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1.
Pediatrics ; 146(4)2020 10.
Artículo en Inglés | MEDLINE | ID: mdl-32938778

RESUMEN

BACKGROUND: Involvement with Child Protective Services (CPS) provides an opportunity to recognize those children at risk for ongoing adverse childhood experiences (ACEs). The relationship between ACEs and child health among CPS-involved children and the role of primary care providers (PCPs) in moderating this relationship is unknown. METHODS: We conducted a convergent mixed-methods study of caregivers of children age 2 to 12 years with a CPS finding of physical abuse, modeling the association between cumulative ACEs and child health-related quality of life (HRQoL) using the PedsQL4.0, a validated 23-item survey of multidimensional health, with and without the moderator of a patient-centered medical home. Interviews elicited descriptions of a child's experience with ACEs, the impact of ACEs on child health, and the role of a PCP in this context. RESULTS: One hundred seventy-eight surveyed caregivers reported a mean of 5.5 (±3.3) ACE exposures per child. In a fully adjusted model, each ACE resulted in a 1.3-point (95% confidence interval: 0.7-2.0) reduction in HRQoL, a clinically important difference in HRQoL associated with ACE exposures. This association was explained by reduced psychosocial HRQoL and was not moderated by a patient-centered medical home. Twenty-seven interviewed caregivers described the influence of ACEs on a child's health. Many felt that a trusted PCP could support a child's well-being after such experiences. CONCLUSIONS: Children with CPS involvement have ACE exposures that are associated with reduced HRQoL. Although PCPs are often unaware of CPS involvement or other ACEs, many caregivers welcome the support of a child's PCP in improving child well-being after adversity.


Asunto(s)
Experiencias Adversas de la Infancia/estadística & datos numéricos , Cuidadores/psicología , Maltrato a los Niños/psicología , Salud del Niño , Servicios de Protección Infantil , Calidad de Vida/psicología , Adulto , Cuidadores/estadística & datos numéricos , Niño , Preescolar , Intervalos de Confianza , Femenino , Humanos , Masculino , Atención Dirigida al Paciente , Investigación Cualitativa , Tamaño de la Muestra
2.
PLoS One ; 15(9): e0238320, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32911529

RESUMEN

AIM: In view of the current context of poverty and socio-economic inequalities and the high and rising burdens of HIV infection and non-communicable diseases in South Africa, this study aims to describe the distribution of adverse life events (ALEs) by age and gender, and examine the socio-demographic characteristics, psychosocial coping mechanisms, risky lifestyle behaviours and family burden of HIV-related ill-health associated with ALEs in 25-74-year-old black residents of Cape Town. MATERIALS AND METHODS: In a random cross-sectional sample, 12 ALEs, tobacco and alcohol use, sense of coherence (SOC), locus of control (LOC) and impact of HIV in the family were determined by administered questionnaires. Data analyses included descriptive statistics adjusted for the realised sample. Multivariable linear regression models assessed the independent associations of increasing number of ALEs. RESULTS: Among 1099 participants, mean lifetime score of ALE categories examined was 6.1 ±2.1 (range 0-12) with men reporting significantly higher number of events compared with women (p<0.001). The most frequent ALE was the death of a loved one (88.5%) followed by a major financial crisis (81.2%) with no trend across gender or age group. In the multivariable linear regression model, increasing ALEs were significantly associated with male gender, unemployment, having spent >50% of life in urban areas, >7 years of education, problematic alcohol use and poorer psychosocial coping mechanisms defined by low SOC and LOC. All four variables pertaining to HIV-related burden of ill-health in the family were significantly associated with increasing ALEs. CONCLUSIONS: Considering that lower SOC and LOC and problem drinking were significantly linked to ALEs, policymakers need to formulate strategies that improve coping mechanisms and promote problem-solving behaviours, target the high burden of alcohol misuse and address unemployment.


Asunto(s)
Adaptación Psicológica , Experiencias Adversas de la Infancia/estadística & datos numéricos , Consumo de Bebidas Alcohólicas/epidemiología , Infecciones por VIH/complicaciones , Acontecimientos que Cambian la Vida , Fumar Tabaco/epidemiología , Población Urbana/estadística & datos numéricos , Adulto , Grupo de Ascendencia Continental Africana , Anciano , Estudios Transversales , Femenino , VIH/aislamiento & purificación , Infecciones por VIH/psicología , Infecciones por VIH/virología , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Factores de Riesgo , Sudáfrica/epidemiología
3.
BMC Public Health ; 20(1): 1327, 2020 Sep 10.
Artículo en Inglés | MEDLINE | ID: mdl-32907569

RESUMEN

BACKGROUND: Adversity experienced during childhood manifests deleteriously across the lifespan. This study provides updated frequency estimates of ACEs using the most comprehensive and geographically diverse sample to date. METHODS: ACEs data were collected via BRFSS (Behavioral Risk Factor Surveillance System). Data from a total of 211,376 adults across 34 states were analyzed. The ACEs survey is comprised of 8 domains: physical/emotional/sexual abuse, household mental illness, household substance use, household domestic violence, incarcerated household member, and parental separation/divorce. Frequencies were calculated for each domain and summed to derive mean ACE scores. Findings were weighted and stratified by demographic variables. Group differences were assessed by post-estimation F-tests. RESULTS: Most individuals experienced at least one ACE (57.8%) with 21.5% experiencing 3+ ACEs. F-tests showed females had significantly higher ACEs than males (1.64 to 1.46). Multiracial individuals had a significantly higher ACEs (2.39) than all other races/ethnicities, while White individuals had significantly lower mean ACE scores (1.53) than Black (1.66) or Hispanic (1.63) individuals. The 25-to-34 age group had a significantly higher mean ACE score than any other group (1.98). Generally, those with higher income/educational attainment had lower mean ACE scores than those with lower income/educational attainment. Sexual minority individuals had higher ACEs than straight individuals, with significantly higher ACEs in bisexual individuals (3.01). CONCLUSION: Findings highlight that childhood adversity is common across sociodemographic, yet higher in certain categories. Identifying at-risk populations for higher ACEs is essential to improving the health outcomes and attainment across the lifespan.


Asunto(s)
Experiencias Adversas de la Infancia/estadística & datos numéricos , Divorcio , Composición Familiar , Trastornos Mentales , Prisiones , Trastornos Relacionados con Sustancias , Violencia , Adolescente , Adulto , Afroamericanos , Anciano , Sistema de Vigilancia de Factor de Riesgo Conductual , Niño , Preescolar , Grupos Étnicos , Femenino , Hispanoamericanos , Humanos , Masculino , Persona de Mediana Edad , Padres , Factores de Riesgo , Factores Socioeconómicos , Adulto Joven
4.
PLoS One ; 15(9): e0239940, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32991598

RESUMEN

BACKGROUND: Exposure to adverse childhood experiences (ACEs) is associated with many childhood diseases and poor health outcomes in adulthood. However, the association with childhood obesity is inconsistent. We investigated the association between reported cumulative ACE score and body mass index (BMI) in a large sample of patients at a single institution. METHODS: This cross-sectional study included children aged 2-20 years that were screened in a general pediatrics clinic for ACEs utilizing the Center for Youth Wellness ACEs questionnaire between July 2017 and July 2018. Overall ACE score was categorized as 'no exposure' (score = 0), 'low exposure' (score = 1), and 'high exposure' (score≥ 2). BMI was categorized as overweight/obese (BMI percentile ≥ 85) or non-obese (BMI percentile < 85). The association between ACEs score and obesity was determined using univariate and multivariable logistic regression. RESULTS: Of the 948 patients included in the study, 30% (n = 314) were overweight/obese and 53% (n = 504) had no ACE exposure, 19% (n = 179) had low ACE exposure, and 28% (n = 265) had high ACE exposure. High ACE exposure was associated with increased odds of obesity (OR = 1.47, 95%CI = 1.07-2.03, p = 0.026). However, after adjusting for age, race/ethnicity, insurance type, and birth weight, the association attenuated and was null (OR = 1.01, 95%CI = 0.70-1.46, p = 0.97). CONCLUSION: The study findings may suggest an association between ACE and childhood obesity. However, the association attenuated after adjusting for age, race/ethnicity, insurance type, and birth weight. Larger prospective studies are warranted to better understand the association.


Asunto(s)
Experiencias Adversas de la Infancia/estadística & datos numéricos , Obesidad Pediátrica/epidemiología , Adolescente , Niño , Preescolar , Femenino , Humanos , Masculino , Obesidad Pediátrica/psicología , Factores Socioeconómicos , Adulto Joven
5.
Pediatrics ; 146(3)2020 09.
Artículo en Inglés | MEDLINE | ID: mdl-32747472

RESUMEN

BACKGROUND AND OBJECTIVES: Little is known about the 2% of US children being raised by their grandparents. We sought to characterize and compare grandparent- and parent-headed households with respect to adverse childhood experiences (ACEs), child temperament, attention-deficit/hyperactivity disorder (ADHD), and caregiver aggravation and coping. METHODS: Using a combined data set of children ages 3 to 17 from the 2016, 2017, and 2018 National Survey of Children's Health, we applied survey regression procedures, adjusted for sociodemographic confounders, to compare grandparent- and parent-headed households on composite and single-item outcome measures of ACEs; ADHD; preschool inattention and restlessness; child temperament; and caregiver aggravation, coping, support, and interactions with children. RESULTS: Among 80 646 households (2407 grandparent-headed, 78 239 parent-headed), children in grandparent-headed households experienced more ACEs (ß = 1.22, 95% confidence interval [CI]: 1.07 to 1.38). Preschool-aged and school-aged children in grandparent-headed households were more likely to have ADHD (adjusted odds ratio = 4.29, 95% CI: 2.22 to 8.28; adjusted odds ratio = 1.72, 95% CI: 1.34 to 2.20). School-aged children in these households had poorer temperament (ßadj = .25, 95% CI: -0.63 to 1.14), and their caregivers experienced greater aggravation (ßadj = .29, 95% CI: 0.08 to 0.49). However, these differences were not detected after excluding children with ADHD from the sample. No differences were noted between grandparent- and parent-headed households for caregiver coping, emotional support, or interactions with children. CONCLUSIONS: Despite caring for children with greater developmental problems and poorer temperaments, grandparent caregivers seem to cope with parenting about as well as parents.


Asunto(s)
Experiencias Adversas de la Infancia/estadística & datos numéricos , Salud de la Familia , Abuelos/psicología , Responsabilidad Parental/psicología , Padres/psicología , Adaptación Psicológica , Adolescente , Trastorno por Déficit de Atención con Hiperactividad/epidemiología , Niño , Preescolar , Intervalos de Confianza , Estudios Transversales , Escolaridad , Femenino , Abuelos/educación , Estado de Salud , Humanos , Masculino , Oportunidad Relativa , Evaluación de Resultado en la Atención de Salud , Relaciones Padres-Hijo , Padres/educación , Agitación Psicomotora/epidemiología , Familia de Padres Solteros/psicología , Familia de Padres Solteros/estadística & datos numéricos , Apoyo Social , Temperamento
6.
BMC Oral Health ; 20(1): 202, 2020 07 11.
Artículo en Inglés | MEDLINE | ID: mdl-32652974

RESUMEN

BACKGROUND: Adverse childhood experiences (ACE) and bullying have negative effects on oral health. Promotive assets (resilience, self-esteem) and resources (perceived social support) can ameliorate their negative impact. The aim of this study was to determine the association between oral diseases (caries, caries complications and poor oral hygiene), ACE and bully victimization and the effect of access to promotive assets and resources on oral diseases. METHODS: This was a secondary analysis of data collected through a cross-sectional school survey of children 6-16-years-old in Ile-Ife, Nigeria from October to December 2019. The outcome variables were caries, measured with the dmft/DMFT index; caries complications measured with the pufa/PUFA index; and poor oral hygiene measured with the oral hygiene index-simplified. The explanatory variables were ACE, bully victimization, resilience, self-esteem, and social support. Confounders were age, sex, and socioeconomic status. Association between the explanatory and outcome variables was determined with logistic regression. RESULTS: Of the 1001 pupils with complete data, 81 (8.1%) had poor oral hygiene, 59 (5.9%) had caries and 6 (10.2%) of those with caries had complications. Also, 679 (67.8%) pupils had one or more ACE and 619 (62.1%) pupils had been bullied one or more times. The median (interquartile range [IQR]) for ACE was 1(3), for bully victimization was 1(5), and for self-esteem and social support scores were 22(5) and 64(34) respectively. The mean (standard deviation) score for resilience was 31(9). The two factors that were significantly associated with the presence of caries were self-esteem (AOR: 0.91; 95% CI: 0.85-0.98; p = 0.02) and social support (AOR: 0.98; 95% CI: 0.97-1,00; p = 0.02). No psychosocial factor was significantly associated with caries complications. Self-esteem was associated with poor oral hygiene (AOR: 1.09; 95% CI: 1.09-1.17; p = 0.03). CONCLUSION: There was a complex relationship between ACE, bully victimization, access to promotive assets and resources by children and adolescents, and oral health. ACE and bully victimization were not associated with oral health problems. Though self-esteem was associated with caries and poor oral hygiene, the relationships were inverse. Promotive assets and resources were not associated with caries complications though resources were associated with lower prevalence of caries.


Asunto(s)
Experiencias Adversas de la Infancia/estadística & datos numéricos , Acoso Escolar , Higiene Bucal/estadística & datos numéricos , Resiliencia Psicológica , Autoimagen , Adolescente , Niño , Estudios Transversales , Caries Dental/epidemiología , Femenino , Humanos , Masculino , Nigeria/epidemiología , Higiene Bucal/psicología , Prevalencia , Apoyo Social
7.
PLoS One ; 15(6): e0234923, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32555604

RESUMEN

BACKGROUND: Methamphetamine (MA) is a commonly used substance among youths, particularly those who are living in poor economic conditions with low levels of education and who have had bad childhood experiences. The Akha and Lahu hill tribe youths living on the Thailand-Myanmar-Laos border are identified as the group most vulnerable to MA use in Thailand. The study aimed to estimate the prevalence of MA use and determine its associations with childhood experiences among Akha and Lahu youths aged 15-24 years in northern Thailand. METHODS: A cross-sectional study was performed. Validated and sealed questionnaires were used to gather information from participants after obtaining the informed consent form. Questionnaires were completed by participants and their parents at home. Logistic regression was used to identify the associations between variables at the α = 0.05 level. RESULTS: A total of 710 participants participated in the study: 54.2% were Akha, 52.5% were females, 50.6% were aged 15-17 years, and 11.4% did not have Thai identification card (ID) cards. The overall prevalence of MA use at least once among Akha and Lahu youths was 14.5%. After controlling for all potential confounding factors, 8 variables were found to be associated with MA use. Males had a greater chance of MA use than females (AOR = 4.75; 95% CI = 2.27-9.95). Participants aged 21-24 years had a greater chance of MA use than those aged 15-17 years (AOR = 2.51; 95% CI = 1.11-5.71). Those who had a family member who used MA had a greater chance of MA use than those who did not (AOR = 5.04; 95% CI = 1.66-15.32). Those who had been physically assaulted by a family member while aged 0-5 years had a greater chance of MA use than those who had not (AOR = 2.29; 95% CI = 1.02-5.12). Those who had been physically assaulted by a family member while aged 6-14 years had a greater chance of MA use than those who had not (AOR = 3.15; 95% CI = 1.32-7.54). Those who had a close friend who used alcohol had a greater chance of MA use than those who did not (AOR = 2.24; 95% CI = 1.24-4.72). Those who had a highly confident personality had a greater chance of MA use than those who did not (AOR = 2.35; 95% CI = 1.17-4.69), and those who smoked had a greater chance of MA use than those who did not (AOR = 8.27; 95% CI = 4.42-15.46). CONCLUSIONS: All relevant government and nongovernment agencies together with the Ministry of Public Health Thailand should address MA use among Akha and Lahu youths by properly developing a community health intervention that lowers risk of MA use by addressing family relationships, male youth behaviors, and focused on those individuals with a highly confident personality.


Asunto(s)
Experiencias Adversas de la Infancia/estadística & datos numéricos , Drogas Ilícitas , Metanfetamina , Trastornos Relacionados con Sustancias/epidemiología , Adolescente , Adulto , Estudios Transversales , Consumidores de Drogas , Grupos Étnicos , Femenino , Humanos , Masculino , Prevalencia , Factores de Riesgo , Encuestas y Cuestionarios , Tailandia/epidemiología , Adulto Joven
8.
PLoS One ; 15(5): e0232242, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32365094

RESUMEN

BACKGROUND: Suicide is a severe health problem, with high rates in individuals with addiction. Considering the lack of studies exploring suicide predictors in this population, we aimed to investigate factors associated with attempted suicide in inpatients diagnosed with cocaine use disorder using two analytical approaches. METHODS: This is a cross-sectional study using a secondary database with 247 men and 442 women hospitalized for cocaine use disorder. Clinical assessment included the Addiction Severity Index, the Childhood Trauma Questionnaire, and the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, totalling 58 variables. Descriptive Poisson regression and predictive Random Forest algorithm were used complementarily to estimate prevalence ratios and to build prediction models, respectively. All analyses were stratified by gender. RESULTS: The prevalence of attempted suicide was 34% for men and 50% for women. In both genders, depression (PRM = 1.56, PRW = 1.27) and hallucinations (PRM = 1.80, PRW = 1.39) were factors associated with attempted suicide. Other specific factors were found for men and women, such as childhood trauma, aggression, and drug use severity. The men's predictive model had prediction statistics of AUC = 0.68, Acc. = 0.66, Sens. = 0.82, Spec. = 0.50, PPV = 0.47 and NPV = 0.84. This model identified several variables as important predictors, mainly related to drug use severity. The women's model had higher predictive power (AUC = 0.73 and all other statistics were equal to 0.71) and was parsimonious. CONCLUSIONS: Our findings indicate that attempted suicide is associated with depression, hallucinations and childhood trauma in both genders. Also, it suggests that severity of drug use may be a moderator between predictors and suicide among men, while psychiatric issues shown to be more important for women.


Asunto(s)
Experiencias Adversas de la Infancia/estadística & datos numéricos , Trastornos Relacionados con Cocaína/psicología , Cocaína Crack/efectos adversos , Depresión/epidemiología , Alucinaciones/epidemiología , Intento de Suicidio/estadística & datos numéricos , Adulto , Brasil/epidemiología , Estudios Transversales , Femenino , Hospitalización , Humanos , Aprendizaje Automático , Masculino , Prevalencia , Medición de Riesgo , Intento de Suicidio/psicología , Adulto Joven
9.
Health Soc Work ; 45(2): 81-89, 2020 May 27.
Artículo en Inglés | MEDLINE | ID: mdl-32393967

RESUMEN

Police violence is reportedly common among those diagnosed with mental disorders characterized by the presence of psychotic symptoms or pronounced emotional lability. Despite the perception that people with mental illness are disproportionately mistreated by the police, there is relatively little empirical research on this topic. A cross-sectional general population survey was administered online in 2017 to 1,000 adults in two eastern U.S. cities to examine the relationship between police violence exposure, mental disorders, and crime involvement. Results from hierarchical logistic regression and mediation analyses revealed that a range of mental health conditions are broadly associated with elevated risk for police violence exposure. Individuals with severe mental illness are more likely than the general population to be physically victimized by police, regardless of their involvement in criminal activities. Most of the excess risk of police violence exposure related to common psychiatric diagnoses was explained by confounding factors including crime involvement. However, crime involvement may necessitate more police contact, but does not necessarily justify victimization or excessive force (particularly sexual and psychological violence). Findings support the need for adequate training for police officers on how to safely interact with people with mental health conditions, particularly severe mental illness.


Asunto(s)
Víctimas de Crimen , Trastornos Mentales/psicología , Policia , Violencia/estadística & datos numéricos , Adulto , Experiencias Adversas de la Infancia/estadística & datos numéricos , Crimen/estadística & datos numéricos , Estudios Transversales , Femenino , Humanos , Internet , Masculino , Trastornos Psicóticos/psicología , Encuestas y Cuestionarios , Estados Unidos
10.
BMC Public Health ; 20(1): 657, 2020 May 12.
Artículo en Inglés | MEDLINE | ID: mdl-32397975

RESUMEN

BACKGROUND: Adverse Childhood Experiences (ACEs) such as abuse, neglect or household adversity may have a range of serious negative impacts. There is a need to understand what interventions are effective to improve outcomes for people who have experienced ACEs. METHODS: Systematic review of systematic reviews. We searched 18 database sources from 2007 to 2018 for systematic reviews of effectiveness data on people who experienced ACEs aged 3-18, on any intervention and any outcome except incidence of ACEs. We included reviews with a summary quality score (AMSTAR) of 5.5 or above. RESULTS: Twenty-five reviews were included. Most reviews focus on psychological interventions and mental health outcomes. The strongest evidence is for cognitive-behavioural therapy for people exposed to abuse. For other interventions - including psychological therapies, parent training, and broader support interventions - the findings overall are inconclusive, although there are some positive results. CONCLUSIONS: There are significant gaps in the evidence on interventions for ACEs. Most approaches focus on mitigating individual psychological harms, and do not address the social pathways which may mediate the negative impacts of ACEs. Many negative impacts of ACEs (e.g. on health behaviours, social relationships and life circumstances) have also not been widely addressed by intervention studies.


Asunto(s)
Experiencias Adversas de la Infancia/estadística & datos numéricos , Maltrato a los Niños/psicología , Maltrato a los Niños/terapia , Resiliencia Psicológica , Sobrevivientes/psicología , Sobrevivientes/estadística & datos numéricos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Maltrato a los Niños/estadística & datos numéricos , Preescolar , Femenino , Humanos , Masculino , Persona de Mediana Edad
11.
Compr Psychiatry ; 100: 152175, 2020 07.
Artículo en Inglés | MEDLINE | ID: mdl-32345436

RESUMEN

BACKGROUND: Multiple developmental risk factors for Substance Use Disorders (SUDs) during young adulthood have been identified. In this investigation, we examined the impact of homelessness, foster care, and adverse childhood experiences (ACEs) prior to 12th grade on the development of three common SUDs during young adulthood-Alcohol Use Disorder (AUD), Tobacco Use Disorder (TUD) and Cannabis Use Disorder (CUD). Our hypothesis was that while both homelessness and ACEs are significant risk factors for young adult SUDs, foster care involvement might convey protection. METHODS: Using nationally representative data from the National Longitudinal Study of Adolescent to Adult Health, measures of ACEs were derived from the CDC-Kaiser ACE study, and DSM-V SUD diagnoses were derived from items originally based on DSM-IV. SUD diagnoses were binned into "mild", "moderate", and "severe" groupings. Survey-based logistic models were used to estimate risks of SUDs while controlling for demographics. RESULTS: The results suggest that the experience of homelessness prior to 12th grade in addition to ACEs were significantly associated with the development in young adulthood of the most severe forms of AUD and TUD and all severity levels of CUD. Foster care was not associated with either risk or protection from SUDs. CONCLUSIONS: The experience of homelessness during development may be viewed as another detrimental ACE that is a risk factor for the most common SUDs in young adulthood. Given the magnitude of the current epidemic of homelessness in the U.S., these results should raise substantial concern.


Asunto(s)
Experiencias Adversas de la Infancia/estadística & datos numéricos , Alcoholismo/epidemiología , Niño Acogido , Personas sin Hogar/estadística & datos numéricos , Abuso de Marihuana/epidemiología , Trastornos Relacionados con Opioides/epidemiología , Trastornos Relacionados con Sustancias/epidemiología , Tabaquismo/epidemiología , Adolescente , Adulto , Alcoholismo/psicología , Niño , Manual Diagnóstico y Estadístico de los Trastornos Mentales , Femenino , Humanos , Estudios Longitudinales , Masculino , Abuso de Marihuana/psicología , Persona de Mediana Edad , Trastornos Relacionados con Opioides/psicología , Factores de Riesgo , Trastornos Relacionados con Sustancias/psicología , Encuestas y Cuestionarios , Tabaquismo/psicología , Adulto Joven
12.
Public Health ; 182: 131-138, 2020 May.
Artículo en Inglés | MEDLINE | ID: mdl-32298843

RESUMEN

OBJECTIVES: Since 2010, the number of homeless people in the UK has increased, and homelessness in its different types has become a major public health problem. Housed older people with past experience of homelessness are an understudied population that can provide valuable insight into this problem. For this reason, we examined the lifetime prevalence of homelessness and its associations with childhood adversity and mortality in a national sample of older people. STUDY DESIGN: This is a longitudinal cohort study. METHODS: We studied 6649 housed individuals aged 55-79 years in 2007 from the English Longitudinal Study of Ageing (ELSA). We used logistic regression to model the association between adverse childhood experiences (ACE) and lifetime experience of homelessness (ever been homeless for ≥1 months) and Cox proportional hazards regression to model the prospective association between lifetime experience of homelessness and mortality. RESULTS: We identified 107 participants with lifetime experience of homelessness. We found a strong graded association between the number of ACE and lifetime experience of homelessness; participants with two ACE had 5.35 (95% confidence interval [CI]: 3.17-9.05) times greater odds of having experienced homelessness than those reporting none. Most ACE were individually associated with lifetime homelessness, but fewer remained so in the mutually adjusted model. Participants with lifetime experience of homelessness had 1.55 (95% CI: 1.01-2.37) times greater risk of mortality over a 10-year follow-up and after adjustment for covariates. CONCLUSIONS: Exposure to childhood adversity is associated with increased risk of experiencing homelessness. Older housed people with past experience of homelessness are at increased risk of mortality.


Asunto(s)
Experiencias Adversas de la Infancia/estadística & datos numéricos , Personas sin Hogar/estadística & datos numéricos , Mortalidad , Anciano , Estudios de Cohortes , Inglaterra/epidemiología , Femenino , Estudios de Seguimiento , Vivienda , Humanos , Modelos Logísticos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Prevalencia , Estudios Prospectivos , Factores de Riesgo , Encuestas y Cuestionarios
14.
J Youth Adolesc ; 49(6): 1195-1208, 2020 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-32297174

RESUMEN

Extensive literature documents that adverse childhood experiences increase risk for non-suicidal self-injury (NSSI) and suicide behaviors among adolescents. However, few studies have examined patterns of co-occurring family based adversities, whether distinct patterns of adversity are differentially associated with NSSI and suicide behaviors, and if social support can offset the impact of adversity for these behaviors. This study used a statewide school-based sample that was 50.1% female, 71% non-Hispanic White, and evenly divided by grade (9th grade N = 39,682; 11th grade N = 33,966). Latent class analysis identified three mutually exclusive, homogeneous subgroups of co-occurring familial adversities; low or no family based adversity, parental dysfunction but low maltreatment, and parental dysfunction plus maltreatment. The relationships between membership in the identified subgroups and past year NSSI, suicidal ideation, and suicide attempt were assessed separately for 9th graders (average age = 14) and 11th graders (average age = 17). Although membership in the parent dysfunction plus maltreatment class was associated with the highest odds of NSSI, suicidal ideation, and suicide attempt, membership in either class of familial adversity elevated risk for these behaviors compared to membership in the low or no adversity class. Whether the protective effects of perceived peer and teacher social support moderated these associations and varied across age groups was also explored. The findings suggest that peer and teacher social support can promote positive outcomes even for youth living in stressful family conditions and that the protective effects of social support increase as the number of sources of support expands.


Asunto(s)
Conducta del Adolescente/psicología , Experiencias Adversas de la Infancia/estadística & datos numéricos , Autoimagen , Conducta Autodestructiva/psicología , Ideación Suicida , Adolescente , Femenino , Humanos , Masculino , Grupo Paritario , Factores de Riesgo , Apoyo Social , Estudiantes/psicología , Intento de Suicidio/psicología
15.
Public Health ; 182: 173-178, 2020 May.
Artículo en Inglés | MEDLINE | ID: mdl-32334184

RESUMEN

OBJECTIVES: Adverse childhood experiences (ACEs) are events stressful, traumatic, and related to the development of a wide range of health conditions throughout the person's lifespan. This study explored the relationship between ACEs and health conditions among older adults in Bhutan. STUDY DESIGN: Cross-sectional survey. METHODS: Older adults aged 60-101 years (n = 337) completed a face-to-face interview in a convenient community setting in the four major towns of Bhutan. Measurements included the modified World Health Organization Adverse Childhood Experiences International Questionnaire and the checklist of chronic health conditions. RESULTS: Commonest ACEs reported by the sample were related to the contribution of physical labour in childhood (n = 284 [84.3%]) and witnessing of community violence (n = 185 [54.9%]). Assuming an adult role while still a child highly co-occur with other forms of ACEs. Compared to 0-2 ACEs, participants with ≥7 ACEs had the higher odds of reporting lung disease (odds ratio [OR] = 2.15, 95% confidence interval [CI]: 1.03-4.49), visual impairment (OR = 2.38, 95%CI: 1.16-4.85), insomnia (OR = 2.35, 95%CI: 1.11-4.98), and memory decline (OR = 2.30, 95%CI: 1.10-4.78) by twofold and high blood pressure by threefold (OR = 3.21, 95%CI: 1.39-7.38). Overall, the odds of self-rated poor health conditions among those ≥7 ACEs compared to 0-2 ACEs was high by almost twofold (OR = 1.97; 95%CI: 1.04-3.73). CONCLUSIONS: The influence of ACEs on health conditions persisted into late adulthood, and older people in Bhutan have had a complex variety of chronic health conditions implicating greater demand on the free healthcare system in Bhutan. ACEs prevention is critical to promote better health for a country like Bhutan, where the healthcare services are provided free of cost to its citizens.


Asunto(s)
Experiencias Adversas de la Infancia/estadística & datos numéricos , Enfermedad Crónica/epidemiología , Salud Mental/estadística & datos numéricos , Anciano , Anciano de 80 o más Años , Bután/epidemiología , Disfunción Cognitiva/epidemiología , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Trastornos del Inicio y del Mantenimiento del Sueño/epidemiología , Encuestas y Cuestionarios , Trastornos de la Visión/epidemiología
16.
Psychiatry Res ; 287: 112897, 2020 05.
Artículo en Inglés | MEDLINE | ID: mdl-32203750

RESUMEN

Adolescents with childhood trauma may be associated with psychotic-like experiences (PLEs) and is at high risk for later development of psychoses. Exploring early age risk factors for childhood trauma may provide useful information for prevention of mental disorders and improvement of mental health, yet no studies have examined the association between exposure to specific forms of trauma and different types of PLEs in a sample of Chinese adolescents. Thus, the Childhood Trauma Questionnaire-Short Form was used to measure five types of childhood trauma (emotional abuse, EA; physical abuse, PA; sexual abuse, SA; emotional neglect, EA; physical neglect, PA) in junior middle school students. And the positive subscale of Community Assessment of Psychic Experiences divided into four types (bizarre experiences, perceptual abnormalities, persecutory ideation and magical thinking) was used to measure PLEs. Then the possible associations among demographic information and specific types of childhood trauma on specific forms of PLEs was compared. The rates of EA, PA, SA, EA and PA were 14.2%, 13.0%, 16.1%, 60.0%, and 78.6%, respectively. Moreover, childhood trauma seems to be a main role in the development of PLE, and EA and SA patients are particularly likely to experience PLEs.


Asunto(s)
Experiencias Adversas de la Infancia/estadística & datos numéricos , Trastornos Psicóticos/epidemiología , Trastornos Psicóticos/psicología , Estudiantes/psicología , Adolescente , Grupo de Ascendencia Continental Asiática/psicología , Niño , China/epidemiología , Femenino , Humanos , Masculino , Prevalencia , Factores de Riesgo , Estudiantes/estadística & datos numéricos , Encuestas y Cuestionarios
17.
JAMA Netw Open ; 3(2): e1920740, 2020 02 05.
Artículo en Inglés | MEDLINE | ID: mdl-32031646

RESUMEN

Importance: The prevalence of dementia in Japan has been increasing. Childhood poverty has been associated with increased risk of cognitive impairment, possibly mediated by individuals' educational paths. However, the associations between dementia and adverse childhood experiences other than poverty and education have not been well documented. Objective: To examine the association between adverse childhood experiences and dementia onset among Japanese individuals born before 1948 who grew up during and after World War II. Design, Setting, and Participants: A 3-year (2013-2016) follow-up was performed of 17 412 participants in the Japan Gerontological Evaluation Study, a population-based cohort study of adults aged 65 years or older. Data were analyzed in December 2019. Main Outcomes and Measures: Dementia onset was assessed through the public long-term care insurance system. Adverse childhood experiences before the age of 18 years were assessed by survey at baseline. Seven adverse childhood experiences were assessed: parental death, parental divorce, parental mental illness, family violence, physical abuse, psychological neglect, and psychological abuse. Participants were classified according to whether they had 0, 1, 2, or 3 or more adverse childhood experiences. Cox regression models were used to estimate hazard ratios for the risk of dementia. Results: Among 17 412 participants (9281 women [53.3%]; mean [SD] age, 73.5 [6.0] years), dementia occurred in 703 participants (312 men and 391 women) during a mean follow-up of 3.2 years (range, 2.4-3.3 years). Among all participants, 6804 (39.1%) were older than 75 years; 10 968 (63.0%) reported 0 adverse childhood experiences, 5129 (29.5%) reported 1 adverse childhood experience, 964 (5.5%) reported 2 adverse childhood experiences, and 351 (2.0%) reported 3 or more adverse childhood experiences. Participants who experienced 3 or more adverse childhood experiences had a greater risk of developing dementia compared with those who grew up without adverse childhood experiences, after adjustment for age, sex, childhood economic hardship, nutritional environment, and education (hazard ratio, 2.18; 95% CI, 1.42-3.35). After successive adjustment for adult sociodemographic characteristics, social relationships, health behavior, and health status, this hazard ratio was attenuated but remained statistically significant (1.78; 95% CI, 1.15-2.75; P = .009). Conclusions and Relevance: This study found that having 3 or more adverse childhood experiences was associated with increased dementia risk among older Japanese adults.


Asunto(s)
Adultos Sobrevivientes de Eventos Adversos Infantiles/psicología , Experiencias Adversas de la Infancia/estadística & datos numéricos , Demencia/epidemiología , Demencia/psicología , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Japón/epidemiología , Masculino , Modelos de Riesgos Proporcionales , Factores de Riesgo , Encuestas y Cuestionarios
19.
Sleep Health ; 6(2): 246-252, 2020 04.
Artículo en Inglés | MEDLINE | ID: mdl-32085968

RESUMEN

OBJECTIVE: We investigated how quantity, timing, and type of childhood adversity were associated with subjectively reported and actigraphically measured sleep in adulthood. DESIGN: This is a cross-sectional design. SETTING: Data were collected from three clinical sites at the University of California, Los Angeles; the University of Wisconsin-Madison; and Georgetown, in the Washington, DC area. PARTICIPANTS: The participants were a group of 863 U.S. adults aged 25-76 years who participated in the Biomarker Project in the Midlife in the United States Refresher study. MEASUREMENT: Subjective sleep was measured by the Pittsburgh Sleep Quality Index and actigraphic sleep measures included sleep-onset latency, sleep efficiency, wake time after sleep onset, and total sleep time. Participants retrospectively reported whether they experienced 18 adverse events before age 18 years and the ages they experienced the events. RESULTS: Childhood adversity, operationalized as quantity (i.e., the total number of adverse events or experiencing 3 or more adverse events) and timing (i.e., experiencing adverse events during both childhood and adolescence) of adverse events, was related to worse subjective and actigraphic sleep (except for total sleep time) after adjusting for age, sex, and race. Models using the cumulative (i.e. dose-response) number of adverse events fit better than models using the timing and type specifications of childhood adversity in relation to subjective or actigraphic sleep measures (except for total sleep time). CONCLUSIONS: These findings highlight the importance of considering the quantity of childhood adversity in relation to self-reported and actigraphically measured sleep in adulthood.


Asunto(s)
Adultos Sobrevivientes de Eventos Adversos Infantiles/psicología , Experiencias Adversas de la Infancia/estadística & datos numéricos , Sueño , Actigrafía , Adulto , Adultos Sobrevivientes de Eventos Adversos Infantiles/estadística & datos numéricos , Anciano , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Autoinforme , Factores de Tiempo , Estados Unidos
20.
Lancet Psychiatry ; 7(6): 538-546, 2020 06.
Artículo en Inglés | MEDLINE | ID: mdl-32006466

RESUMEN

The rates of suicide and self-harm in Northern Ireland are high, and have increased from 143 registered suicides in 1996 to 313 in 2010 and 318 in 2015. This Review summarises the epidemiology of suicidal behaviour, as well as the evidence from a small number of studies that have identified risk factors associated with high suicide rates in Northern Ireland. These risk factors were mental illness, trauma, exposure to the conflict known as the Troubles, deprivation, relationship problems, employment difficulties, financial difficulties, being LGBT, childhood adversities, and alcohol or drug use. We highlight the key challenges and opportunities for suicide prevention, emphasising a so-called lifespan approach. More needs to be done to address the relationship between substance misuse and suicide. Future research and prevention efforts should also focus on the transgenerational effect of the conflict, youth suicide, suicide prevention in minority groups, and the criminal justice context. The provision of and access to suicide-specific psychosocial interventions need to be prioritised, more support for people in crisis is required, as well as interventions for mental illness. Protect Life 2, the national suicide prevention strategy, needs to be implemented in full. Given the legacy of conflict in Northern Ireland, all suicide prevention efforts should be trauma informed.


Asunto(s)
Trastornos Mentales/psicología , Conducta Autodestructiva/prevención & control , Suicidio/prevención & control , Adolescente , Adulto , Experiencias Adversas de la Infancia/estadística & datos numéricos , Alcoholismo/epidemiología , Alcoholismo/psicología , Niño , Preescolar , Conflicto Psicológico , Empleo/psicología , Femenino , Humanos , Masculino , Trastornos Mentales/epidemiología , Irlanda del Norte/epidemiología , Carencia Psicosocial , Sistemas de Apoyo Psicosocial , Factores de Riesgo , Conducta Autodestructiva/epidemiología , Minorías Sexuales y de Género/psicología , Trastornos Relacionados con Sustancias/epidemiología , Trastornos Relacionados con Sustancias/psicología , Ideación Suicida , Suicidio/estadística & datos numéricos , Heridas y Traumatismos/epidemiología , Heridas y Traumatismos/psicología , Adulto Joven
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