Objective and subjective experiences of childhood maltreatment and their relationships with cognitive deficits: a cohort study in the USA.

BACKGROUND: Cognitive deficits might contribute to the elevated risk of life-course psychopathology observed in maltreated children. Leading theories about the links between childhood maltreatment and cognitive deficits focus on documented exposures (objective experience), but empirical research has largely relied on retrospective self-reports of these experiences (subjective experience), and the two measures identify largely non-overlapping groups. We aimed to test the associations of objective and subjective measures of maltreatment with cognitive abilities within the same individuals. METHODS: We studied a cohort of individuals from the US Midwest with both objective, court-documented evidence of childhood maltreatment and subjective self-reports of individuals' histories at age 29 years. Between the ages of 29 years and 41 years, participants were assessed with a comprehensive set of cognitive tests, including tests of general verbal intelligence (Quick Test and Wide Range Achievement Test-Revised [WRAT]), non-verbal intelligence (Matrix Reasoning Test [MRT]), executive function (Stroop Test and Trail Making Test Part B [TMT-B]), and processing speed (Trail Making Test Part A [TMT-A]). Participants were also assessed for psychopathology (Center for Epidemiologic Studies Depression Scale and Beck Anxiety Inventory). We tested the associations between objective or subjective measures of childhood maltreatment with cognitive functions using ordinary least squares regression. To test whether cognitive deficits could explain previously described associations between different measures of maltreatment and subsequent psychopathology, we re-ran the analyses accounting for group differences in the Quick Test. People with lived experience were not involved in the research or writing process. FINDINGS: The cohort included 1196 individuals (582 [48·7%] female, 614 [51·3%] male; 752 [62·9%] White, 417 [34·9%] Black, 36 [3·8%] Hispanic) who were assessed between 1989 and 2005. Of the 1179 participants with available data, 173 had objective-only measures of childhood maltreatment, 492 had objective and subjective measures, 252 had subjective-only measures, and 262 had no measures of childhood maltreatment. Participants with objective measures of childhood maltreatment showed pervasive cognitive deficits compared with those without objective measures (Quick Test: ß=-7·97 [95% CI -9·63 to -6·30]; WRAT: ß=-7·41 [-9·09 to -5·74]; MRT: ß=-3·86 [-5·86 to -1·87]; Stroop Test: ß=-1·69 [-3·57 to 0·20]; TMT-B: ß=3·66 [1·67 to 5·66]; TMT-A: ß=2·92 [0·86 to 4·98]). The associations with cognitive deficits were specific to objective measures of neglect. In contrast, participants with subjective measures of childhood maltreatment did not differ from those without subjective measures (Quick Test: ß=1·73 [95% CI -0·05 to 3·50]; WRAT: ß=1·62 [-0·17 to 3·40]; MRT: ß=0·19 [-1·87 to 2·24]; Stroop Test: ß=-1·41 [-3·35 to 0·52]; TMT-B: ß=-0·57 [-2·69 to 1·55]; TMT-A: ß=-0·36 [-2·38 to 1·67]). Furthermore, cognitive deficits did not explain associations between different measures of maltreatment and subsequent psychopathology. INTERPRETATION: Previous studies based on retrospective reports of childhood maltreatment have probably grossly underestimated the extent of cognitive deficits in individuals with documented experiences of childhood maltreatment, particularly neglect. Psychopathology associated with maltreatment is unlikely to emerge because of cognitive deficits, but might instead be driven by individual appraisals, autobiographical memories, and associated schemas. FUNDING: National Institute of Justice, National Institute of Mental Health, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institute on Aging, Doris Duke Charitable Foundation, and National Institute for Health and Care Research.

Prevalence and Course of Unwanted, Intrusive Thoughts of Infant-Related Harm.

Objective: Unwanted, intrusive thoughts (UITs) of infant-related harm are a common postpartum phenomenon and can be classified into thoughts of accidental harm (TAHs) and thoughts of intentional harm (TIHs). Our study's objective was to complete a comprehensive, comparative analysis of TAHs and TIHs by commenting on their prevalence, course, characteristics (time, distress, and impairment) and most intense period.Methods: A total of 763 English-speaking pregnant women across British Columbia were recruited to participate in a prospective cohort study. Study data were collected between February 2014 and February 2017. UITs were assessed by semistructured interviews twice during the postpartum period.Results: The prevalence of TAHs and TIHs in the postpartum period was 95.8% and 53.9%, respectively. The most common TAHs included thoughts of the baby suffocating or dying from sudden infant death syndrome; the most common TIHs included thoughts of neglect. On average, TAHs are more prevalent, time-consuming, and result in greater interference compared to TIHs. The most intense period for TAHs (5.74 weeks postpartum) and TIHs (within first 8 weeks postpartum) was identified. During this period, over 40% of participants reported moderate or extreme distress related to UITs. For most, UITs decreased in frequency or completely resolved by 6 months postpartum, and most participants did not report clinically significant symptoms.Conclusion: UITs are a normative and typically self-resolving occurrence in the postpartum period. UITs' most intense period signifies a time of heightened vulnerability. Increased education is necessary to normalize and reduce distress associated with UITs.J Clin Psychiatry 2024;85(3):23m15145. Author affiliations are listed at the end of this article.

Impact of childhood maltreatment on aging: a comprehensive Mendelian randomization analysis of multiple age-related biomarkers.

BACKGROUND: Childhood maltreatment (CM) is linked to long-term adverse health outcomes, including accelerated biological aging and cognitive decline. This study investigates the relationship between CM and various aging biomarkers: telomere length, facial aging, intrinsic epigenetic age acceleration (IEAA), GrimAge, HannumAge, PhenoAge, frailty index, and cognitive performance. METHODS: We conducted a Mendelian randomization (MR) study using published GWAS summary statistics. Aging biomarkers included telomere length (qPCR), facial aging (subjective evaluation), and epigenetic age markers (HannumAge, IEAA, GrimAge, PhenoAge). The frailty index was calculated from clinical assessments, and cognitive performance was evaluated with standardized tests. Analyses included Inverse-Variance Weighted (IVW), MR Egger, and Weighted Median (WM) methods, adjusted for multiple comparisons. RESULTS: CM was significantly associated with shorter telomere length (IVW: ß = - 0.1, 95% CI - 0.18 to - 0.02, pFDR = 0.032) and increased HannumAge (IVW: ß = 1.33, 95% CI 0.36 to 2.3, pFDR = 0.028), GrimAge (IVW: ß = 1.19, 95% CI 0.19 to 2.2, pFDR = 0.040), and PhenoAge (IVW: ß = 1.4, 95% CI 0.12 to 2.68, pFDR = 0.053). A significant association was also found with the frailty index (IVW: ß = 0.31, 95% CI 0.13 to 0.49, pFDR = 0.006). No significant associations were found with facial aging, IEAA, or cognitive performance. CONCLUSIONS: CM is linked to accelerated biological aging, shown by shorter telomere length and increased epigenetic aging markers. CM was also associated with increased frailty, highlighting the need for early interventions to mitigate long-term effects. Further research should explore mechanisms and prevention strategies.

Effectiveness of a predator avoidance program for elementary-aged youth.

Introduction: With thousands of children abducted and abused each year, efforts are needed to keep children safe from predators. Revved Up Kids (RUK) is an intervention that gives elementary-aged children the necessary tools to recognize and avoid dangerous people and situations. The purposes of this study were to describe the RUK intervention components and document its effectiveness. Methods: This evaluation utilized a quasi-experimental design to determine the effectiveness of RUK. The single-session intervention was offered in two formats: one-hour (n = 119 youth) and three-hour (n = 28 youth) workshops. RUK workshop effectiveness was compared to a comparison group (n = 211 youth) that did not receive an intervention. Data were collected at baseline, immediate-post, and 1-month follow-up from second to fourth grade participants. A series of linear mixed models were fitted. Results: Compared to the comparison group, participants in both RUK workshops showed significant improvements across the three time points. More specifically, participants in the one-hour and three-hour RUK workshops significantly increased their safety knowledge measured by the Recognize Score (p < 0.01), Avoid Score (p < 0.01), and Escape Score (p < 0.01), respectively. Discussion: These effective single-session workshops can be easily introduced into schools and community-based settings to complement existing efforts to prevent child abduction and abuse.

Childhood maltreatment associated suicidal risk in Chinese children and adolescents: a mediation of resilience.

BACKGROUND: Existing evidence suggests that children and adolescents who had experienced childhood maltreatment (CM) are at higher suicidal risk. However, the mediation role of resilience in this association remains unclear. We aim to investigate the mediation via resilience in the associations between CM and three suicidal risk indicators (suicidal ideation, SI; suicidal plan, SP; suicidal attempt, SA) among a large sample of Chinese children and adolescents. METHODS: A population-based cross-sectional survey was conducted in southwestern China Yunnan province. A total of 9723 children and adolescents were included and analyzed by using a multi-stage stratified cluster sampling design. Univariate and multivariate logistic regression models were fitted to explore the associations between CM, resilience, and the three suicidal risk indicators, dose-response trends further elucidated by using the restricted cubic splines. Path models were adopted to estimate the mediation of resilience. RESULTS: The estimated prevalence rates for one-year SI, SP and SA were 32.86% (95% CI: 31.93-33.80%), 19.36% (95% CI: 18.57-20.16%) and 9.07% (95% CI: 8.51-9.66%). After adjustment, CM significantly associated with all 3 suicidal risk indicators, and the odds ratios (ORs) were 2.13 (95% CI: 1.91-2.37), 2.45 (95% CI: 2.13-2.81), and 3.61 (95% CI: 2.90-4.52) for one-year SI, SP, and SA, respectively. Path models revealed that resilience significantly mediated the associations between CM and the three suicidal risk indicators, and among all dimensions of resilience, family support presented the strongest mediation consistently. CONCLUSIONS: Our study results suggest that intervention measures which focusing on improving psychological resilience might be effective in reducing suicidal risk for children and adolescents who had experienced maltreatment. Prospective studies should be done to corroborate our findings.

History of childhood maltreatment associated with hospitalization or death due to COVID-19: a cohort study.

BACKGROUND: Childhood maltreatment (CM) has been indicated in adverse health outcomes across the lifespan, including severe infection-related outcomes. Yet, data are scarce on the potential role of CM in severe COVID-19-related outcomes as well as on mechanisms underlying this association. METHODS: We included 151,427 individuals in the UK Biobank who responded to questions on the history of CM in 2016 and 2017 and were alive on January 31, 2020. Binomial logistic regression models were performed to estimate the association between a history of CM and severe COVID-19 outcomes (i.e. hospitalization or death due to COVID-19), as well as COVID-19 diagnosis and vaccination as secondary outcomes. We then explored the potential mediating roles of socio-economic status, lifestyle and pre-pandemic comorbidities, and the effect modification by polygenic risk score for severe COVID-19 outcomes. RESULTS: The mean age of the study population at the start of the pandemic was 67.7 (SD = 7.72) years, and 56.5% were female. We found the number of CM types was associated with the risk of severe COVID-19 outcomes in a graded manner (pfor trend < 0.01). Compared to individuals with no history of CM, individuals exposed to any CM were more likely to be hospitalized or die due to COVID-19 (odds ratio [OR] = 1.54 [95%CI 1.31-1.81]), particularly after physical neglect (2.04 [1.57-2.62]). Largely comparable risk patterns were observed across groups of high vs. low genetic risks for severe COVID-19 outcomes (pfor difference > 0.05). Mediation analysis revealed that 50.9% of the association between CM and severe COVID-19 outcomes was explained by suboptimal socio-economic status, lifestyle, and pre-pandemic diagnosis of psychiatric disorders or other chronic medical conditions. In contrast, any CM exposure was only weakly associated with COVID-19 diagnosis (1.06 [1.01-1.12]) while significantly associated with not being vaccinated for COVID-19 (1.21 [1.13-1.29]). CONCLUSIONS: Our results add to the growing knowledge base indicating the role of childhood maltreatment in negative health outcomes across the lifespan, including severe COVID-19-related outcomes. The identified factors underlying this association represent potential intervention targets for mitigating the harmful effects of childhood maltreatment in COVID-19 and similar future pandemics.

Childhood Trauma Questionnaire-based child maltreatment profiles to predict efficacy of the Cognitive Behavioral Analysis System of Psychotherapy versus non-specific psychotherapy in adults with early-onset chronic depression: cluster analysis of data from a randomised controlled trial.

BACKGROUND: Child maltreatment is a broadly confirmed risk factor for mental and physical illness. Some psychological treatments specifically target mental health conditions associated with child maltreatment. For example, the Cognitive Behavioral Analysis System of Psychotherapy (CBASP) focuses on maladaptive interpersonal behaviours in chronic depression. However, how the assessment of child maltreatment could inform personalised treatment is unclear. We used data from a previously published clinical trial to investigate whether a pre-established child maltreatment clustering approach predicts differential outcomes after CBASP versus non-specific supportive psychotherapy in patients with early-onset chronic depression. METHODS: We did a cluster analysis of data from a previous randomised controlled trial of unmedicated adult outpatients with early-onset chronic depression who were treated at eight university clinics and psychological institutes in Germany with 32 sessions of CBASP or non-specific supportive psychotherapy. Participants were eligible for the original trial if they were aged 18-65 years; had major depressive disorder (MDD) with an early onset and duration of at least 2 years, current MDD superimposed on a pre-existing dysthymic disorder, or recurrent MDD with incomplete remission between episodes as defined by DSM-IV; and had a score of at least 20 points on the 24-item Hamilton Rating Scale for Depression (HRSD-24). Participants were included in the current study if they had completed the short form of the Childhood Trauma Questionnaire (CTQ) at trial baseline. We used an agglomerative hierarchical clustering approach to derive child maltreatment clusters from individual patterns across the five domains of the CTQ. We used linear mixed models to investigate whether clustering could predict differential clinical outcomes (change in symptom severity on the HRSD-24) up to 2 years after treatment onset. People with lived experience were involved in the current study. FINDINGS: 253 patients (129 [51%] treated with CBASP and 124 [49%] with supportive psychotherapy) had complete CTQ records and were included in the analysis. 169 (67%) participants were women, 84 (33%) were men, and the mean age was 45·9 years (SD 11·7). We identified seven child maltreatment clusters and found significant differences in treatment effects of CBASP and supportive psychotherapy between the clusters (F(6,948·76)=2·47; p=0·023); differences were maintained over the 2-year follow-up. CBASP was superior in distinct clusters of co-occurring child maltreatment: predominant emotional neglect (change in ß -6·02 [95% CI -11·9 to -0·13]; Cohen's d=-0·98 [95% CI -1·94 to -0·02]; p=0·045), predominant emotional neglect and abuse (-6·39 [-10·22 to -2·56]; -1·04 [-1·67 to -0·42]; p=0·0011), and emotional neglect and emotional and physical abuse (-9·41 [-15·91 to -2·91]; -1·54 [-2·6 to -0·47]; p=0·0046). INTERPRETATION: CTQ-based cluster analysis can facilitate identification of patients with early-onset chronic depression who would specifically benefit from CBASP. Child maltreatment clusters could be implemented in clinical assessments and serve to develop and personalise trauma-informed care in mental health. FUNDING: The German Research Foundation and the German Federal Ministry of Education and Research.

The mediating effects of school bullying victimization in the relationship between childhood trauma and NSSI among adolescents with mood disorders.

BACKGROUND: Nonsuicidal self-injury (NSSI) is a serious problem in the adolescent population worldwide. Childhood trauma and bullying have been identified as risk factors for NSSI. We explored the relationships among Childhood trauma, Bullying victimization and the severity of NSSI behaviours, and test the effect of Bullying victimization in mediating the association between Childhood trauma and the NSSI behaviours. METHODS: A total of 123 adolescents were recruited. They were diagnosed with depression or depressive episodes of bipolar disorder and had experienced NSSI in the last year. They were assessed using the Chinese version of the Childhood Trauma Questionnaire (CTQ-C), the Revised Olweus Bullying Victimization Questionnaire (OBVQ-R), and the Adolescent Self-Harm Questionnaire (ASHQ). RESULTS: Females presented a significantly greater prevalence of sexual abuse and relationship bullying than boys. Individuals in the younger age group (10-14 years) presented a greater incidence of emotional neglect, verbal bullying, relationship bullying, and total bullying, and their NSSI score was also higher than that of those in the older age group (15-19 years). Only children show a greater prevalence of sexual abuse than nononly children. Single-parent families scored higher on emotional abuse, emotional neglect, physical neglect and physical bullying than two-parent families. There was a significant positive correlation between each dimension of childhood trauma and all the dimensions of bullying, between childhood trauma and NSSI, and between bullying and NSSI. Childhood trauma can not only directly affect the severity of NSSI but also indirectly aggravate the severity of NSSI through bullying victimization. The mediating effects of bullying victimization on emotional abuse, physical abuse, emotional neglect and physical neglect were 14%, 21%, 20%, 13% and 20%, respectively. CONCLUSION: There was a significant positive correlation between childhood trauma and bullying, between childhood trauma and NSSI, and between bullying and NSSI. Childhood trauma can not only directly affect the severity of NSSI but also indirectly aggravate the severity of NSSI through bullying victimization. Bullying victimization played the partial mediating effects between Childhood trauma and NSSI.

Child physical abuse: changes over ten years in the perceptions of Finnish dental professionals.

OBJECTIVE: This study aimed to assess perceptions and actions taken by Finnish dental professionals in suspected cases of child physical abuse (CPA) and to describe changes over 10 years. MATERIAL AND METHODS: Data collected from two child abuse and neglect (CAN) surveys among Finnish dental professionals, working in public health care, covering suspicions of CPA and actions taken as well as training on CPA issues, were compared. The chi-squared (χ2) test was used to analyze associations. RESULTS: In total, 625 (2008) and 1,025 (2019) questionnaires were completed. Respondents reported that they suspected CPA more frequently in 2008 than in 2019 (21.0% vs. 8.7%, p < 0.001). Out of all respondents, 1.1% had reported their concern to the police in 2019. Worries about the report's negative consequences to the child at home (44.5% vs. 56.4%, p < 0.001) and to the informer (30.2% vs. 36.3%, p = 0.016) increased between the surveys. The proportion of respondents with previous training on CPA issues increased between the surveys (5.9% vs. 36.4%, p < 0.001). CONCLUSIONS: Recognition of CPA was low and decreased over the years. Furthermore, mandatory reporting to the police was low. Additional education on issues related to CPA is needed.

Explaining child maltreatment and aggression among Chinese drug user: The mediating and moderating roles of drug craving and impulsivity.

BACKGROUND: The cycle of violence highlights a strong correlation between child maltreatment and aggression. However, there remains a significant gap in the pathway models of the cycle of violence. Given the exceptionally high rates of child maltreatment and violent crime among Chinese drug users, it is essential to examine the mechanisms of the cycle of violence within this group. OBJECTIVE: The current study incorporates drug craving and impulsivity into the child maltreatment-aggression mechanism. We explore the potential mediating and moderating roles of these variables and further examine the heterogeneity. PARTICIPANTS AND SETTING: A total of 894 participants (Meanage = 38.30, SDage = 8.38) were recruited as the final sample. METHODS: We employed moderated mediation and serial mediation models to explore the roles of drug craving and impulsivity. The Johnson-Neyman method was utilized to investigate moderating effects. Rich demographic variables and depression were controlled. RESULTS: There was no direct relationship between child maltreatment and aggression. The moderated mediation model indicated that drug craving played a mediating role, and there was a substitutive relationship between impulsivity and drug craving. The serial mediation model showed that child maltreatment could only affect drug craving (not impulsivity) and could ultimately influence aggression through a chain relationship. Heterogeneity tests revealed that the mechanisms might differ among various types of maltreatment. CONCLUSION: Drug craving holds a significant position in the cycle of violence. Compared to impulsivity, it is a more proximal factor to child mistreatment. Future research should also focus on the heterogeneity of child maltreatment for targeted interventions.

Reducing risk factors for child maltreatment: The Parenting-STAIR open pilot study.

BACKGROUND: Despite a large body of evidence linking the impact of trauma, parenting, and child maltreatment recidivism, current child welfare services often do not target maternal trauma and post-traumatic stress disorder (PTSD). Moreover, there is little evidence that traditional family preservation services (FPS) lower the rates of repeat incidences of child abuse and neglect. The novel intervention, Parenting-STAIR (P-STAIR), seeks to address maternal mental health and parenting skills in order to reduce punitive parenting behaviors. OBJECTIVE: This study analyzes the effects of P-STAIR on child maltreatment risk. PARTICIPANTS AND SETTING: P-STAIR was administered to 112 child welfare-involved mothers in New York City (NYC). The mothers were between 18 and 52 years old (M = 31.1, SD = 6.6) and were referred from 4 child welfare preventive service agencies in NYC. METHODS: To evaluate change over time in indicators of maltreatment risk, two-tailed paired sample t-tests compared 1) pre- and post-treatment scores and 2) pre-treatment and 3-month follow-up scores. RESULTS: Among the 71 mothers who completed treatment, significant improvements from baseline to post-assessment and pre- to 3-month follow-up were observed across total scores on the CTSPC and the AAPI-2. Improvements were evident in nonviolent disciple, psychological aggression, expectations, empathy, and parent-child family roles at both the post-assessment and 3-month follow-up which are proximal outcomes of P-STAIR (CTSPC: pre-post nonviolent disciple d = 0.70; pre-post psychological aggression d = 0.34; pre-follow-up nonviolent disciple d = 0.42; pre-follow-up psychological aggression d = 0.36; AAPI-2; pre-post expectations d = 0.31; pre-post empathy d = 0.39; pre-post parent-child roles d = 0.47; pre-follow-up expectations d = 0.33; pre-follow-up empathy d = 0.42; pre-follow-up parent-child roles d = 0.66). CONCLUSIONS: The improvement in indicators of maltreatment risk demonstrates promising support for the utility of P-STAIR within the child welfare system.

Social determinants of child abuse: Evidence from seven countries in sub-Saharan Africa.

BACKGROUND: Child abuse is a dominant public health concern that permeates race, varied social contexts and culture. Child abuse comprises any act of omission or commission perpetrated by a child's parent, caregiver, or other adult leading to harm, potential for, or any threat of harm to a child (below age 18), either intentional or unintentional. This subject has usually been explored by focusing on men. This study investigated the prevalence and social correlates of child abuse across seven countries in sub-Saharan Africa. METHODS AND MATERIALS: Data was obtained from Demographic and Health Surveys (DHS) conducted in seven countries in sub-Saharan Africa between 2013 and 2020. The outcome variable employed for this study was acts of child abuse (including shouting, striking, and slapping). Descriptive and inferential analyses were carried out. The descriptive analysis focused on the bivariate analysis between the country variable and the outcome variables. Multivariate analysis was, however, utilized to determine the relationship between the outcome variables and the respondents' explanatory variables, using a binary logistic regression model. The adjusted odds ratios for each variable were calculated using a 95% confidence range. RESULTS: The proportion of women shouting at children was 72 percent. This ranged from 49.2 percent in Chad to 84.2 percent in Benin. The proportion of women striking children was 52.5 percent and this ranged from 37.1 percent in Chad to 63.8 percent in Benin. The odds of women striking their children was higher for those with children aged 10-14 (aOR = 1.18, CI = 1.03, 1.34), women with primary education (aOR = 1.25, CI = 1.17, 1.33), cohabiting women (aOR = 1.17, CI = 1.10, 1.25) and women who had experienced intimate partner violence (aOR = 1.06, CI = 1.00, 1.12). The odds of women shouting at their children was higher for those aged 30-34 years (aOR = 1.31, CI = 1.11, 1.55) and for working women (aOR = 1.43, 1.33, 1.56). The odds of women slapping their children was higher for those who justify wife-beating (aOR = 1.10, CI = 1.03, 1.16) and for women with richest wealth status (aOR = 1.25, CI = 1.17, 1.33). CONCLUSIONS: The findings show that it is imperative for the governments of the countries studied, especially those with high prevalence like Benin, to consider parent-friendly and culturally acceptable non-formal educational initiatives that will dissuade parents and guardians from abusing children. Possibly, legal reforms that sanction harsher punishments to perpetrators of child abuse may help make child abuse less attractive to parents and guardians.

Evaluation of the relationship between childhood traumas and emotion regulation skills in terms of adult obesity.

This study aims to reveal the relationship between childhood traumas and emotion regulation skills of obese and non-obese individuals. The research is a comparative-descriptive and correlational study. The obese group included 52 people with a BMI ≥ 30, and the non-obese group included 58 people with a BMI ≤ 25 kg/m2. Information Form, Childhood Trauma Questionnaire (CTQ), and Emotion Regulation Skills Questionnaire (ERSQ) were used in the study data. The rates of total childhood trauma and physical neglect were significantly higher in obese individuals (53.8 % vs. 32.8 %; 50 % vs. 22.4 %, respectively) than in non-obese individuals. Obese individuals were found to have lower emotion regulation skills. While a significant inverse relationship was found between childhood trauma and emotion regulation skills total and sub-dimension scores in obese individuals, no significant relationship was found in non-obese individuals. Psychiatric-mental health nurses can play an active role in the prevention and treatment of obesity by providing emotion regulation training to individuals in their roles as counselors and educators.

Adverse Childhood Experiences Among Adolescents With Body Dysmorphic Disorder: Frequency and Clinical Correlates.

Increasing empirical attention has been given to the role of adverse childhood experiences (ACEs) in the development and maintenance of body dysmorphic disorder (BDD). Yet, current research has predominantly focused on adult and nonclinical BDD samples, and little is known about relevance of ACEs in adolescent BDD. The present study examined (a) the frequency of ACEs in adolescents with a primary diagnosis of BDD (n = 50) versus obsessive compulsive disorder (OCD) (n = 50) and (b) the clinical profile of ACE-exposed youth with BDD. ACEs were ascertained through a systematic search of electronic patient records, as well as through a parent- and self-report screening item for exposure to traumatic events. Results showed higher rate of peer victimisation (74% vs. 38%) and child maltreatment (44% vs. 24%) among BDD versus OCD youths; sexual abuse was the most common type of child maltreatment documented in the BDD group (28%) according to patient records. Parent-reported exposure to traumatic events was also significantly higher in the BDD than the OCD group (40% vs. 18%, respectively). Clinical presentation and treatment outcomes did not differ between those with versus without a history of ACEs. The current study is the first to demonstrate that a range of ACEs are common in adolescent BDD. Our findings highlight the importance of screening for these experiences. Although further research is needed, our findings also indicate that adolescents with BDD who have a history of ACEs are broadly similar in their clinical presentation to those without, and benefit from BDD-focused treatment.

The relationship between childhood maltreatment and self-harm: the mediating roles of alexithymia, dissociation, internalizing and posttraumatic symptoms.

Background: Although childhood maltreatment is associated with later self-harm, the mechanism through which it might lead to self-harm is not completely understood. The purpose of this study was to examine the roles of alexithymia, dissociation, internalizing and posttraumatic symptoms in the association between exposure to childhood maltreatment and subsequent self-harm.Methods: A total of 360 adolescents were asked to complete the Childhood Trauma Questionnaire, the Toronto Alexithymia Scale, the Dissociative Experience Scale, the Somatoform Dissociation Questionnaire-20, the Posttraumatic Stress Checklist for DSM-5, and the Deliberate Self-Harm Inventory.Results: Results of structural equation modelling analysis revealed the significant mediation effects of alexithymia and dissociative symptoms in the relationship between childhood maltreatment and self-harm, while internalizing and posttraumatic symptoms did not significantly mediate.Conclusion: The findings indicate that alexithymia and dissociative symptoms may be proximal mechanisms linking maltreatment exposure and adolescence self-harm.

Self-harm can be used as a maladaptive coping strategy in response to both hyper- and hypo-arousal symptoms.Alexithymia and dissociative symptoms may be proximal mechanisms linking maltreatment exposure and adolescent self-harm.Posttraumatic symptoms did not mediate the relationship between a history of childhood maltreatment and self-harm.

Childhood Maltreatment and Longitudinal Epigenetic Aging: NIMHD Social Epigenomics Program.

Importance: Child physical and emotional abuse and neglect may affect epigenetic signatures of accelerated aging several years after the exposure. Objective: To examine the longitudinal outcomes of early-childhood and midchildhood exposures to maltreatment on later childhood and adolescent profiles of epigenetic accelerated aging. Design, Setting, and Participants: This cohort study used data from the Future of Families and Child Wellbeing Study (enrolled 1998-2000), a US birth cohort study with available DNA methylation (DNAm) data at ages 9 and 15 years (assayed between 2017 and 2020) and phenotypic data at birth (wave 1), and ages 3 (wave 3), 5 (wave 4), 9 (wave 5), and 15 (wave 6) years. Data were analyzed between June 18 and December 10, 2023. Exposures: Emotional aggression, physical assault, emotional neglect, and physical neglect via the Parent-Child Conflict Tactics Scale at ages 3 and 5 years. Main Outcomes and Measures: Epigenetic accelerated aging (DNAmAA) was measured using 3 machine learning-derived surrogates of aging (GrimAge, PhenoAge, and DunedinPACE) and 2 machine learning-derived surrogates of age (Horvath and PedBE), residualized for age in months. Results: A total of 1971 children (992 [50.3%] male) representative of births in large US cities between 1998 and 2000 were included. Physical assault at age 3 years was positively associated with DNAmAA for PhenoAge (ß = 0.073; 95% CI, 0.019-0.127), and emotional aggression at age 3 years was negatively associated with PhenoAge DNAmAA (ß = -0.107; 95% CI, -0.162 to -0.052). Emotional neglect at age 5 years was positively associated with PhenoAge DNAmAA (ß = 0.051; 95% CI, 0.006-0.097). Cumulative exposure to physical assault between ages 3 and 5 years was positively associated with PhenoAge DNAmAA (ß = 0.063; 95% CI, 0.003-0.123); emotional aggression was negatively associated with PhenoAge DNAmAA (ß = -0.104; 95% CI, -0.165 to -0.043). The association of these measures with age 15 years PhenoAge DNAmAA was almost fully mediated by age 9 years PhenoAge DNAm age acceleration. Similar patterns were found for GrimAge, DunedinPACE, and PhenoAge, but only those for PhenoAge remained after adjustments for multiple comparisons. Conclusions and Relevance: In this cohort study, altered patterns of DNAmAA were sensitive to the type and timing of child maltreatment exposure and appeared to be associated with more proximate biological embedding of stress.

The Pediatrician's Role in Preventing Child Maltreatment: Clinical Report.

Pediatricians have always seen the value of preventing health harms; this should be no less true for child maltreatment than for disease or unintentional injuries. Research continues to demonstrate that maltreatment can be prevented, underscoring the vital roles of both the family and society in healthy childhood development and the importance of strong, stable, nurturing relationships in preventing maltreatment and building the child's resilience to adversity. This clinical report elaborates the pediatrician's multitiered role in supporting relational health from infancy through adolescence, from universal interventions assessing for maltreatment risks and protective factors to targeted interventions addressing identified needs and building on strengths. When maltreatment has already occurred, interventions can prevent further victimization and mitigate long-term sequelae. Advice is provided on engaging community resources, including those that provide food, shelter, or financial support for families in need.

Knowledge and awareness level of health undergraduate students on child abuse: a cross-sectional study.

OBJECTIVE: The aim of the study was to investigate the level of knowledge of symptoms and risks of child abuse among undergraduate health science students according to their socio-demographic characteristics. METHODS: This is a cross-sectional study involving 485 student volunteers. The data collection tools used in the study were the Demographic Data Collection Form and the Scale for Diagnosing Symptoms and Risks of Child Abuse and Neglect. RESULTS: It was found that health students' knowledge of the symptoms and risks of child abuse was moderate. It was also found that knowledge of diagnosing the symptoms and risks of child abuse was higher among women than among men, higher among those who had received education on child abuse, and increased with grade level. CONCLUSION: Child abuse is an important public health issue, and there is a need to raise awareness of this issue among health students.

Impact of family and caregiver factors on development and behaviours in maltreated young children.

Introduction: This study aimed to evaluate the prevalence of developmental and emotional/ behavioural concerns in maltreated children and to examine the impact of adverse family/caregiver risk factors on these outcomes. Method: We analysed family demographic and baseline data of 132 maltreated children and their caregivers from a family support programme in Singapore. We examined the associations of 3 main risk factors (i.e., caregiver mental health, educational attainment, and family socio-economic status [SES]) with developmental/behavioural outcomes using multivariable logistic regression, controlling for caregiver relationship to the child. Caregiver mental health was assessed using the Patient Health Questionnaire 9 (PHQ-9) and General Anxiety Disorder 7 (GAD-7) tools. Developmental/behavioural outcomes were assessed using the Ages and Stages Questionnaires (ASQ-3), ASQ-Social-Emotional (ASQ-SE), and the Child Behaviour Checklist (CBCL). Results: The children ranged in age, from 2 months to 3 years 11 months (median age 1.7 years, interquartile range [IQR] 0.9-2.6). Among caregivers, 86 (65.2%) were biological mothers, 11 (8.3%) were biological fathers, and 35 (26.5%) were foster parents or extended family members. Low family SES was associated with communication concerns on the ASQ-3 (adjusted odds ratio [AOR] 3.04, 95% CI 1.08-8.57, P=0.04). Caregiver mental health concerns were associated with increased behavioural concerns on the CBCL (AOR 6.54, 95% CI 1.83-23.33, P=0.004) and higher scores on the ASQ-SE (AOR 7.78, 95% CI 2.38-25.38, P=0.001). Conclusion: Maltreated children with caregivers experiencing mental health issues are more likely to have heightened emotional and behavioural concerns. Those from low SES families are also at increased risk of language delay, affecting their communication.