Trends in the dose-response relationship between adverse childhood experiences and maladaptive metacognitive beliefs: A cross-sectional study.

BACKGROUND: Since the publication of the major research on adverse childhood experiences (ACE) at the turn of the millennium, our knowledge about the prevalence and physical and mental consequences of childhood adversities has increased substantially. In parallel, research on metacognition, which plays an important role in understanding our mental functioning, has also been on the rise. Although the adverse effects of ACEs on mental processes and the role of metacognitive deficits in the development of mental disorders are widely known, hardly any research into the interaction between these two areas has been conducted; this is what triggered our investigation. METHODS: Our research was carried out as a cross-sectional study on a sample of 304 members of the general population. We measured ACEs with the 10-item Adverse Childhood Experiences Questionnaire and maladaptive metacognitions-positive and negative metacognitive beliefs, cognitive confidence, cognitive self-consciousness, and need to control thoughts- using the Meta-Cognitions Questionnaire. The closeness of the relationship between the ACE score and metacognitions was measured using Pearson's linear correlation coefficient, while the association of ACE accumulation with metacognitive beliefs was assessed using generalized linear models. RESULTS: The most common ACE in our sample turned out to be emotional neglect (44.74%). All the examined maladaptive metacognitive beliefs correlate mildly to moderately with the number of suffered ACEs (r = 0.13-0.34), with an increase in the ACE score leading to a rise in the salience of maladaptive metacognitive beliefs. Moreover, a dose-response relationship was seen between increases in ACE scores and the overall values of metacognition, negative metacognitive beliefs, and the maladaptive metacognitive belief of the need to control thoughts. CONCLUSIONS: Our results suggest that the more ACEs were experienced in childhood, the more pronounced the dysfunctional metacognitive beliefs are. Therefore, our findings emphasize the importance of further research into the topic.

Validity and reliability of the 10-Item Adverse Childhood Experiences Questionnaire (ACE-10) among adolescents in the child welfare system.

Introduction: Multiple evidence suggests that the vast majority of children in the Child Welfare System (CWS) are victims of early, chronic, and multiple adverse childhood experiences. However, the 10-item version of the Adverse Childhood Experiences Questionnaire (ACE-10) has never been tested in such a particularly vulnerable population as adolescents living in the CWS. We aimed to assess the psychometric properties of the ACE-10 in a community sample of 240 Hungarian adolescents placed in family style group care (FGC) setting. Methods: Demographic data, the 10-item version of the Adverse Childhood Experiences Questionnaire (ACE-10), the Strengths and Difficulties Questionnaire (SDQ), and the HBSC Bullying Measure were used. Results: Our results showed acceptable internal consistency (α = 0.701) and item-total correlations (rpb = 0.25-0.65, p < 0.001). However, our results also reflect that item 6 ("Parental separation/divorce") is weakly correlated with both the cumulative ACE score and the rest of the questionnaire items. When item 6 is removed, the 9-item version of the ACE produces more favorable consistency results (α = 0.729). Strong and significant associations of the cumulative ACE score with emotional and behavioral symptoms and bully victimization confirm the concurrent criterion validity of both versions of the instrument. Discussion: Our findings suggest that ACE-9 and ACE-10 are viable screening tools for adverse childhood experiences in the CWS contributing to the advancement of trauma-informed care. We recommend considering the use of either the 9-item or the 10- item version in the light of the characteristics of the surveyed population. The implications and limitations are discussed.

Residence in segregated settlements (colonies) rather than Roma identity increases the risk of unfavourable mental health in Hungarian adults.

Background: Roma are the largest and most disadvantaged minority in Europe, but there is few research on how mental health and social support of Roma people living in segregated settlements compares to the majority population. Our aim was to compare the subjective well-being, life satisfaction, mental status, and social support of representative samples of adults living in segregated settlements (colonies) and identifying as Roma with those of the general population in Hungary. Methods: A cross-sectional study was conducted with random samples of 417 individuals from the general Hungarian adult population (55.6% female, mean age = 43.89 ± 12.61 years) and 394 adults living in segregated settlements (colonies) (73.9% female, mean age = 42.37 ± 12.39 years). Demographic questions were used as well as the WHO Well-Being Index (WBI-5), the single item Life Satisfaction Scale, the 12-item version of the General Health Questionnaire (GHQ-12), and the Oslo Social Support Scale (OSSS-3). Results: Residents of colonies reported significantly lower levels of subjective well-being and life satisfaction than the general population. The proportion of individuals at high risk for mental morbidity was more than twice as high among colony dwellers (16.4%) as in non-colony dwellers (7.6%). Similar unfavorable differences were seen at the expense of self-identified Roma compared to self-identified Hungarians but no difference was found in terms of social support either by type of residence or ethnicity. 32.2% of colony-dwellers self-identified themselves as Hungarian. Mental health assessed by principal component was directly determined by settlement type of permanent residence, age, educational attainment, employment, financial status, and social support but not ethnic identity. Conclusion: The study based on representative data shows that residents of segregated settlements are in worse mental health than those not living in colonies; that housing segregation is not limited to Roma people, and that housing conditions and financial status are major social determinants of mental health for which data must be collected to avoid using self-reported Roma identity as a proxy measure of socioeconomic deprivation.

Identifying academic motivation profiles and their association with mental health in medical school.

INTRODUCTION: Academic motivation (AM), motivation in relation to formal studies that as a construct of the self-determination theory (SDT), is frequently assessed by the Academic Motivation Scale (AMS). However, the scoring of AMS in itself is not fully consistent with the SDT theory as only scores of the subscales can be calculated resulting in seven different score means instead of positioning the individual on the self-determination continuum. There have been few attempts at a person-centered approach to AMS scoring, especially among medical students. Our study aimed to find distinct academic motivation profiles and demonstrate their concurrent criterion validity with mental health variables (psychological distress, life satisfaction) among medical students. METHODS: The AMS-28 college version, the General Health Questionnaire (GHQ-12), and the Single-Item Measure of Life Satisfaction were administered among medical freshmen. Academic motivation profiles were generated by two methods: 1) two-step cluster analysis, and 2) quantile analysis. RESULTS: The sample consisted of 189 participants (mean age = 19.38 ± 2.03 years, 72% females). The cluster analyses revealed three fairly distinct profiles of self-determination: 'High' (n = 59; mean im = 5.48 ± 0.60; mean em = 6.07 ± 0.41; mean am = 1.57 ± 0.95), 'Moderate' (n = 111; mean im = 4.5 ± 1.06; mean em = 4.41 ± 0.87; mean am = 1.25 ± 0.36), and 'Low' (n = 19; mean im = 4.22 ± 1.02; mean em = 4.03 ± 1.16; mean am = 3.07 ± 1.30). The creation of deciles allowed the identification of those who were most intrinsically (n = 14, 7.4%), extrinsically (n = 10, 5.3%), and least motivated (amotivated) (n = 18, 9.5%). 'Low' self-determination/amotivation was associated with increased psychological distress and decreased life satisfaction. CONCLUSION: Our results provide means to position medical students on the SDT continuum based on 'Low', 'Moderate', or 'High' levels of self-determination toward their studies. These AM profiles predict the mental health of medical freshmen, which supports the validity of the outcomes and highlight the risks of amotivation for psychological morbidity. The limitations and implications are discussed.

Detrimental consequences of tebuconazole on redox homeostasis and fatty acid profile of honeybee brain.

Excessive use of azole fungicides in agriculture poses a potential threat to honeybees and other pollinator insects; however, the detailed effects of these molecules remain largely unclear. Hence, in the present study it was aimed to investigate the acute sublethal effects of tebuconazole on the redox homeostasis and fatty acid composition in the brain of honeybees. Our findings demonstrate that tebuconazole decreased total antioxidant capacity, the ratio of reduced to oxidized glutathione and disturbed the function of key antioxidant defense enzymes along with the induction of lipid peroxidation indicated by increased malondialdehyde levels, while it also altered the fatty acid profile of the brain. The present study highlights the negative impact of tebuconazole on honeybees and contributes to the understanding of potential consequences related to azole exposure on pollinator insects' health, such as the occurrence of colony collapse disorder.

Psychometric properties of the Adverse Childhood Experiences Questionnaire 10 item version (ACE-10) among Hungarian adolescents.

Introduction: Although a number of studies have been conducted since the 1995 initiation of the ACE study to map the effects of adverse childhood experiences, few studies have examined the psychometric properties of the individual versions of the ACE questionnaire. Aims: The Adverse Childhood Experiences Questionnaire 10 item version (ACE-10) has only been tested in a single study in an adult population, while its applicability in a particularly vulnerable population, the adolescents, has not been investigated yet. Our present study aims to address this gap in an adolescent sample of 792 subjects from a non-representative general population. Methods: Besides demographic data, the Adverse Childhood Experiences Questionnaire 10 item version (ACE-10), the Strengths and Difficulties Questionnaire (SDQ), and the HBSC Symptom Checklist (HBSC-SCL) were employed. Results: Our results showed acceptable internal consistency (ɵ = 0.86, α = 0.64) and adequate internal validity (r = 0.28-0.70, p < 0.001). In addition, proper concurrent criterion validity of the questionnaire was found when tested along the SDQ and HBSC-SCL items. Conclusion: Our results demonstrate that the ACE-10 is suitable for assessing intrafamilial adverse childhood experiences in adolescents.

Adverse childhood experiences increase the risk for eating disorders among adolescents.

Purpose: Traumatic events often feature prominently in eating disorders. A questionnaire survey to assess the relation of eating disorder risk to the frequency of adverse childhood experiences (ACEs) and the possible association of eating disorder risk with a particular type of ACE was conducted in a community sample of Hungarian adolescents. Methods: Demographic and anthropometric data, risk for eating disorders (by SCOFF questionnaire), and ACEs (by ACE score calculator) were collected from 432 adolescents aged 12-17 years. Results: Adolescents who had undergone four or more ACEs were 5.7 times more likely to be in the high eating disorder risk group than those who did not report any ACEs. Cumulative maltreatment showed a greater association with overall risk for eating disorders than cumulative family dysfunction. There is an increased risk of eating disorders from emotional maltreatment (OR = 3.475), physical maltreatment (OR = 3.440), sexual maltreatment (OR = 10.973), and emotional neglect (OR = 3.331). Dysfunctional family circumstances revealed an association with household mental illness (OR = 3.401). Conclusion: Our study of the connection between eating disorder risk and ACE is the first of its kind in Central and Eastern Europe. Maltreatments had a greater role than family dysfunctions in increasing the risk of eating disorders. Our findings contribute to a more precise understanding of the role that ACEs play in eating disorders. It is important to bring to clinicians' attention the importance of ACEs in the diagnosis and therapy of eating disorders and their potentially fundamental significance for therapy.

Transfer of Mental Health Services for Medical Students to Cyberspace during the COVID-19 Pandemic: Service Use and Students' Preferences for Psychological Self-Help Techniques.

The high risk of mental health problems among medical students has been compounded by the COVID-19 pandemic, which greatly reduced social contact. The mental health support service of the medical school of one Hungarian university was transferred to the online learning management system and was expanded by self-help materials in three domains: Improving study skills, stress management techniques, and reducing stress related to the COVID-19 pandemic. We wanted to understand the preferences of medical students for psychological self-help techniques by investigating the pattern of access to online self-help materials and the characteristics of the users. Access to the online materials between April 2020 and April 2021 among Hungarian and international medical students was analyzed using the logging data of the system. Of all the students who logged in during the examination period (n = 458), 36.6-40.4% viewed materials to improve study skills and 23-29% viewed stress management materials, of which short-duration audio format techniques were preferred. The access rate of content targeting coping with the mental health effects of COVID-19 was 9.5-24%. Support to improve study skills is significantly more preferred than interventions targeting distress-reduction. The pattern of access can be used for the development of interventions that are of most interest to medical students.

Barriers to Seeking Mental Help and Interventions to Remove Them in Medical School during the COVID-19 Pandemic: Perspectives of Students.

Medical students are at increased risk for psychological morbidity but the majority of those with mental health problems do not seek professional care. We aimed to uncover the viewpoints of medical students regarding barriers and facilitators to using university mental health services and their attitudes and preferences towards online counselling. Four semi-structured focus groups were conducted (n = 26, mean age = 21.8, ±1.88, 73% males). After reaching data saturation, interviews were audio-recorded, transcribed and content-analysed by two independent coders. Intrapersonal barriers emerged to be perceived low risk, excessive self-reliance, lack of belief in the effectiveness of service, lack of openness. Interpersonal factors were the following: assumed long waiting list, insufficient provision of service information, fear of exposure, and not being familiar with the counsellor and the process. Extrapersonal barriers such as insurance problems, the number of available sessions, adverse sociocultural attitudes, fear of stigmatisation were identified. Students suggested that the university should provide psychoeducation and routine screening, apply social marketing and stigma reduction campaigns, improve information flow, and offer not only personal but also online video counselling to target removing these barriers. The results provide a reference for the redesign of mental health services to facilitate their access by students. Implications and limitations are discussed.

Efficacy of metacognitive training on symptom severity, neurocognition and social cognition in patients with schizophrenia: A single-blind randomized controlled trial.

Over the past decades, a number of complementary treatments for schizophrenia have emerged. One of these is metacognitive training (MCT), which combines the principles of cognitive-behavioral therapies, cognitive remediation, and psychoeducation into a hybrid approach placing emphasis on increasing metacognitive awareness. The aim of our study was to investigate the efficacy of MCT on symptom severity, and neurocognitive and social cognitive functioning in schizophrenia; also, attention was paid to the assessment of subjective acceptability. Forty-six patients diagnosed with schizophrenia were included in our single-blind randomized controlled trial, who were assigned to the intervention or control group. The intervention group was provided standard MCT, while the control group received treatment as usual. We assessed symptom severity and cognitive functions before and after the training, as well as after a 6-month follow-up period. Compared to the control group, the intervention group showed improvement in overall symptom severity, and positive and disorganized symptoms. Training participans showed further improvement at the follow-up assessment. Regarding neurocognitive functions, improvement in visuospatial functions was observed between pre- and post-intervention assessments compared to the control group. Patients showed excellent adherence, and evaluated the training as useful and interesting. In line with the results of previous studies, our results demonstrate the efficacy of MCT on symptom severity in schizophrenia. Improvements in cognitive functions that are closely related to the onset and prevalence of symptoms of schizophrenia were also found.

Can the Cumulative Adverse Childhood Experiences (ACE) Score Actually Identify the Victims of Intrafamilial Childhood Maltreatment? Findings from a Study in the Child Welfare System.

Studies show that a significant proportion of children in the Child Welfare System (CWS) have suffered adverse childhood experiences (ACEs), which have led to well documented serious consequences. This study assessed and compared the ACE status of adolescents aged 12 to 17 placed in a family style group care (FGC) setting (n = 240) to the ACE status of adolescents living with their biological parents (n = 516). The ACE Score Calculator was employed. The populational differences in ACE scores and in the prevalence of ACEs were assessed using generalized linear and logistic regression models. Adolescents living in FGC settings reported more than five times as many multiple adverse experiences (≥4 types of ACEs) as those living with their biological parents. Adolescents living in FGC settings seem to be more willing to report family dysfunction rather than their maltreatment history and are less willing to report maltreatment. In the FGC group, a surprisingly high proportion of adolescents reported having experienced no maltreatment, which is probably highly underreported and/or unrecognised in the CWS. In fact, a high ACE score will not identify the children who have experienced direct maltreatment but will highlight the consequences of the unfavourable factors inherent in disadvantaged social situation instead.

[The relationship of muscle dysmorphia to the body image and early maladaptive schemata created by parental behaviours].

INTRODUCTION: the purpose of our study was to investigate the link between specific traits that determine muscle dysmorphia in bodybuilders and the parental behaviours which play a role in developing these schemata, as well as the eating-disorder-specific traits which differentiate bodybuilders from the normal population. AIM: conceptualising the similarities of personality traits in case of muscle dysmorphia and eating disorders, as well as their etiology based on the schema theory. METHOD: to measure muscle dysmorphia was used the Muscle Appearance Satisfaction Scale. We explored its connec - tion with eating disorders applying the Eating Disorder Inventory and thereof with the parental behaviours was used the Young Parental Inventory. RESULTS: a number of eating-disorder-specific traits differentiate persons with muscle dysmorphic traits from the normal population. These are Drive for thinness, Body dissatisfaction, Feeling of inadequacy, Interoceptive awareness and Perfectionism. Regarding the perceived parental behaviour the father violated the child's need of autonomy, compe - tence and self-identity and the mother violated the need of boundaries and self-control. CONCLUSIONS: Based on several personality characteristics, muscle dysmorphia may be related to anorexia nervosa and bulimia nervosa. In its etiology parental care can have a role, as the father is disposed to detain the autonomy, and the expression of personal needs, while the mother demonstrates insufficient control functions, and the detention of the autonomy and the need for competency.

Assessing adverse childhood experiences, social, emotional, and behavioral symptoms, and subjective health complaints among Hungarian adolescents.

BACKGROUND: Adverse Childhood Experiences (ACEs) can have lifelong adverse impacts; they can play a role in the development of subsequent emotional, cognitive, and social impairments leading to somatic and mental difficulties, as well as health damaging behaviours. Unfortunately, there are currently no research data available in Hungary regarding the frequency of ACEs among adolescents. AIMS: A cross sectional questionnaire survey was conducted in a community sample of Hungarian adolescents to assess the frequency of ACEs and analyse their association with current social, emotional, and behavioural symptoms (SEB), and subjective health complaints (SHC). METHODS: Demographic data, ACEs, SEB and SHC status of 516 adolescents aged 12 to 17 were collected. ACEs were assessed using the ACE Score Calculator; for SEB the Strengths and Difficulties Questionnaire, and for SHC some specific items from the Health Behaviour of School Children questionnaire were employed. To analyse the relationship of ACEs to SEB and SHC logistic regression was performed. RESULTS: Our results showed that the frequency of ACEs, SEB and SHC is high among adolescents. One-fourth of the students reported ≥ 2 categories of childhood exposures, and 7.4% reported having experienced ≥ 4 types of ACEs. The most prevalent forms of child maltreatment were emotional neglect (15.5%) and emotional abuse (14.5%). The most frequent dysfunctional household condition was parental divorce or separation (23.8%), followed by household substance abuse (8.9%) and household mental illness (8.1%). Almost one-fifth of students (17.5%) reported SEB symptoms (peer relationship problems in 21.7%, emotional symptoms in 14.6%, conduct problems in 18.3%, hyperactivity in 15%). The prevalence of SHC was also high: more than half of the students experienced at least one subjective health complaint multiple times a week. Significant associations were found between ACEs and the SEB/SHC reported by students. CONCLUSIONS: Adverse childhood experiences, social, emotional, and behavioural symptoms, and SHC are common among Hungarian adolescents. The cumulation of ACEs is associated with a higher number of SEB and SHC symptoms. Therefore, prevention programmes, early recognition, risk reduction, and therapy are needed.