What words can tell us about social determinants of mental health: A multi-method analysis of sentiment towards migration experiences and community life in Lima, Perú.

To support resilience in contexts of migration, a deeper understanding of the experiences of both receiving communities and migrants is required. Research on the impacts of migration on community life is limited in contexts with high internal migration (i.e., migrating within one's country of origin). Evidence suggests that cultural similarity, community relationships, and access to resources may be protective factors that could be leveraged to support the mental health of internal migrants. The current study uses data drawn from a sample of pregnant Peruvian women (N = 251), 87 of whom reported being internal migrants and 164 of whom reported being from the locale of the study (Lima, Perú). The aim was to better understand the social experience of internal migration for both local and migrant women. Inductive thematic analysis was used to examine migration experience and perceived impact of migration on community life. Internal migrants discussed three themes relative to their experiences: motivations, adjustment, and challenges. Experiences of women in receiving communities consisted of four themes related to migration: positive, negative, neutral, and mixed perceptions. Linguistic Inquiry and Word Count (LIWC-22) software was also used to assess sentiment towards migration. Across both analytic methods, migration motivations and perceptions were multifaceted and migrants reported a wide range of challenges before, during, and after migration. Findings indicated that attitudes toward migration are broadly positive, and that there is a more positive appraisal of migration's impact on the community life for internal as opposed to international migration.

Evaluating the effects of prenatal intervention on parenting in women exposed to intimate partner violence.

The Pregnant Moms' Empowerment Program (PMEP) is a brief, group intervention for pregnant women who have experienced intimate partner violence (IPV). This study was a quasirandomized trial of the effects of PMEP on parenting. Participants were 137 pregnant women exposed to IPV in the past year; 82 received PMEP and 55 were in a no-treatment control condition. Participants completed four assessments (pretest [T1], posttest [T2], 3-month postpartum[T3], and 12-month postpartum [T4]). At T1-T4, women self-reported on their parenting attitudes (i.e., expectations of children, parental empathy, corporal punishment, parent-child family roles) and parenting confidence. At the postpartum assessments, mother-infant dyads participated in a videorecorded free play session that was coded for warm-sensitive parenting. Results showed that women who received PMEP had more appropriate expectations of children (ß = 0.51, 95% CI [0.03, 0.99], dr = 0.53, 95% CI [0.31, 1.02]) and higher empathy toward children (ß = 0.64, 95% CI [0.05, 1.23], dr = 0.53, 95% CI [0.04, 1.02]) at T2, as compared to women in the control group. Women who received PMEP also showed more warm-sensitive parenting at T4 (Wald χ² = 4.01, p = .045; R² = 5.58%, d = 0.41, 95% CI [0.07, 0.88]) as compared to women in the control group. No differences emerged on corporal punishment, parent-child family roles, postpartum empathy and expectations of children, parenting confidence, or 3-month postpartum parenting behaviors. Thus, results were mixed, with some short-term positive effects and other benefits emerging only at 1-year postpartum. Findings highlight the potential clinical utility of brief interventions for pregnant, IPV-exposed women. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Associations between childhood polyvictimization, intimate partner violence victimization and substance use among college students.

Objectives: Intimate partner violence (IPV) is associated with an elevated risk of substance use, but few studies have simultaneously examined other aspects of victimization history that may contribute to substance use. The current study examined the direct and moderating effects of childhood polyvictimization (i.e., multiple experiences of violence victimization before age 18) on the association between IPV subtypes (physical, sexual, psychological, and injury) and alcohol/drug use. Methods: A sample of 256 college students ages 18-25 (72% female, 68% white) completed a survey assessing past-year IPV, childhood polyvictimization, and past three-month substance use. Results: There were no direct or joint associations between IPV, childhood polyvictimization, and alcohol use. There were direct associations between psychological IPV, childhood polyvictimization, and drug use. No other forms of IPV were significantly associated with drug use. Conclusions: Results highlight unique direct associations between violence victimization and drug use risk compared to alcohol use risk in this context.

A Developmental Psychopathology Perspective on Political Violence and Youth Adjustment.

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Causal inference for treatment effects in partially nested designs.

artially nested designs (PNDs) are common in intervention studies in psychology and other social sciences. With this design, participants are assigned to treatment and control groups on an individual basis, but clustering occurs in some but not all groups (e.g., the treatment group). In recent years, there has been substantial development of methods for analyzing data from PNDs. However, little research has been done on causal inference for PNDs, especially for PNDs with nonrandomized treatment assignments. To reduce the research gap, in the current study, we used the expanded potential outcomes framework to define and identify the average causal treatment effects in PNDs. Based on the identification results, we formulated the outcome models that could produce treatment effect estimates with causal interpretation and evaluated how alternative model specifications affect the causal interpretation. We also developed an inverse propensity weighted (IPW) estimation approach and proposed a sandwich-type standard error estimator for the IPW-based estimate. Our simulation studies demonstrated that both the outcome modeling and the IPW methods specified following the identification results can yield satisfactory estimates and inferences of the average causal treatment effects. We applied the proposed approaches to data from a real-life pilot study of the Pregnant Moms' Empowerment Program for illustration. The current study provides guidance and insights on causal inference for PNDs and adds to researchers' toolbox of treatment effect estimation with PNDs. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Attentional Bias to Threat: Examining Associations with Children's Emotional Regulation and Interactions with Intimate Partner Violence.

Intimate partner violence (IPV) in the home-a prevalent environmental risk for children-exemplifies a key factor that may alter the role of attentional bias to threat (ABT) in children's psychological adjustment. The current study aims to (1) examine potential variations in ABT and emotion regulation across animal and face stimuli and (2) test IPV as a potential moderator of the relationship between ABT and child outcomes. Participating children (N = 37) completed computerized tasks assessing ABT. Mothers provided data on IPV in the home, child victimization, and child emotion regulation. Children's ABT toward animal stimuli was not associated with emotion regulation; IPV significantly moderated the link between ABT and emotion regulation (ß = - 0.06, p < .001). At low levels of IPV, children's ABT and emotion regulation were not related, but at high levels of IPV, ABT was negatively associated with emotion regulation skills. The relevance of ABT for understanding functioning may vary by both stimulus selection and by previous experiences of environmental risk.

Elucidating the relations between adverse childhood experiences, age of exposure to adversity, and adult posttraumatic stress symptom severity in pregnant women.

BACKGROUND: Adverse childhood experiences (ACEs) are typically assessed within two subscales: child maltreatment (CM) and household dysfunction (HD). More research is needed about how the CM and HD subscales differentially contribute to adult posttraumatic stress symptoms (PTSS), accounting for additional adversities. OBJECTIVE, PARTICIPANTS, AND SETTING: In a sample of 137 pregnant women exposed to recent intimate partner violence (IPV) in the United States, this study aimed to (1) explore the contributions of ACEs subscales to pregnant women's PTSS severity, (2) examine the inclusion of the witnessing IPV ACE in the CM subscale, and (3) contextualize the contributions of the ACEs subscales to women's PTSS by examining the moderating effect of age of first ACE exposure. METHODS: The study used linear, multiple, and hierarchical regression analyses and the Hotelling-Williams test. RESULTS: The CM subscale predicted pregnant women's PTSS significantly better than the HD subscale, controlling for past-year IPV (t(134) = 2.69, p = .008). Adding the witnessing IPV ACE to the CM subscale did not significantly improve the subscale's prediction of PTSS (ΔR2 = 0.07, p = .290). Age of first exposure did not significantly moderate the effects of the CM (ß = 0.12, p = .140) or HD (ß = -0.10, p = .238) ACEs subscales on PTSS. CONCLUSIONS: Results suggest that for pregnant women exposed to high levels of trauma, polyvictimization and particularly experiencing multiple types of CM have stronger predictive validity for PTSS than HD. Cumulative victimization may be more influential than age of exposure to adversity.

Patterns and predictors of perinatal posttraumatic stress symptoms: A latent transition analysis.

BACKGROUND: Pregnancy is a time of increased risk for intimate partner violence (IPV), yet there is a dearth of prospective research examining the relationship between IPV and posttraumatic stress symptoms (PTSS) in the perinatal period. Further, relationships among different types of IPV and perinatal PTSS remain understudied. METHODS: Latent class and transition analyses were used to examine classes of PTSS in pregnancy and postpartum, the longitudinal patterns of transitions across these classes, and the role of IPV types, childhood adversity, and depressive symptoms in PTSS presentation. Participants (N = 238) were drawn from two longitudinal studies of high-risk perinatal women. RESULTS: Four latent PTSS classes emerged: High, Avoidant, Hypervigilant, and Low. Childhood adversity (χ2(3) = 13.09, p = .004), prenatal depression (χ2(3) = 17.58, p = .001), and psychological IPV (χ2(3) = 10.51, p = .01) were associated with membership in High, Avoidant, and Hypervigilant classes. Women with low prenatal PTSS continued to have low levels at postpartum. Women in higher severity classes during pregnancy tended to transition into classes with adjacent, and often lower, levels of symptom severity postpartum. Women in the High PTSS class in pregnancy with elevated levels of depression were significantly more likely to remain in the High PTSS class or transition into the Avoidant class at postpartum, compared to the Low PTSS class, χ2(3) = 11.84, p = .008. LIMITATIONS: Relatively modest sample size precluded examination of a broader range of symptoms consistent with PTSD. CONCLUSIONS: Findings highlight the importance of individualized approaches to assessing, monitoring, and treating perinatal PTSS.

Examining the efficacy of prenatal intervention in reducing IPV revictimization and improving maternal mental health: A quasirandomized controlled trial of the Pregnant Moms' Empowerment Program (PMEP).

OBJECTIVE: The present study was a quasirandomized trial of the Pregnant Moms' Empowerment Program (PMEP) that examined the effects of the program on women's intimate partner violence (IPV) revictimization, depression, posttraumatic stress, and resilience. It was hypothesized that treatment would be associated with improvements across all of the indicated dimensions and that those women completing the module on violence and mental health would have particularly strong improvements. METHOD: Women who were currently pregnant, IPV-exposed, and at least 16 years of age were recruited and assigned to either a treatment or control condition. Participants (N = 137) completed four assessments (pretest [T1], posttest [T2], 3-months postpartum [T3], and 12-months postpartum [T4]). The key outcomes assessed included IPV (Revised Conflict Tactics Scales), depressed mood (Center for Epidemiological Studies Depression Scale), posttraumatic stress (PTSD Checklist for DSM-5), and resilience (Connor-Davidson Resilience Scale). RESULTS: Results of multilevel models examining IPV revictimization indicated that treatment was associated with significantly fewer experiences of physical assault and sexual coercion at all follow-up interviews (T2, T3, and T4) and fewer IPV-related injuries at T3 and T4. In addition, treatment exposure was associated with statistically and clinically significant improvement in depression at T2 and T4. The intervention had limited efficacy in increasing women's self-reported resilience or in reducing symptoms of posttraumatic stress. CONCLUSIONS: Together, these data suggest that PMEP is a promising evidence-based intervention for pregnant, IPV-exposed women, and that the effects-particularly for IPV and depression-are likely to be sustained over time. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Evaluating the Role of Maternal and Paternal Trauma Exposure, Emotional Security, and Mental Health in Predicting Psychological Adjustment among Palestinian Adolescents.

Previous research has established a strong relationship between family system functioning and child adjustment outcomes. However, within the context of Gaza, an evaluation of both maternal and paternal factors associated with adolescent psychological adjustment has not yet been thoroughly evaluated. The current study examines how maternal and paternal trauma exposure, emotional security, and mental health are related to parent-reported scores of adolescent psychological adjustment, while controlling for adolescent trauma exposure and security in the family. The sample included N = 68 family units living in the Gaza Strip, with two parents and one adolescent surveyed within each unit (adolescent Mage = 14.03 years). The regression model examining maternal factors was significant overall (F = 7.44, R2 = 42.70%, p < 0.001), with increased maternal depression associated with greater adolescent adjustment difficulties (ß = 0.31, p = 0.011) and greater maternal emotional security in the family associated with fewer adolescent adjustment difficulties (ß = −0.36, p = 0.004). The regression model examining paternal factors was also significant (F = 4.57, R2 = 31.00%, p < 0.001), with increased paternal trauma exposure associated with greater adolescent adjustment difficulties (ß = 0.32, p = 0.012). Understanding family-level factors associated with adolescent adjustment is an important step in conceptualizing the mental health needs of conflict-affected youth within the context of Gaza and more broadly.

Supporting Youth and Families in Gaza: A Randomized Controlled Trial of a Family-Based Intervention Program.

Background: A total of 450 million children are now living in active conflict zones. The negative consequences for children are significant and long lasting. In response to the urgent need for sustainable interventions for children and families, the current study evaluated a brief (12 hr, 8 session) family-based coping and support program, Promoting Positive Family Futures (PPFF), in Gaza. Methods: Families (n = 68, mother/father/adolescent triads) were randomized into the PPFF intervention or another lengthier (50 hr, 25 session) locally well-established psychosocial support program (treatment as usual; TAU). Results: Improvements were found for both conditions for paternal and maternal depression, emotion regulation using cognitive reappraisal, family-wide emotional security, and adolescent adjustment. Effect sizes were medium to large (d = 0.35-1.27). Fathers in the PPFF condition reported lower depression and higher emotion regulation using cognitive reappraisal at post-test than did fathers in the TAU condition. Mothers in the PPFF condition reported higher levels of emotion regulation using cognitive reappraisal at post-test than did mothers in the TAU condition. PPFF was also indirectly associated with improved depression at post-test for both mothers and fathers via improvements in emotion regulation using cognitive reappraisal and with adolescent adjustment at six months via improvements in maternal emotion regulation using cognitive reappraisal. Conclusions: These findings suggest that the PPFF intervention has many benefits comparable with a longer and locally well-established program. PPFF was also associated with unique positive implications for family-wide adjustment over time. Support was also identified for transdiagnostic processes of improvement associated with the PPPF intervention consistent with the theoretical models informing the approach.

Trauma, resilience, and distress in post-revolution Egypt.

OBJECTIVE: Trauma represents a persistent threat to health and wellbeing. Yet, little research has examined links between trauma, psychopathology, and resilience in the Middle East and North Africa region outside of refugee settings, especially in Egypt. Existing studies in Egypt rarely examine trauma exposure from a polyvictimization lens, assess multiple forms of trauma-related psychopathology, or focus on dimensional symptom assessment. The current study aimed to address these gaps by (a) reporting on the diverse range of trauma exposure types, including direct, witnessed, and indirect exposure in a trauma-exposed sample; and (b) examining the associations between trauma exposure, psychopathology, and resilience. METHOD: Participants (N = 87) were drawn from the baseline survey of a randomized clinical trial for online treatment of posttraumatic stress and reported on demographics, trauma exposure, resilience, and psychopathology. RESULTS: Men reported more direct and witnessed exposure to sociopolitical violence than women, but there were no gender differences in sexual violence or total trauma exposure. Multivariate regression models examining the effect of trauma and resilience on psychopathology, controlling for age and gender, indicated that all models explained significant variance for posttraumatic stress and anxiety (F(87, 7)PTSS = 2.64, p = .022, R² = 16.5%; F(87, 7)Anx = 6.04, p < .001, R² = 31.2%) but not depression. Direct trauma exposure was associated with higher severity levels of posttraumatic stress and anxiety (ßPTSS = 1.11, p = .005; ßAnx = 1.04, p = .001). Resilience was only associated with lower levels of anxiety (ßAnx = -.22, p < .001). CONCLUSIONS: These findings suggest the high need for evidence-based care in Egypt for trauma-related psychopathology. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Pregnancy complications and intimate partner violence: The moderating role of prenatal posttraumatic stress symptoms.

Intimate partner violence (IPV) and posttraumatic stress disorder increase the risk of poor pregnancy outcomes, but associations among IPV exposure, mental health, and pregnancy complications remain underexplored. This study assessed the interaction between three types of IPV exposure (i.e., physical, sexual, psychological) and posttraumatic stress symptoms (PTSS) on prenatal complications (e.g., preeclampsia, gestational diabetes) among pregnant women exposed to IPV. Participants included 137 IPV-exposed pregnant women (Mage = 27.29, SD = 6.00; 66.9% African American/Black). Three regression models were run to test the main effect of each type of IPV and PTSS on pregnancy complications, and the moderating effect of PTSS on the association between IPV and pregnancy complications, controlling for socioeconomic status, gestational age, and childhood trauma. Main effects were observed for sexual coercion, ß = .32, p = .010, R2 part = .050, and PTSS, ß = 0.19, p = .039, R2 part = .026, with more frequent sexual IPV and higher levels of PTSS associated with more pregnancy complications. Moderating effects were also evident, with the IPV x PTSS interaction significant for all three IPV domains: psychological aggression, f2 = .046; sexual coercion, f2 = .079; and physical assault, f2 = .048. PTSS strengthened the positive association between psychological and sexual IPV and pregnancy complications. Physical IPV and pregnancy complications were inversely related for participants with low-level PTSS. Results provide novel information on how IPV types and PTSS function together during pregnancy. Findings highlight the need for evidence-based prenatal interventions that successfully address both IPV exposure and PTSS severity.

User experiences of a culturally adapted web-based intervention for posttraumatic stress disorder in Egypt: A qualitative study.

The following study describes the usability and the acceptability of an online intervention for the treatment of posttraumatic stress disorder (PTSD), PTSD Coach Online that was culturally adapted and translated into local Egyptian dialect. The adapted intervention was piloted in a randomized control trial with 87 Egyptians meeting clinical criteria for a diagnosis of PTSD. Of the 41 participants who participated in the treatment condition, 15 participants (10 females, 5 males) were randomly selected to take part in a semistructured interview to explore their user experience. Favorable feedback centered on the program's ease of access, user-friendly tools, and cultural appropriateness. Participants also described benefits including increased awareness of PTSD, symptom reduction, and increased willingness to seek psychological support online or in person. In contrast, participants highlighted some drawbacks of the online program, particularly the need for further support or some kind of "human" interaction as well as feelings that the information was not sufficiently personalized and that activities could have been more interesting. The findings suggest that while the PTSD Coach Online-Arabic is unlikely to be an effective stand-alone support, approximately half of the sample indicated that the availability of online tools is important for accessibility of mental health care, particularly for those concerned with stigma. As such, it may be an important supplemental offering for other forms of ongoing care and support. Future research may consider integrated approaches to care that were highlighted as being of particular interest to participants. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

A qualitative exploration of families' experiences and resilience factors during the COVID-19 pandemic.

The COVID-19 pandemic has prompted widespread changes and challenges worldwide. In the context of the early months of the pandemic, the current study utilized thematic analysis to assess parents' (N = 13) perspectives of need for resources to foster their family's wellbeing. Five themes emerged: Information Deficits, Need for More Instrumental Supports, Frustration and Worry, Resources Promoting Resilience, and Positive Perspective Shift. Results indicate the importance of information and expanded access to community resources to scaffold resilience in the face of ongoing mass stressors.

"I Did It to Save My Children": Parenting Strengths and Fears of Women Exposed to Intimate Partner Violence.

Intimate partner violence (IPV) is experienced by one in four women in the United States, and a wealth of quantitative research has underscored its detrimental effects on women's mental health and parenting practices. Little research, however, has considered ways in which women exposed to IPV retain and foster parenting strengths and ways in which motherhood serves as a source of resilience for these women. The objective of the current study was to conduct a thematic analysis of IPV-exposed women's parenting strengths and concerns as reported through focus groups conducted with IPV-exposed women (n = 22) and service providers (n = 31) in two urban areas in the Mid-West and Mid-South. Results of the thematic analysis indicated the emergence of three core themes: resilience and challenges of parenting in the context of IPV, leaving the violent partner, and intergenerational processes. Overall, service providers recognized far fewer strengths in parenting on all dimensions than did women, suggesting that service providers may be conceptualizing parenting in the context of IPV from a deficit model that underestimates the resilience demonstrated by these women. This has important consequences for the extent to which women may feel stigmatized or blamed when receiving resources and services critical to their families. Future research on parenting among women experiencing IPV would be enhanced by capturing the dynamic interplay between women's parenting strengths and challenges, and the ways in which these capacities are affected by resource access within and across social ecological contexts.

The Multidimensional Taxonomy of Individual Resilience.

Theoretical work in resilience has continuously evolved to inform and respond to advances in empirical work. In order to further scientific inquiry, it must continue to do so. This narrative overview of the field of resilience science focuses on contemporary challenges confronted by theoretical models of individual resilience and proposes a taxonomic structure for resilience-the multidimensional taxonomy of individual resilience (MTIR). The goal of the MTIR is to articulate a systematic framework within which extant theoretical and empirical work can be nested. Consistent with existing work, the MTIR organizes resilience into two primary branches-manifested resilience and generative resilience. These two components are then organized into subdomains that demonstrate evidence of conceptual distinctiveness. The specification of the subdomains in the MTIR draws support from a diverse body of work on resilience across disciplines and in multiple global contexts. The MTIR makes several critical advances, including expanding and refining the definitions and components of resilience in psychology, providing a clearer framework for conceptualizing mixed profiles of resilience, and tempering assumptions regarding the relational dependencies across domains of resilience. Finally, the utility of the MTIR in organizing research in resilience and advancing theory-testing and development is discussed.

Types of Childhood Exposure to Violence and Association With Caregiver Trauma in Peru.

This study examined typologies of childhood polyvictimization and the associations of profiles with demographic characteristics at the levels of child, household, and primary caregiver. This study evaluated a sample of children aged 4 to 17 years residing in San Juan de Lurigancho District, an urban setting on the edge of Lima, Peru (n = 384). An in-person interview of the primary caregiver of each child was conducted in June 2018, assessing the victimization of the child, the caregiver's exposure to trauma and abuse, and general socioeconomic and demographic characteristics of the household. Latent class analysis was used to identify typologies of child victimization. Follow-up analysis was conducted to quantify differences between the classes which emerged, in terms of the child, caregiver, and household. Five classes emerged: High Peer victimization, Moderate Community victimization; High Community victimization; Verbal Abuse; High victimization across domains; and Low victimization across domains. Caregiver exposure to trauma was positively associated with membership in the high-exposure classes. This study offers a unique opportunity to more deeply understand childhood exposure to violence in Latin America, specifically in an urban setting in Peru, and to further understand how childhood victimization is associated with various characteristics of the child, caregiver, and household. These findings could inform interventions supporting children and families at risk of exposure to violence in Peru or globally.

Examining person-centered maternity care in a peri-urban setting in Embakasi, Nairobi, Kenya.

INTRODUCTION: Peri-urban settings have high maternal mortality and the quality of care received in different types of health facilities is varied. Yet few studies have explored the construct of person-centered maternity care (PCMC) within peri-urban settings. Understanding women's experience of maternity care in peri-urban settings will allow health facility managers and policy makers to improve services in these settings. This study examines factors associated with PCMC in a peri-urban setting in Kenya. METHODS AND MATERIALS: We analyzed data from a cross-sectional study with 307 women aged 18-49 years who had delivered a baby within the preceding six weeks. Women were recruited from public (n = 118), private (n = 76), and faith based (n = 113) health facilities. We measured PCMC using the 30-item validated PCMC scale which evaluates women's experiences of dignified and respectful care, supportive care, and communication and autonomy. Factors associated with PCMC were evaluated using multilevel models, with women nested within facilities. RESULTS: The average PCMC score was 58.2 (SD = 13.66) out of 90. Controlling for other factors, literate women had, on average, about 6-point higher PCMC scores than women who were not literate (ß = 5.758, p = 0.006). Women whose first antenatal care (ANC) visit was in the second (ß = -5.030, p = 0.006) and third trimester (ß = -7.288, p = 0.003) had lower PCMC scores than those whose first ANC were in the first trimester. Women who were assisted by an unskilled attendant or an auxiliary nurse/midwife at birth had lower PCMC than those assisted by a nurse, midwife or clinical officer (ß = -8.962, p = 0.016). Women who were interviewed by phone (ß = -7.535, p = 0.006) had lower PCMC scores than those interviewed in person. CONCLUSIONS: Factors associated with PCMC include literacy, ANC timing and duration, and delivery provider. There is a need to improve PCMC in these settings as part of broader quality improvement activities to improve maternal and neonatal health.

Charting a Course towards Resilience Following Adverse Childhood Experiences: Addressing Intergenerational Trauma via Strengths-Based Intervention.

Early research on adverse childhood experiences (ACEs) provided staggering evidence of the significant ramifications of ACEs on physical health and functioning. It brought to the forefront the importance of addressing trauma and family dysfunction to enhance public health. Over the past several decades, the study of childhood adversity has blossomed, with expanded conceptualizations and assessments of ACEs. This review brings together various biological, psychological, and sociological principles that inform our understanding of ACEs and our approach to treatment. Specifically, we document the evolution of ACEs research, focusing on the intergenerational impact of ACEs, the importance of incorporating a resilience framework when examining ACEs, and implementing interventions that address adversity across generations and at multiple levels of the social ecology. Evidence is provided to support the evolving perspective that ACEs have long-lasting effects beyond the ACE(s)-exposed individual, with significant attention to the impact of parental ACEs on child development. An intergenerational and multilevel approach to understanding and addressing ACEs offers specific areas to target in interventions and in public policy.