however, is not a deterministic uninventable fortune. Reduction of chronic stress, fostering of social support, and educational and vocational paths as interventional targets are discussed to enable those with precarious starting conditions to partake in society.