Adverse childhood experiences and trauma informed care for chiropractors: a call to awareness and action.

BACKGROUND: Trauma is an emotional response to distressing events where coping and subsequent recovery are absent. Adverse Childhood Experiences (ACEs) are traumas, occurring before the age of 18 years, such as child abuse or neglect, caregiver instability, and household dysfunction. Sixty-four percent of the U.S. population report experiencing at least one ACE, with over 1 billion children experiencing abuse and neglect annually worldwide. Chronic exposure to stressful circumstances or multiple traumatic events has negative physiologic impacts. Persons who experience 3 or more ACEs in childhood are at greater risk of poor mental health outcomes and may be more likely to engage in high-risk behaviors, predisposing them to long-term health impacts, such as metabolic diseases, anxiety, depression, substance use, and chronic pain. Trauma informed care (TIC) is a recommended approach to healthcare delivery across professions, especially when a trauma history is suspected. This commentary aims to increase awareness of the impact of ACEs on health outcomes and introduce TIC concepts as they may apply to chiropractic care for adults with a history of ACEs. DISCUSSION: This commentary reviews an introductory model (4R's: realize, recognize, respond, resist re-traumatization) as one TIC framework used by healthcare practitioners. Prior trauma can lessen trust, alter perceptions of physical touch, and hands-on examinations and chiropractic treatments may trigger stress responses. Using TIC after appropriate training, includes referrals to multidisciplinary providers to address trauma-related concerns outside the scope of chiropractic, and screening for ACEs if deemed appropriate. Creating safe spaces, communicating clearly, avoiding victimizing language, explaining procedures, asking for consent before physical contact, and giving patients choice and control in their own care may avoid triggering prior traumas. CONCLUSION: Given the high worldwide prevalence of persons experiencing 3 or more ACEs, TIC principles are practical adaptations to chiropractic care for use with many patient populations. As TIC and ACEs are emerging concepts within chiropractic, students and practitioners are encouraged to undertake additional training to better understand these complex and sensitive topics. Exploratory research on the incidence, presentation, and impacts of various trauma types, including ACEs, to support adoption of TIC in chiropractic settings is essential.

[Prevalence of adverse and victimization experiences in adult people with severe mental illness in Barcelona]. / Prevalencia de experiencias adversas y victimización en personas adultas con trastorno mental grave en Barcelona.

OBJECTIVE: To describe the extension of the adverse experiences, including victimization, lived in childhood and adulthood in a sample of people with severe mental illness residing in Barcelona, Spain. METHOD: Descriptive, quantitative and cross-sectional study. Adverse and victimization experiences were assessed using 26 items from the Adverse Childhood Experiences Questionnaire (ACE-IQ). Items were included obtain information regarding victimization during adulthood. Seventy-four people with severe mental illness were interviewed (median age: 42.03 years; standard deviation: 9.60). RESULTS: All participants reported at least two victimization experiences throughout their lifetime. The most frequent experiences were conventional crimes (87.8%) and victimization by caregivers (86.5%). Before age 18, half of the participants reported having experienced physical violence by their caregivers (52.7%) and almost one out of three reported to have been victim of sexual abuse (32.4%). Women were almost 13 times more likely to experience sexual victimization than men throughout their lifetime (odds ratio: 12.75; 95% confidence interval: 4.19-38.71). CONCLUSIONS: Victimization experienced by people with severe mental illness is a widespread problem that has received little attention. The results of this study are consistent with those obtained in previous investigations and underscore the need to translate this knowledge into medical practice into medical practice, considering them in order to develop treatments with a comprehensive approach to mental health.

Prevalencia de experiencias adversas y victimización en personas adultas con trastorno mental grave en Barcelona / Prevalence of adverse and victimization experiences in adult people with severe mental illness in Barcelona

Objetivo: Conocer la extensión y las características de las experiencias adversas y de victimización en una muestra de personas adultas con un trastorno mental grave residentes en la ciudad de Barcelona. Método: Estudio descriptivo, cuantitativo y transversal. Las experiencias adversas y de victimización se evaluaron a partir de 26 ítems del Adverse Childhood Experiences Questionnaire (ACE-IQ), el cual se amplió para incluir experiencias acontecidas en la edad adulta. Se entrevistó a 74 personas con trastorno mental grave (edad media: 42,03 años; desviación estándar: 9,60). Resultados: Todas las personas entrevistadas reportaron haber vivido como mínimo dos victimizaciones a lo largo de su vida. Las más frecuentes fueron los delitos comunes (87,8%) y la victimización por parte de los cuidadores principales (86,5%). Las mujeres presentaban casi 13 veces más probabilidades de sufrir victimización sexual que los hombres a lo largo de la vida (odds ratio: 12,75; intervalo de confianza del 95%: 4,19-38,71). Antes de los 18 años destaca la alta prevalencia de violencia física por parte de los cuidadores principales (52,7%) y el abuso sexual infantil (32,4%). Conclusiones: La victimización sufrida por las personas con un trastorno mental grave es un problema extendido que ha recibido muy poca atención. Los resultados de este estudio son coherentes con los obtenidos en investigaciones previas y ponen de manifiesto la necesidad de trasladar estos conocimientos a la práctica médica, teniéndolos en cuenta para desarrollar tratamientos con un abordaje integral de la salud mental.(AU)

Objective: To describe the extension of the adverse experiences, including victimization, lived in childhood and adulthood in a sample of people with severe mental illness residing in Barcelona, Spain. Method: Descriptive, quantitative and cross-sectional study. Adverse and victimization experiences were assessed using 26 items from the Adverse Childhood Experiences Questionnaire (ACE-IQ). Items were included obtain information regarding victimization during adulthood. Seventy-four people with severe mental illness were interviewed (median age: 42.03 years; standard deviation: 9.60). Results: All participants reported at least two victimization experiences throughout their lifetime. The most frequent experiences were conventional crimes (87.8%) and victimization by caregivers (86.5%). Before age 18, half of the participants reported having experienced physical violence by their caregivers (52.7%) and almost one out of three reported to have been victim of sexual abuse (32.4%). Women were almost 13 times more likely to experience sexual victimization than men throughout their lifetime (odds ratio: 12.75; 95% confidence interval: 4.19–38.71). Conclusions: Victimization experienced by people with severe mental illness is a widespread problem that has received little attention. The results of this study are consistent with those obtained in previous investigations and underscore the need to translate this knowledge into medical practice into medical practice, considering them in order to develop treatments with a comprehensive approach to mental health.(AU)

Religião e experiências na infância de ouvidores de vozes psiquiátricos / Religion and childhood experiences of psychiatric voice hearers / La religión y las experiencias infantiles de los escuchadores de voces psiquiátricos

RESUMO Objetivo: analisar a relação entre as experiências na infância de ouvidores de vozes e religião quando adulto. Método: pesquisa transversal com ouvidores de vozes de um Centro de Atenção Psicossocial em município do interior do Rio Grande do Sul, Brasil. A coleta dos dados ocorreu em 2019, por meio da utilização de questionários padronizados; para a variáveis sobre religião ,utilizou-se o questionário Duke Religious Index. Para a análise dos dados, utilizou-se frequências absolutas, proporções e análise bivariada. Resultados: participaram 112 pessoas, 66 referiram ouvir vozes, 65% relataram ter religião, com maior prevalência de evangélicos (n=31; 52%). Não ter uma infância prazerosa (78%), ter vivenciado uma infância estressante (76%) e não ter se sentido seguro na rua quando criança (83%) apresentaram relação com ter religião quando adulto. Conclusão: este estudo propõe uma mudança de produção de conhecimento e cuidado em saúde mental, que considere a experiência e a religiosidade.

ABSTRACT Objective: to analyze the relationship between childhood experiences of voice hearers and religion as an adult. Method: cross-sectional research with voice hearers from a Psychosocial Care Center in a city in the interior of Rio Grande do Sul, Brazil. Data collection occurred in 2019 using standardized questionnaires; for the variables on religion, the Duke Religious Index questionnaire was used. For data analysis, absolute frequencies, proportions, and bivariate analysis were used. Results: 112 people participated, of these, 66 reported hearing voices, 65% reported having religion, with a higher prevalence of evangelicals (n=31; 52%). Not having a pleasant childhood (78%), having experienced a stressful childhood (76%) and not having felt safe on the streets as a child (83%) were related to having religion as an adult. Conclusion: this study proposes a change in knowledge production and care in mental health that considers experience and religiosity.

RESUMEN Objetivo: analizar la relación entre las experiencias infantiles de los escuchadores de voces y la religión en la edad adulta. Método: investigación transversal con escuchadores de voces de un Centro de Atención Psicosocial de un municipio del interior de Rio Grande do Sul, Brasil. La recogida de datos se realizó en 2019 mediante el uso de cuestionarios estandarizados; para las variables sobre religión se utilizó el cuestionario Duke Religious Index. Para el análisis de los datos se utilizaron las frecuencias absolutas, las proporciones y el análisis bivariante. Resultados: Participaron 112 personas, 66 de ellas declararon oír voces, el 65% declaró tener religión, con una mayor prevalencia de evangélicos (n=31; 52%). No haber tenido una infancia agradable (78%), haber vivido una infancia estresante (76%) y no haberse sentido seguro en la calle cuando era niño (83%) estaban relacionados con tener religión como adulto. Conclusión: este estudio propone un cambio de producción de conocimiento y atención en salud mental, que considera la experiencia y la religiosidad.

Religião e experiências na infância de ouvidores de vozes psiquiátricos / Religion and childhood experiences of psychiatric voice hearers / La religión y las experiencias infantiles de los escuchadores de voces psiquiátricos

RESUMO Objetivo: analisar a relação entre as experiências na infância de ouvidores de vozes e religião quando adulto. Método: pesquisa transversal com ouvidores de vozes de um Centro de Atenção Psicossocial em município do interior do Rio Grande do Sul, Brasil. A coleta dos dados ocorreu em 2019, por meio da utilização de questionários padronizados; para a variáveis sobre religião ,utilizou-se o questionário Duke Religious Index. Para a análise dos dados, utilizou-se frequências absolutas, proporções e análise bivariada. Resultados: participaram 112 pessoas, 66 referiram ouvir vozes, 65% relataram ter religião, com maior prevalência de evangélicos (n=31; 52%). Não ter uma infância prazerosa (78%), ter vivenciado uma infância estressante (76%) e não ter se sentido seguro na rua quando criança (83%) apresentaram relação com ter religião quando adulto. Conclusão: este estudo propõe uma mudança de produção de conhecimento e cuidado em saúde mental, que considere a experiência e a religiosidade.

ABSTRACT Objective: to analyze the relationship between childhood experiences of voice hearers and religion as an adult. Method: cross-sectional research with voice hearers from a Psychosocial Care Center in a city in the interior of Rio Grande do Sul, Brazil. Data collection occurred in 2019 using standardized questionnaires; for the variables on religion, the Duke Religious Index questionnaire was used. For data analysis, absolute frequencies, proportions, and bivariate analysis were used. Results: 112 people participated, of these, 66 reported hearing voices, 65% reported having religion, with a higher prevalence of evangelicals (n=31; 52%). Not having a pleasant childhood (78%), having experienced a stressful childhood (76%) and not having felt safe on the streets as a child (83%) were related to having religion as an adult. Conclusion: this study proposes a change in knowledge production and care in mental health that considers experience and religiosity.

RESUMEN Objetivo: analizar la relación entre las experiencias infantiles de los escuchadores de voces y la religión en la edad adulta. Método: investigación transversal con escuchadores de voces de un Centro de Atención Psicosocial de un municipio del interior de Rio Grande do Sul, Brasil. La recogida de datos se realizó en 2019 mediante el uso de cuestionarios estandarizados; para las variables sobre religión se utilizó el cuestionario Duke Religious Index. Para el análisis de los datos se utilizaron las frecuencias absolutas, las proporciones y el análisis bivariante. Resultados: Participaron 112 personas, 66 de ellas declararon oír voces, el 65% declaró tener religión, con una mayor prevalencia de evangélicos (n=31; 52%). No haber tenido una infancia agradable (78%), haber vivido una infancia estresante (76%) y no haberse sentido seguro en la calle cuando era niño (83%) estaban relacionados con tener religión como adulto. Conclusión: este estudio propone un cambio de producción de conocimiento y atención en salud mental, que considera la experiencia y la religiosidad.

Adverse Childhood Experiences Among 28,047 Norwegian Adults From a General Population.

Aim: The purpose of this study was to estimate the prevalence of adverse childhood experiences (ACEs) among Norwegian adults from a general population and to identify potential associations with demographic and socioeconomic characteristics. Methods: A randomly drawn sample (N = 61,611) from the public registry of inhabitants was invited to participate in the Norwegian Counties Public Health Survey. The present study was based on online responses from 28,047 adults ≥18 years (mean age: 46.9 years, SD = 16.03). Log-link binomial regression analyses were performed to examine associations between four measures of ACEs (family conflict, lack of adult support, bad memories, and difficult childhood) and demographic (age, gender, civil status, parental divorce) and socioeconomic characteristics (education level, perceived financial situation, and welfare benefits). Results: Single individuals and those with parents that divorced during childhood were at elevated risk of all four ACEs. The risk varied to some degree between the sexes. The prevalence of ACEs declined with increasing age. We found a consistent social gradient that corresponded to the frequency of ACEs for all three socioeconomic characteristics investigated. The risks were highest for those in the lowest socioeconomic levels (RR: 1.53, 95% CI: 1.32-1.78 to RR: 4.95, CI: 4.27-5.74). Conclusions: Public health strategies should direct more attention to the interplay between ACEs and socioeconomic factors. Welfare services should be sensitive to ACEs among their service recipients.

Associations between parental alcohol problems in childhood and adversities during childhood and later adulthood: a cross-sectional study of 28047 adults from the general population.

BACKGROUND: Adverse childhood experiences (ACE) are related to adverse physical and mental health outcomes. However, few larger studies based on a general population sample with age groups ranging from young adults to elderly have investigated whether parental alcohol problems increase the risk of offspring subjective reports of ACE both during childhood and current adult adversities. The purpose of this study was to examine the associations between parental alcohol problems and adversities during childhood and later in adulthood. METHODS: The 28,047 respondents were adults (> 18 years old) from the general population who participated in the Norwegian Counties Public Health Survey. The study had a cross-sectional design and included respondents' evaluations of childhood experiences and current adult adversities. The short version of the Children of Alcoholics Screening Test (CAST-6, cut-off ≥3) measured parental alcohol problems. Multivariable logistic regression was adjusted for gender, age, and education. RESULTS: Growing up with parental alcohol problems strongly increased the risk of experiencing a dysfunctional family environment during childhood (odds ratio [OR] 6.84; 95% confidence interval [CI] 6.36-7.36), perceiving childhood as difficult (OR 5.01; 95% CI 4.58-5.49), and reporting a lack of support from a trusted adult (OR 3.07; 95% CI 2.86-3.29). Parental alcohol problems were associated with a modestly increased risk of harmful alcohol use (OR 1.38; 95% CI 1.29-1.48), but the association with struggling with bad memories was strong (OR 4.56; 95% CI 4.17-4.98). CONCLUSIONS: Parental alcohol problems increased the risk of offspring experiencing adversities during both childhood and adulthood. Providing supportive services to these children and their families and addressing this issue as part of treatment is important to prevent alcohol related harm.

Childhood trauma determines different clinical and biological manifestations in patients with eating disorders.

PURPOSE: There is a significant relationship between childhood trauma and the development of an eating disorder in adolescence or adulthood, possibly influenced by circulating levels of inflammatory parameters. The main objective is to identify and describe a subgroup of patients with eating disorders and a history of trauma in childhood or adolescence with differential clinical features. METHODS: An observational study on a sample of 55 patients who met the diagnostic criteria for any DSM-5 eating disorder was carried out. Inflammatory parameters in white blood cells were examined. Patients underwent different assessments, including clinical and personality scales. RESULTS: Patients with a history of trauma had higher scores in the delirious and narcissistic items of the Millon Clinical Multiaxial Inventory (MCMI-II) (p < 0.05) and a higher score in the paranoid item of the SCID-5 Personality Disorders Version (SCID-5-PD) (p < 0.05). Patients with distinguishing personality features were grouped according to the Childhood Trauma Questionnaire sexual subscale. Tumor necrosis alpha (TNF-α) showed a significant association with childhood trauma history. CONCLUSIONS: There is a profile of patients with eating disorders who have increased activity in the inflammatory pathways that, if identified precociously, can benefit from specifically aimed interventions. LEVEL OF EVIDENCE: Level V, observational study.

Adult frequent presentation to emergency departments and adverse childhood experiences: a scoping review.

BACKGROUND: Extensive literature reports the influence of childhood adversity on adult health, however few studies have explored these life antecedents in people who frequently present to the emergency department. This review synthesizes literature exploring childhood adversity influences on emergency department presentations, if and how it is identified, and interventions addressing the health care needs of this group. METHODS: Eight electronic databases were searched. Arksey and O'Malley's framework guided this review, and a quality appraisal was undertaken. Searches included all published studies until August 2020. RESULTS: Twenty-one articles were included in this review. They revealed that childhood adversity is common among adults who frequently attend the emergency department. It impacts physical and psychological health into adulthood and there is no standardized approach described to documenting childhood adversity, nor any consistent intervention reported by emergency departments to address its sequelae in adulthood. CONCLUSIONS: Several studies call for screening, intervention, and education to identify and address impacts of childhood adversity for patients who frequently present to the emergency department. However, reliable high-level studies exploring these topics specific to the emergency department are uncommon. Consequently, definitive interventions to address the healthcare needs of this group is lacking and warrants further research.

Cross-cultural Adaptation of the Adverse Childhood Experiences International Questionnaire / Adaptação transcultural do Adverse Childhood Experiences International Questionnaire

ABSTRACT OBJECTIVE: To translate, adapt and validate the contents of the Adverse Childhood Experiences International Questionnaire to a Portuguese version, to be used in Brazil, named Questionário Internacional de Experiências Adversas na Infância. METHODS: This is a methodological study of cross-cultural adaptation of evaluation instruments presenting the results of semantic equivalence between the original instrument and the adapted version. The semantic equivalence of the instrument involved the following steps: 1) two translations and a synthesis of the translations; 2) two retranslations; 3) validation of contents by eight health workers; 4) synthesis of the retranslations; 5) pre-tests to assess acceptability, understanding and emotional impact of the questions; and, finally, 6) writing of the final version of the instrument. RESULTS: the adapted version proved to be easy to apply and to understand and achieved good semantic equivalence when compared to the original version. The psychometric properties of the instrument still need to be evaluated. Limitations and recommendations for improving the instrument and its use are presented. CONCLUSION: The process of cross-cultural adaptation of the Adverse Childhood Experiences International Questionnaire resulted in an adapted version to Brazilian Portuguese.

RESUMO OBJETIVO: Traduzir, adaptar e validar o conteúdo do Adverse Childhood Experiences International Questionnaire para uma versão em português, vigente no Brasil, nomeada como Questionário Internacional de Experiências Adversas na Infância. MÉTODOS: Trata-se de um estudo metodológico de adaptação transcultural de instrumentos de avaliação, em que são apresentados os resultados da equivalência semântica entre o instrumento original e a versão adaptada. A equivalência semântica do instrumento envolveu as seguintes etapas: 1) duas traduções e uma síntese das traduções; 2) duas retraduções; 3) validação de conteúdo realizado por oito profissionais da área da saúde; 4) síntese das retraduções; 5) pré-testes para avaliar a aceitabilidade, a compreensão e o impacto emocional das questões; e, por fim, 6) a elaboração da versão final do instrumento. RESULTADOS: A versão adaptada demonstrou ser de fácil aplicação e compreensão e obteve boa equivalência semântica quando comparada à original. As propriedades psicométricas do instrumento devem, ainda, ser avaliadas. Limitações e recomendações para a melhoria do instrumento e para a sua utilização são apresentadas. CONCLUSÃO: O processo de adaptação transcultural do Adverse Childhood Experiences International Questionnaire proporcionou uma versão adaptada para o português vigente no Brasil.

Importance of trauma-related fear in patients with irritable bowel syndrome and early adverse life events.

BACKGROUND: Although early adverse life events (EALs) are prevalent among patients with irritable bowel syndrome (IBS), the impact of fear or dissociation experienced during the trauma has not been evaluated. We investigated the prevalence of fear at the time of trauma and its association with IBS status among individuals with early-life trauma before the age of 18. METHODS: Among participants with ≥1 EAL, association of fear and dissociation with IBS status was determined with logistic regression, and improvement in prediction of IBS over ETI score alone was determined with the likelihood ratio test. Controlling for age, sex, and IBS status, we then examined the association of each EAL with reported fear. KEY RESULTS: Compared to healthy controls (HCs), IBS subjects reported a higher prevalence of fear (60.4% vs 36.2%, P < .0005) and dissociation (23.5% vs 13.0%, P < .0005) at the time of EAL. Fear, but not dissociation, improved prediction of IBS over the total number of EALs (odds ratio = 2.00, P < .0001). CONCLUSIONS AND INFERENCES: This study highlights the importance of EAL-related factors such as fear in addition to the presence or absence of EALs in IBS pathophysiology.

Experience of emergency department use among persons with a history of adverse childhood experiences.

BACKGROUND: Adverse childhood experiences (ACEs) are associated with increased morbidity and mortality, lower levels of distress tolerance, and greater emotional dysregulation, as well as with increased healthcare utilization. All these factors may lead to an increased use of emergency department (ED) services. Understanding the experience of ED utilization among a group of ED users with high ACE scores, as well as their experiences as viewed through the lens of a trauma and violence informed care (TVIC) framework, could be important to their provision of care. METHODS: This is the qualitative portion of a larger mixed methods study. Twenty-five ED users with high ACE scores completed in depth interviews. Thematic analysis of the interview transcripts was undertaken and directed content analysis was used to examine the transcripts against a TVIC framework. RESULTS: The majority of participants experienced excellent care although challenges to this experience were faced by many in the areas of registration and triage. Some participants did identify negative experiences of care and stigma when presenting with mental health conditions and pain crises, as did participants who perceived that they were considered "different" (dressed differently, living in poverty, young parents, etc.). Participants were thoughtful about their reasons for seeking ED care including lack of timely access to their family doctor, perceived urgency of their condition, or needs that fell outside the scope of primary care. Participants' experiences mapped onto a TVIC framework such that their needs and experiences could be framed using a TVIC lens. CONCLUSIONS: While the ED care experience was excellent for most participants, even those with a trauma history, there existed a subset of vulnerable patients for whom the principles of TVIC were not met, and for whom implementation of trauma informed care might have a positive impact on the overall experience of care. Recommendations include training around TVIC for ED leadership, staff and physicians, improved access to semi-urgent primary care, ED patient care plans integrating TVIC principles, and improved support for triage nurses and registration personnel.

Factores sociodemográficos y eventos de vida tempranos asociados con la felicidad en adultos de Lima Metropolitana / Socio-demographic factors and early life events associated with happiness in adults of Metropolitan Lima

RESUMEN Objetivos: Estimar los factores sociodemográficos y eventos de vida tempranos asociados con la feli cidad en adultos de Lima Metropolitana. Materiales y métodos: Se realizó un análisis secundario del Estudio Epidemiológico de Salud Mental de Lima Metropolitana 2012, el cual utilizó los instrumentos de índice de calidad de vida, la versión breve y modificada del EMBU, un cuestionario de eventos adver sos tempranos, un índice de felicidad construido a partir del ítem único sobre felicidad de Andrews y la escala de satisfacción con la vida. Se realizaron análisis multivariados ajustados. Resultados: La felicidad se asoció con el sexo, estado civil, pobreza y nivel de instrucción. Los estilos de crianza asociados con menor felicidad fueron: las conductas de rechazo y las actitudes machistas, y con mayor felicidad: el calor emocional. No se encontró asociación con prácticas de crianza de sobreprotección o favoritismo. Como eventos adversos tempranos se asociaron significativamente: discusiones dentro de la familia, padre con problemas de alcohol, ausencia paterna, conductas de amenazas o chantaje emocional. Conclusiones: Los hallazgos resaltan la importancia de desarrollar programas intensivos en los primeros años de vida que estimulen estilos de crianza y ambientes de desarrollo saludables.

ABSTRACT Objectives: To estimate socio-demographic factors and early life events associated with happiness in adults in metropolitan Lima. Materials and methods: A secondary analysis was carried out on the Epi demiological Study of Mental Health of Metropolitan Lima 2012. The instruments used were the Quality of Life Index; a brief and modified version of the EMBU; a questionnaire of early adverse events; a Hap piness Index built from Andrews' single item of Happiness and the Life Satisfaction Scale. Adjusted mul tivariate analyses were performed. Results: Happiness was significantly associated with gender, marital status, poverty, and level of education. Parenting styles associated significantly with less happiness were: behaviors of rejection and sexist attitudes; and with higher happiness: emotional warmth. No associa tion was found with overprotection or favoritism breeding practices. Early adverse events significantly associated with lower happiness were discussions within the family, father with problems of alcohol, parental absence, behaviors of emotional blackmail or threats. Conclusions: This study highlights the importance of developing intensive programs in the first years of life that promote parenting styles and healthy development environments.

Refining Trauma-Informed Perinatal Care for Urban Prenatal Care Patients with Multiple Lifetime Traumatic Exposures: A Qualitative Study.

INTRODUCTION: Because lifetime trauma exposure has been linked to multiple adverse pregnancy outcomes, there is a need for all perinatal care providers to be versed in trauma-informed care practices. However, there are few data to guide trauma-informed practice during the perinatal period. The objective of this study was to refine ongoing development of a trauma-informed care framework for perinatal care by conducting a qualitative study of all trauma experiences and preferred screening practices of pregnant patients at an urban prenatal clinic. METHODS: In this qualitative study, we conducted semistructured interviews with 30 women receiving prenatal care at an urban clinic. Participants also completed a trauma history questionnaire. Inductive coding was used to generate themes and subthemes. RESULTS: Participants described multiple lifetime traumatic exposures as well as background exposure to community violence. Not all participants desired routine trauma screening; factors limiting disclosure included fear of retraumatization and belief that prior trauma is unrelated to the current pregnancy. Strong therapeutic relationships were identified as critical to any trauma history discussion. DISCUSSION: This study supports a trauma-informed care approach to caring for pregnant women with prior traumatic exposures, including trauma screening without retraumatization and trusting patient-provider relationships.

Association of Adverse Childhood Experiences with Glycemic Control and Lipids in Children with Type 1 Diabetes.

Adverse childhood experiences (ACE) have been associated with a greater prevalence of risky behaviors and chronic health conditions, such as diabetes in adulthood. While adolescents with risk taking behaviors experience worsening of diabetic metabolic control, it is yet to be determined whether glycemic management in children and adolescents is negatively and independently influenced by ACEs. This study examines the relationship between ACEs in children and adolescents with type 1 diabetes (T1DM) and glycemic control, BMI and lipids. For such children, we hypothesized that hemoglobin A1c (HbA1c) is positively correlated with ACE scores. Parents of children (age 2-18 years) with T1DM completed a validated ACE questionnaire. The associations between parent and child ACE score and HbA1c, lipids and BMI z-scores were assessed using linear regression. The prevalence of any ACE was 27.9% among children and 49.0% among parents. HbA1c was significantly higher in children who had exposure to three or more ACEs (ß:0.63 (4.5 mmol/mol); p = 0.02), in those who had a parent exposed to four or more ACEs (ß:0.87 (7.2 mmol/mol); p = 0.03), in children who had exposure to household incarceration (ß:0.62 (4.4 mmol/mol); p = 0.05) and children who witnessed or had been victim of violence in the neighborhood (ß:0.71 (5.4 mmol/mol); p = 0.02). ACEs were highly prevalent among children with T1DM and had a positive association with glycemic control.

Gene-environment interactions between HPA-axis genes and childhood maltreatment in depression: a systematic review.

OBJECTIVE: Gene-environment (GxE) interactions may comprise an important part of the aetiology of depression, and childhood maltreatment (CM), a significant stressor, has consistently been linked to depression. Hence, in this systematic review, we aimed to investigate the interaction between hypothalamus-pituitary-adrenal axis (HPA-axis) genes and CM in depression. METHODS: We conducted a literature search using the Pubmed, Embase, and PsychINFO databases in adherence with the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. We included studies investigating GxE interactions between HPA-axis genes [Angiotensin Converting Enzyme (ACE), Arginine Vasopressin (AVP), Corticotrophin Releasing Hormone (CRH), Corticotrophin Releasing Hormone Receptor 1 (CRHR1), Corticotrophin Releasing Hormone Receptor 2 (CRHR2), FK506 binding protein (FKBP5), Nuclear Receptor subfamily 3 group C member 1 (NR3C1), Nuclear Receptor subfamily 3 group C member 2 (NR3C2)] and CM in depression. RESULTS: The literature search identified 159 potentially relevant studies. Following screening, 138 of these were excluded. Thus, 21 studies, investigating a total of 51 single nucleotide polymorphisms, were included in the final study. The most prevalent genes in the current study were CRHR1 and FKBP5. Significant GxE interactions were reported in seven of eight studies for CRHR1:rs110402 and CM, and in five of eight studies for FKBP5:rs1360780 and CM. In summary, our results suggest possible GxE interactions between CRHR1, FKBP5, NR3C1, and NR3C2 and CM, respectively. For the remaining genes, no relevant literature emerged. CONCLUSIONS: We find that genetic variation in four HPA-axis genes may influence the effects of CM in depression.

Social and early life adversity and chronic health conditions among Tunisian adults.

Early life adversities (ELAs) are shown as significant risk factors for chronic health conditions (CHCs). ELAs include multiple types of abuse such as the social abuse (peer, community, and collective violence). The purpose is to describe the relationship between childhood social abuse and chronic conditions in adulthood among a sample of adults in Tunisia and to investigate the role of obesity and tobacco use as mediators of this association. A cross-sectional study was conducted in Tunisia, from January to June 2016 using the Arabic Adverse Childhood Experiences International Questionnaire (ACE-IQ). Items of social abuse (peer violence, witnessing community violence, and exposure to collective violence) were analyzed. A total of 2,120 adults were enrolled. After adjustment for age, gender, and intrafamilial ELA, social adversities were associated significantly with the selected CHC. Experiencing more than two social ELA increase the risk of occurrence of hypertension and coronary diseases. After accounting for the indirect effect of body mass index, statistically significant partial mediation effects were observed for the cumulative number of social ELA as the exposure variable and chronic diseases as the outcome variable (p ≤ .001; % mediated = 44.5%). These findings support an association between many chronic health disorders and childhood social abuse, independently of intrafamilial ACEs.

Associação entre maus-tratos na infância e declínio cognitivo no idoso: uma revisão integrativa / Association between maltreatment in childhood and cognitive decline in the elderly: an integrative review

A violência contra a criança representa um importante problema de saúde pública, assim como o declínio cognitivo. A ligação entre essas variáveis vem sendo analisada cada vez mais, porque o estresse experimentado nos primeiros anos de vida pode estar relacionado a mudanças estruturais, funcionais e epigenéticas nas regiões cerebrais envolvidas na cognição. O objetivo deste estudo foi analisar essa associação, por meio de uma revisão integrativa da literatura, pelo meio da pesquisa bibliográfica das seguintes bases de dados: SciELO, LILACS, PUBMED e PsycINFO. O período de seleção dos artigos compreendeu os últimos cinco anos. No total, foram 33 artigos, dos quais dez eram artigos originais que focaram na relação entre maus-tratos na infância e declínio cognitivo em idosos. A presença de maus-tratos na infância possui associação com o declínio da função cognitiva no idoso, agravando-o sobremaneira e inclusive podendo colocar os indivíduos em risco de declínio cognitivo acentuado. Uma das limitações deste estudo foi a percepção de que a temática ainda carece de mais e melhores estudos que abordem esta relação na prática, por meio de estudos longitudinais.

Violence against children and cognitive decline are highly relevant issues for health. The bond between the variables is increasingly being analyzed, since stress early in life may be related to structural, functional and epigenic changes in brain regions involving cognition. Current study analyzes such association through an integrative review of the literature and by bibliographical research retrieved from SciELO, LILACS, PUBMED and PsycINFO during the last five years. Thirty-three original scientific articles were analyzed, with ten related to maltreatment in childhood and cognitive decline in the elderly. Maltreatment in childhood is associated with possible high cognitive decline in old age. A limit in current study was the perception that the theme required more investigation within longitudinal studies.

Traumatic childhood experiences and multiple dimensions of poor sleep among adult women.

STUDY OBJECTIVES: Exposure to traumatic childhood experiences (TCEs) may contribute to poor sleep in adulthood. Previous studies have been limited to mainly investigating physical and sexual abuse and did not consider betrayal trauma, or whether the victim regarded the perpetrator as someone socially close to them, the age group at occurrence, and trauma-related distress/anxiety. METHODS: We used a large cohort of US women, 35-74 years old, enrolled in the Sister Study from 2003 to 2009. Self-reports of specific TCEs occurring before the age of 18 years included sexual, physical, and psychological/emotional trauma; natural disasters; major accidents; and household dysfunction. Participants self-reported average sleep duration (short: <7 hours vs recommended: 7-9 hours), sleep onset latency (SOL) at least 30 vs less than 30 minutes, at least 3 night awakenings once asleep at least 3 times/week (Night awakenings [NA], yes vs no), and napping at least 3 vs less than 3 times/week. RESULTS: Among 40 082 women, 55% reported a TCE, with 82% reporting betrayal trauma. Compared to women reporting no TCE, women with any TCE were more likely to report short sleep (prevalence ratio [PR] = 1.08, [95% confidence interval (CI) = 1.04 to 1.11]), longer SOL (1.11, [1.06 to 1.16]), frequent NAs (1.06, [1.00 to 1.11]), and frequent napping (1.05, [0.99 to 1.12]). The relationship between experiencing any TCE and short sleep was stronger for TCEs by a perpetrator considered socially close vs not close (1.12, [1.09 to 1.16]), SOL (1.27, [1.22 to 1.33]), NA (1.20, [1.14 to 1.27]), and napping (1.24, [1.17 to 1.32]). CONCLUSIONS: TCEs were associated with poor sleep in women with greater impact when the perpetrator was regarded as close. More research is warranted to better understand pathways between childhood trauma and sleep health in adulthood to develop effective interventions.

Development of a prenatal program for adults with personal histories of childhood abuse or neglect: a Delphi consensus consultation study. / Développement d'un programme d'accompagnement prénatal pour les adultes ayant été victimes d'abus ou de négligence au cours de leur enfance : étude de consensus par la méthode Delphi.

INTRODUCTION: Pregnancy and the birth of a child present particular challenges for adults with personal histories of childhood abuse or neglect. However, few prenatal interventions address the specific needs of this population. This research aims to determine a list of actions that should be achieved during group interventions designed for expectant parents who experienced childhood trauma. METHODS: Fifteen stakeholders representing nine different Quebec health care and community organizations that work with families and/or trauma survivors participated in a Delphi process in two rounds. In round 1, three project leaders identified, from clinical and empirical literature, a set of 36 actions relevant for expectant parents who experienced childhood trauma. Using an anonymized online survey, stakeholders coded how important they considered each action and whether they were already conducting similar interventions in their clinical setting. Stakeholders subsequently participated in a one-day in-person meeting during which they discussed the pertinence of each action, proposed new ones and refined them. This was followed by a second anonymized online survey (round 2). A consensus was reached among the stakeholders regarding a final list of 22 actions. RESULTS: Two central clusters of actions emerged from the consultation process: actions aiming to support mentalization about self and parenthood, and actions aiming to support mentalization of trauma. CONCLUSION: The Delphi process helped to identify what should be the core of a prenatal intervention targeting adults who experienced childhood trauma, from the viewpoint of professionals who will ultimately deliver such a program.

INTRODUCTION: La grossesse et la naissance d'un enfant posent des défis particuliers aux adultes ayant été victimes d'abus ou de négligence durant leur enfance. Il existe cependant peu d'interventions prénatales adaptées aux besoins spécifiques de ces personnes. Cette recherche vise à identifier une liste d'actions à mettre en oeuvre dans le cadre d'interventions de groupe destinées aux futurs parents ayant subi des traumatismes relationnels durant leur enfance. MÉTHODOLOGIE: Quinze intervenants représentant neuf organismes communautaires et de soins de santé du Québec travaillant auprès des familles ou des victimes de traumatismes ont participé à un processus de consultation Delphi à deux volets. Dans le premier volet, les trois chercheurs responsables du projet ont élaboré, en se fondant sur la littérature clinique et empirique, 36 actions pertinentes pour les futurs parents ayant subi des traumatismes durant leur enfance. Des intervenants ont ensuite participé à un sondage en ligne anonyme au cours duquel ils avaient à coder l'importance qu'ils accordaient à ces actions ainsi que la similitude entre ces dernières et les interventions pratiquées dans leur milieu clinique. Les intervenants ont ensuite pris part à une journée de consultation en personne, au cours de laquelle ils ont discuté de la pertinence des actions présentées, proposé de nouvelles actions et revu toutes les actions. Un second sondage anonyme a ensuite permis d'en arriver à un consensus sur une liste finale de 22 actions classées en fonction de leur pertinence. RÉSULTATS: Le processus de consultation a abouti à deux séries d'actions : une série visant à favoriser la mentalisation à propos de soi et de son rôle de parent et une série visant à favoriser la mentalisation à propos des traumas. CONCLUSION: Le processus de consultation a abouti à deux séries d'actions : une série visant à favoriser la mentalisation à propos de soi et de son rôle de parent et une série visant à favoriser la mentalisation à propos des traumas.