Recovery Trajectories in Adolescent Girls with Anorexia Nervosa.

Background: This study aimed to document recovery trajectories among adolescents with anorexia nervosa (AN) based on three markers of remission, namely changes in body weight, food restriction, and excessive exercise, and to identify predictors of these trajectories. Methods: One hundred twenty-six adolescent girls (14.7 ± 1.3 years) were recruited during initial assessment visits at specialized eating disorder (ED) programs in five University Health Centers across the province of Quebec, Canada. z-BMI and AN symptom severity (food restriction and excessive exercise) were assessed at initial assessment visits and subsequently reassessed at each quarterly follow-up over a 12-month period to identify recovery trajectories. Results: Considering the three markers of remission, three distinct trajectories emerged: Group 1, rapid responders; Group 2, gradual responders; and Group 3, unstable responders. At initial visits, a difference between groups was found regarding the type of treatment (p = 0.01) and weight suppression (p = 0.02). Group 1 had a higher number of youths hospitalized than Group 2 and Group 3, and a greater weight suppression than Group 3. Furthermore, individuals with atypical AN were more likely to belong to Group 2 than to Group 1 and Group 3 (p < 0.0001). Conclusions: This study contributes to a better understanding of the heterogeneity of recovery trajectories in adolescent girls with AN.

Faecal calprotectin: Marker of intestinal inflammatory process in anorexia nervosa? A preliminary study.

PURPOSE: Anorexia Nervosa (AN) is a serious and potentially lethal mental disorder characterised by a deliberate quest to reduce one's weight. It can have multiple physical and psychological consequences. The clinical presentation of AN can include gastrointestinal symptoms, however, the pathophysiology of these symptoms in the context of AN remains uncertain. It is hypothesised that patients with AN may have an increase in intestinal permeability, which could lead to an increase in faecal calprotectin (fCP), a marker of intestinal inflammation. No relation between AN and elevation of fCP has been previously described in literature. METHODS: Eight patients hospitalised for AN have a dosage of fCP. RESULTS: Calprotectine was found to be elevated in 50% of cases, with or without any underlying comorbid gastrointestinal disease. Only the duration of illness tended to be associated with the increase in fCP suggesting a greater alteration as a function related to the time of denutrition. CONCLUSION: Although these findings provide insights in the potential pathophysiology of gastrointestinal symptoms in AN, further studies that evaluate the factors associated with elevated fCP in patients with AN are needed.

Traumatic head injury due to child maltreatment: epidemiology, cost analysis, and impact of prevention.

BACKGROUND: Traumatic head injury due to child maltreatment (THI-CM), also known as abusive head trauma (AHT), is a significant public health problem due to the wide array of consequences affecting multiple domains of a child's health and development. Several studies have evaluated its cost on healthcare systems, families, and societies. Many jurisdictions have implemented caregiver education programs to prevent THI-CM. OBJECTIVES: This paper aims to provide a brief overview of the epidemiology and cost analysis of THI-CM and discuss its prevention and the intergenerational transmission of child maltreatment. METHODS: Although not systematic, a literature search of original articles published from 2000 to 2022 in English and French was undertaken using the following databases: PubMed, EMBASE (Ovid), and PsycINFO (OVID). The search combined terms related to traumatic head injury and child maltreatment, with terms related to its cost and prevention. Studies of children aged 0-5 years old were included. The authors completed a screen of the titles and abstracts to determine relevance with respect to this article. RESULTS: Globally, although THI-CM accounts for a small proportion of cases of child maltreatment, there is a high incidence of death and neurological sequelae compared to other causes of head trauma.The incidence of THI-CM is likely underestimated due to the lack of standardized definitions, differences in reporting, and challenges in identifying less severe cases. Cost analysis studies reveal the significant short- and long-term costs associated with THI-CM. Caregiver education programs have been studied and implemented in many centers and have shown varying but promising results. CONCLUSION: A multi-pronged approach to prevention efforts should be considered to support families and help to prevent THI-CM and maltreatment throughout childhood.

To Improve the Initial Inpatient Management of Adolescents Admitted with Severe Anorexia Nervosa: A Narrative Review and a Convenient Protocol.

Inadequate nutritional rehabilitation of severely malnourished adolescents with Anorexia Nervosa (AN) increases the risk of medical complications. There is no consensus on best practices for inpatient nutritional rehabilitation and medical stabilization for severe AN. This study aimed to elaborate an admission protocol for adolescents with severe AN based on a comprehensive narrative review of current evidence. A Pubmed search was conducted in July 2017 and updated in August 2020, using the keywords severe AN or eating disorders (ED), management guidelines and adolescent. Relevant references cited in these guidelines were retrieved. A secondary search was conducted using AN or ED and refeeding protocol, refeeding syndrome (RS), hypophosphatemia, hypoglycemia, cardiac monitoring or cardiac complications. Evidence obtained was used to develop the admission protocol. Selective blood tests were proposed during the first three days of nutritional rehabilitation. Higher initial caloric intake is supported by evidence. Continuous nasogastric tube feeding was proposed for patients with a BMI < 12 kg/m2. We monitor hypoglycemia for 72 h. Continuous cardiac monitoring for bradycardia <30 BPM and systematic phosphate supplementation should be considered. Developing protocols is necessary to improve standardization of care. We provide an example of an inpatient admission protocol for adolescents with severe AN.

Exploring the Relationships Between Child Maltreatment and Risk Factors for Pregnancy Complications.

OBJECTIVE: This study explored the pathways underlying the relationships between child maltreatment (CM) subtypes (i.e., physical, sexual, and emotional abuse and neglect) and factors associated with a heightened risk of pregnancy complications by examining post-traumatic stress disorder (PTSD) symptoms as a potential mediator. METHODS: A sample of 98 pregnant parents between the ages of 18 and 29 years was recruited through social media and community organizations throughout Canada. Participants completed a series of surveys on their exposure to CM, PTSD symptoms, and pregnancy experiences on a secure online platform. Following data cleaning procedures, 85 participants were included in this study. RESULTS: Four separate mediation analyses were conducted with child neglect, physical abuse, sexual abuse, and emotional abuse as factors associated with a heightened risk of pregnancy complications (i.e., a congregate score of limited prenatal care, weight gain concerns, smoking, second-hand smoke, alcohol consumption, substance use, and insufficient food intake during pregnancy). Each CM subtype was associated with increased PTSD symptoms, which were in turn associated with the presence of more factors known for increasing the risk of pregnancy complications. Neglect, physical abuse, sexual abuse, and emotional abuse were all indirectly associated with the presence of more factors associated with a heightened risk of pregnancy complications through their association with PTSD symptoms. CONCLUSIONS: Findings from this study could encourage prenatal care providers to screen for CM history and PTSD symptoms. Furthermore, mental health treatment early in the prenatal period may improve pregnant parents' health and lower their risk of pregnancy complications.

Initial inpatient management of adolescents and young adults admitted with severe malnutrition due to anorexia nervosa: protocol for a systematic review.

BACKGROUND: Anorexia Nervosa (AN) is a highly prevalent disease in adolescents and young adults (AYAs). The quality of initial inpatient medical management in a patient with severe malnutrition due to AN is crucial to prevent further medical instability. This review aims to inventory evidence regarding initial refeeding and management of AYAs with AN in an inpatient setting, in order to avoid medical complications. METHODS: A systematic review will be conducted using PubMed, MEDLINE, All EBM Reviews, Embase, PsycINFO, Cochrane Database and CINAHL. The search strategy consists of terms related to anorexia, hospitalization and Pediatrics. Randomized controlled trials, case-control studies, cross-sectional and cohort studies will be included. Participants will include adolescents and adults 18-24 years old diagnosed with AN and meeting criteria for severe disease. The primary outcome will be any of the following complications: hypophosphatemia, refeeding syndrome, hypoglycemia, cardiac arrythmia, hepatic cytolysis or death. Data will be extracted and the risk of bias will be assessed by one author and reviewed by a second author. Results will be presented in a systematic narrative synthesis format. The quality of evidence for all outcomes will be evaluated using the GRADE methodology. DISCUSSION: This systematic review will examine current evidence on initial inpatient refeeding and help to document effectiveness of initial inpatient management in AYAs with severe AN in avoiding further medical complications. TRIAL REGISTRATION: This study is registered on PROSPERO under the reference number CRD42019123608 .

A Longitudinal Study of Suicidal Ideation in Sexually Abused Adolescent Girls: Depressive Symptoms and Affect Dysregulation as Predictors.

Child sexual abuse (CSA) is associated with many repercussions on adolescents' mental health, including suicidal ideation. Yet, the mechanisms linking CSA to adverse outcomes have rarely been investigated within a longitudinal design. The current study aimed to examine the role of affect dysregulation in the association between depressive symptoms and suicidal ideation 1year after the first assessment in a sample of 119 sexually abused adolescent girls. An integrative mediational model was conceptualized to examine the explicatory role of affect dysregulation (Time 2) in the association between depressive symptoms (Time 1) and suicidal ideation (Time 3). Approximately 31% of the girls reported suicidal ideation at Time 3. Path analysis with logistic regressions revealed that the association between depressive symptoms and suicidal ideation presence was partly explained by affect dysregulation, which increased the risk of suicidal ideation presence by 18.4%, OR = 1.18, 95% CI [1.07, 1.33]. The integrative model explained 21.5% of the variance in suicidal ideation. These findings identify potential predictors of suicidal ideation among sexually abused adolescent girls. This present study highlights the role of affect dysregulation in the presence of suicidal ideation and provides potential targets for intervention practices when working with adolescent girl victims of CSA. As such, interventions for this vulnerable population should aim to decrease depressive symptoms and affect dysregulation to reduce suicidal risk.

Hormonal Contraception Effects on Pulmonary Function in Adolescents with Cystic Fibrosis.

STUDY OBJECTIVE: Estrogens are suspected to have a negative effect on pulmonary function in women with cystic fibrosis (CF). The aim of our study was to investigate, in a CF adolescent population, the effect of hormonal contraception (HC) on lung function by assessing the forced expiratory volume in 1 second (FEV1), the number of exacerbations of pulmonary condition, and antibiotic use. DESIGN, SETTING, PARTICIPANTS, INTERVENTIONS, AND MAIN OUTCOME MEASURES: We conducted a cohort retrospective chart review of girls from age 13 to 18 years old who were followed in the CF clinic of a university hospital center. Wilcoxon rank sum test with continuity correction, 2-sample t test, conditional test of Poisson rates, and χ2 test were conducted to identify differences in results between adolescents with or without use of HC for the following outcomes: FEV1, use of antibiotics by nebulizer, and hospital admission for exacerbations of pulmonary condition. RESULTS: Among 127 adolescents, 64/127 (50.4%) took HC; 12/127 (9%) continuously had been taking HC over 3 years. For girls taking HC for more than 3 years, FEV1 at 18 years old was significantly higher than for girls who had never taken HC (85.17% vs 71.05%; P = .043). However, there was no difference in the number of hospital admissions for exacerbation of pulmonary condition between these 2 groups (P = .057). There was no difference between HC vs non-HC users in the percent of patients taking antibiotics by nebulizer over the 6 years of follow-up. CONCLUSION: Our study suggests that in adolescents with CF, HC has no deleterious effects on the FEV1. Further prospective studies could be done to confirm these results.

Relationship between Child Sexual Abuse, Psychiatric Disorders and Infectious Diseases: A Matched-Cohort Study.

Child sexual abuse (CSA) has been strongly associated with a range of psychological and physical problems in childhood and adulthood, such as anxiety, post-traumatic stress disorder (PTSD), and infectious diseases. Despite the strength of these associations, no studies to date have investigated psychobiological processes that might underlie the relationship between CSA and physical health problems occurring during childhood, such as infectious diseases. The goal of the current study is to evaluate PTSD as a potential mediator between CSA and the occurrence of infectious diseases among children and adolescents. Furthermore, we postulate that PTSD plays a specific role as an indicator of chronic stress during childhood, in comparison to other mental disorders, such as anxious and non-anxious disorders (e.g., depression). Via a prospective matched-cohort design, administrative data were used to document PTSD, anxious and non-anxious disorders, and infectious diseases. The sample size was 882 persons with a substantiated report of sexual abuse and 882 matched controls. Negative binomial regressions revealed that CSA is associated with a greater number of anxious diseases diagnoses that, in turn, predict more infectious diseases diagnoses. These findings highlight the importance of preventing and intervening among sexually abused youth with anxious disorder symptoms to limit negative outcomes on physical health.

In malnourished adolescent with anorexia nervosa, Cockroft-Gault formula is the most relevant formula to estimate renal function.

AIM: Serum creatinine level is the most used test to evaluate renal function in patients with anorexia nervosa (AN). We investigated which formula of glomerular filtration rate (GFR) based on simple blood sample had the best correlation with the gold standard in malnourished adolescent patients with AN. METHODS: A prospective study was conducted on 34 adolescents hospitalized for the restrictive type of AN between 2014 and 2017. The GFR was measured by isotopic technique and calculated using the Cockroft-Gault, Schwartz equations and 3 other formula. RESULTS: For the 34 AN patients, mean BMI -2.7 zscore, the mean measured GFR was 107+/-26 mL/min/1.73 m2. Among them, 35% (12/34) had a GFR under 90 mL/min/1.73 m2. The calculated GFR with Cockroft-Gault formula had the best correlation with the measured GFR (R2 = 0.852), whatever the creatinine level. No correlation was found between creatinine level and measured GFR. CONCLUSION: Kidney dysfunction is common in malnourished AN adolescents, so clinicians should always evaluate AN patients for renal impairments. Creatinine level is a poor indicator of renal function in this population. The most accurate formula to test GFR with a simple blood test is the Cockroft-Gault formula.

Excessive laboratory monitoring to prevent adolescent's refeeding syndrome: opportunities for enhancement.

PURPOSE: Anorexia nervosa (AN) is a complex medical condition affecting mainly adolescents and young adults. To monitor and prevent refeeding syndrome, current guidelines recommend daily laboratory testing in the first week of hospitalization and 2-3 times/week for the following 3 weeks. The aims of this study were to determine the proportion of abnormal results of the blood tests done during the first week of nutritional rehabilitation in adolescents with AN, the proportion of test having led to supplementation and the cost of all these tests. METHOD: A retrospective chart review of admissions for eating disorders between May 2014 and May 2015 in a tertiary Pediatric University Hospital center was performed. Patients were included if they were younger than 18 years, admitted for protocol-based refeeding and met criteria for AN (DSM 5). RESULTS: Among the 99 hospitalizations included in the study, the mean age was 14.6 years (± 1.7), with a female predominance (97%). The mean admission BMI was 15.3 ± 2 kg/m2 (Z-score - 2.6 ± 1.4). The mean length of hospitalization was 40.3 days ± 21.8. Of the 1289 laboratory tests performed, only 1.5% revealed abnormal values and 0.85% led to supplementation. No critical value was identified. The total cost for the tests performed was 148,926.80 CAD$, 1504$/admitted patient, instead of 3890$/admitted patient had we followed the recommendations. CONCLUSION: More precise criteria should be developed regarding the frequency of laboratory tests needed to monitor and prevent refeeding syndrome. At present, the recommendations could lead to unnecessary testing and expenses. LEVEL OF EVIDENCE: Level IV: Dramatic results in uncontrolled trials.

Self-Blame, Shame, Avoidance, and Suicidal Ideation in Sexually Abused Adolescent Girls: A Longitudinal Study.

Depressive symptoms, posttraumatic stress disorder, and suicidal ideation are among the most prevalent problems associated with sexual abuse. Based on the Traumagenic dynamic of stigmatization model, the aim of this study was to investigate whether self-blame, shame, and maladaptive coping strategies predicted posttraumatic stress disorder, depressive symptoms, and suicidal ideation among sexually abused adolescent girls using a longitudinal design. A total of 100 adolescent girls completed a series of questionnaires at the initial visit at the intervention center (T1) and 6 months later (T2). Path analysis reveals shame at T1 predicted posttraumatic stress disorder symptoms at T2 whereas self-blame at T1 predicted depressive symptoms at T2. Furthermore, avoidance coping at T1 and depressive symptoms at T2 predicted suicidal ideation at T2 and accounted for 54% of the variance. These findings suggest that interventions designed for sexually abused adolescent girls should target shame, self-blame, and avoidance coping to foster recovery in this vulnerable population.

Association between child sexual abuse and infectious disease diagnoses.

BACKGROUND: Though many studies have linked child sexual abuse (CSA) to psychological health problems, little is known regarding the relationship between CSA and children and adolescents' physical health. OBJECTIVE: The objective of this study was to assess the relationship between CSA and infectious disease diagnoses. PARTICIPANTS: Of the 955 eligible children and adolescents who had a substantiated report of sexual abuse between 2001 and 2010, medical data was retrieved for 882 individuals, who formed the sexually abused group. These 882 participants were matched to 882 participants on age, gender, and administrative healthcare region to form the general population group. SETTING AND METHODS: This matched-cohort study, conducted in a large Canadian city, compared the number of infectious disease diagnoses between the date of the substantiated sexual abuse report and August 1, 2013, between the two groups. RESULTS: Results indicate that sexually abused participants had 1.27 times more (95% CI - 1.13 to 1.42) infectious diseases diagnoses than those from the general population. They received 1.83 times more genitourinary infection diagnoses (95% CI - 1.43 to 2.33), 1.31 times more diagnoses for other types of infections (95% CI - 1.11 to 1.55) and 1.21 times more respiratory and ear infection diagnoses (95% CI - 1.05 to 1.40). There was no statistically significant difference regarding skin infection diagnoses. These results indicate an association between CSA and more frequent infectious diseases diagnoses.

A Matched Cohort Study of the Association Between Childhood Sexual Abuse and Teenage Pregnancy.

PURPOSE: This matched cohort study aims to determine whether teenagers with a history of childhood sexual abuse (CSA) are at greater risk of consulting for a pregnancy and related complications than teenagers from the general population. It also aims to compare provoked abortion, live births, and fetal losses of participants who were sexually abused in childhood and those of the general population. METHODS: A total of 661 girls (aged 13-18 years) with a corroborated by Child Protection Services CSA report between 2001 and 2010 were matched to 661 girls from the general population upon age, biological sex, urban Child Protection Services area, and public drug insurance admissibility at reporting date. Pregnancy consultations and complications during pregnancy and delivery were documented using diagnoses from public health insurance administrative databases from January 1996 to March 2013. Socioeconomic status was controlled. RESULTS: Results indicate that compared with participants from the general population, those with a history of CSA were 4.6 times more likely to consult for at least one pregnancy, 5.3 times more likely to consult for at least one complication during pregnancy or delivery, and on average 5.2 and 3.3 times more likely to consult for at least one live birth and provoked abortion, respectively. There were too few observations to compare fetal losses between groups. CONCLUSIONS: Medical interventions for teenage pregnancies and related complications should take into consideration a possible history of CSA to reinforce gynecological follow-up and treatment for girls who were sexually abused and to prevent unfavorable outcomes.

The behavioral and affective profile of inpatient adolescent girls with restrictive anorexia nervosa.

BACKGROUND: A better understanding of the individual difficulties reported by adolescents presenting with anorexia nervosa seems like an interesting avenue to refine our understanding of their psychological functioning. OBJECTIVE: This study aimed to: (1) describe the behavioral and affective profile of difficulties of inpatient adolescent girls presenting a restricting type of anorexia (ANR); and (2) investigate the presence of a relationship between behavioral and affective problems and severity of the disorder. METHODS: The sample consisted of 52 inpatient adolescent girls presenting an ANR. The youth self report assessed the behavioral and emotional profile of difficulties of participants while the Eating Disorder Risk Composite of the Eating Disorder Inventory measured the symptomatology of the disorder. A ratio between body mass index at admission and at the end of the treatment served as an indicator of weight gain. RESULTS: The sample presented an internalized profile of problems. Individual differences were found and three profiles of difficulties were present in the sample: normative, pure internalizing and mixed (clinical on the internalizing and externalizing clusters). CONCLUSION: This study provides information on the heterogeneity of this specific population otherwise quite similar and demonstrates how severity of the disorder can be associated with a wide range of other behavioral and affective difficulties. LEVEL OF EVIDENCE: Level V, cross-sectional descriptive study.

Caregiving experience and expressed emotion among parents of adolescents suffering from anorexia nervosa following illness onset.

The aim of this study was to better understand the relationship between parents' experience of caregiving and expressed emotion during the early stage of their child's eating disorder. Fifty mothers and 38 fathers of adolescents suffering from anorexia nervosa and hospitalized for the first time participated in this study. They completed the Experience of Caregiving Inventory, a measure of the negative and positive aspects of the caregiving experience, and the Family Questionnaire, which measured the different dimensions of expressed emotion, namely emotional over-involvement and critical comments. Results showed that caregiving experience is significantly and positively correlated to expressed emotion. Among the negative aspects of caregiving, sense of loss contributed most to emotional over-involvement, while difficult behaviours contributed most to critical comments. The results suggest that parents' perceptions of their child and child's future are strongly related to their tendency to be over-involved. The perception of disruptive behaviours in their child could be one of the principal triggers or exacerbating factors of parents' critical attitudes.

Renal injury in pediatric anorexia nervosa: a retrospective study.

PURPOSE: Although primarily a mental health disorder, anorexia nervosa (AN) has many physical consequences. Among them, the consequences on kidney function are often underestimated. We evaluated renal function in adolescent AN inpatients and investigated the correlation between the GFR and intrinsic patient characteristics. METHODS: A single-center retrospective study was conducted on 51 patients hospitalized for the restrictive type of AN in 2013. Data were divided into: (1) medical history of AN; (2) growth parameters and vital signs upon admission; and (3) blood tests. The glomerular filtration rate (GFR) was calculated using the Cockroft-Gault, MAYO Clinical Quadratic (MCQ), Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI), the Modification of Diet in Renal Disease (MDRD), and Schwartz equations. RESULTS: The calculated percentages of patients with a GFR below 90 mL/min/1.73 m2 according to the different equations were as follows: Cockroft-Gault, 45%; MDRD, 28%; CKD-EPI, 14%; MCQ, 12%, and Schwartz, 4%. There was a strong association between the body mass index (BMI) and the GFR according to all equations (p < 0.0001). The lowest heart rate was significantly associated with a reduced GFR according to the Cockroft-Gault equation (p = 0.03). The GFR values did not differ significantly after rehydration. CONCLUSION: Clinicians should evaluate AN patients for renal complications, especially when the BMI and heart rate are very low. Dehydration was not solely responsible for renal impairment. LEVEL OF EVIDENCE: Level III, single-center retrospective cohort study.

Anorexia nervosa in adolescents: evolution of weight history and impact of excess premorbid weight.

The purpose of our study is to establish if the proportion of patients diagnosed with anorexia nervosa that have a history of excess weight has increased over a 10-year period and to study how different premorbid weight groups vary in terms of clinical characteristics. We performed a single-center, retrospective cohort study of all new patients presenting with anorexia nervosa, restrictive and binge/purge subtypes, in 2004 and 2014 at the Adolescent Medicine Clinic of Sainte-Justine University Health Centre (n = 172). The prevalence of excess premorbid weight was similar in both cohorts (32% in 2004 versus 29.5% in 2014). The historically overweight subgroup had a lower heart rate at intake (64.77 versus 69.75, p = 0.03). Patients with excess premorbid weight lost an average of 1 kg more per month than their historically thinner counterparts (2.6 kg versus 1.6 kg/month, p = 0.0011). The total decrease in BMI was much greater in patients with a history of excess weight (7 BMI points versus 3.8, p = 0.0001).Conclusion: Since overweight and obese patients present with significant weight suppression values, our study stresses the importance of screening for AN in all patients rather than in only the noticeably underweight. What is Known: • More than one third of patients presenting with AN have a history of overweight or obesity, which is comparable to the general population. • A delay between AN onset and diagnosis has been described in overweight adolescents. What is New: • Historically overweight patients presenting with AN demonstrate increased speed of weight loss, greater drop in BMI, and lower heart rate at presentation. • For patients with a history of excess weight considered as having recovered from AN, the average BMI at discharge was within normal limits.

Sleep problems and interpersonal violence in youth in care under the Quebec Child Welfare Society.

OBJECTIVE: The objective this study was to investigate the relative contributions of gender, common mental health symptoms, and experiences of interpersonal violence to the presence of sleep disturbances in Youth in Care under Child Welfare Society admitted to residential facilities. METHODS: A sample of 315 teenagers (14-18 years old) completed a self-reported questionnaire upon admission, followed by a medical consultation with a nurse and a physician. Information regarding experiences of interpersonal violence, mental health symptoms, and sleep disturbances was collected using a standardized questionnaire. RESULTS: Anxiety, ADHD symptoms, and sexual abuse were associated with sleep disturbances, F(10, 264) = 5.95, p < 0.001. Results from hierarchical regression analyses revealed that experiences of interpersonal violence, more specifically sexual abuse, were associated with sleep disturbances over and beyond gender and the presence of mental health symptoms. CONCLUSIONS: These results highlight practical implications for health professionals in terms of assessment and intervention for vulnerable youth exposed to interpersonal violence. Implications for research and practice are discussed.