[Editor's note: Dr. Harise Stein at Stanford University edits a web site — abuseresearch.info — that focuses on the effects of abuse, and includes research articles on PACEs. Every month, she posts the summaries of the abstracts and links to research articles that address only ACEs, PCEs and PACEs. Thank you, Harise!]
Child abuse
Ruch DA, Horowitz LM, Hughes JL, et al.
Suicide in US Preteens Aged 8 to 12 Years, 2001 to 2022. JAMA Netw Open. 2024 Jul 1;7(7):e2424664. PMID: 39078634
“Study findings revealed a significant increase in the suicide rate among US preteens between the 2001-2007 and 2008-2022 periods. Results showed a disproportionate increase in female suicide rates relative to male…Black preteens had the highest rates of suicide for both periods, whereas Hispanic preteens had the highest percentage increase… While hanging or suffocation was the predominant method of suicide for the entire period, the largest increase in preteen suicides was by firearm.”
Mintz S, Dykstra H, Cornette M, et al. Characteristics and Circumstances of Suicide Among Children Aged 6 to 9 Years: 2006-2021. Pediatrics. 2024 Nov 1;154(Suppl 3):e2024067043L. PMID: 39484883
“From 2006 to 2021, the National Fatality Review system identified 78 suicide decedents aged 6 to 9 years. The largest share were aged 9 years (72%), male (74%), non-Hispanic Black (42%), and died by hanging (86%) at home (91%). School-related problems (39%), history of child maltreatment (36%), history of mental health services (30%), argument with parents (23%), and familial discord (19%) were common circumstances. Key suicide prevention themes included education for caregivers and school staff, improved behavioral health services, and implementation of school policies and programs.”
González CD, Martínez-Cárdenas CF.
Risk factors and profiles of reattempted suicide in children aged less than 12 years. An Pediatr (Engl Ed). 2024 Nov;101(5):310-318. PMID: 39455351
In this study from Colombia, of 120 children under age 12 with attempted suicide, for 35.8% there were reports of reattempted suicide. The best risk factors for predicting repeated suicide attempts included child maltreatment (odds ratio, 6.22), persistent suicidal ideation (OR, 30.91), a history of violence or sexual abuse (OR, 13.10) and the use of sharp objects (OR, 46.45).
Gaither JR, McCollum S, Bechtel K, Leventhal JM, Mintz S.
The Circumstances Surrounding Fatal Pediatric Opioid Poisonings, 2004-2020. Pediatrics. 2024 Nov 1;154(Suppl 3):e2024067043N. PMID: 39484873
“The majority (65.3%) of the 1696 fatal opioid poisonings occurred in the child’s own home. Prescription opioids contributed to 91.8% of deaths, heroin 5.4%, and illicit fentanyl 7.7%. Co-poisonings with nonopioid substances occurred in 43.2% of deaths. Among 0- to 4-year-olds, 33.9% died of homicide and 45.0% had a primary caregiver with a history of substance use/abuse. Among 10- to 14-year-olds and 15- to 17-year-olds, respectively, 42.0% and 72.8% of decedents had a history of substance use/abuse. In each age group, at least 25.0% of children were victims of previous child maltreatment.”
Adachi K, Srivatsa A, Raymundo A, Bhargava D, Mehta AI.
Risk factors for abusive head trauma in the pediatric population. J Neurosurg Pediatr. 2024 Nov 1:1-7. PMID: 39486073
“Abusive head trauma (AHT) is the leading cause of death from physical child abuse in children younger than 5 years of age in the United States. The mortality rate among patients with AHT is 25%, and the recurrence rate of child abuse rises to 35% when there is a lack of intervention. Thus, identifying child abuse is crucial.” In this review of national data of patients younger than 3 years with acute head trauma 2017-2019, risk factors identified for abusive head trauma included prematurity, congenital disorder, and lower score of neurological function on admission.
Russell DH, Trew S, Dickson J, Hunt GR, Higgins DJ.
The risk and protective factors, response to disclosure, and interventions for sibling sexual abuse: A systematic review. Child Abuse Negl. 2024:107136. PMID: 39551691
From a research review, “sibling sexual abuse behavior was most commonly demonstrated by male siblings with histories of abuse, learning disabilities, and exposure to family conflict, violence, and disadvantage. Rates of disclosure to parents were low, with many victims (most commonly female) not disclosing until adulthood. Parents were also found to often respond poorly by minimising and disbelieving victimized children.”
Chapman RL, Ebzery KS, Ronken CA, Thompson D.
Problem Sexual Behavior and Engagement in Therapeutic Intervention among Children Aged 4-12.J Child Sex Abus. 2024;33(5):671-90. PMID: 39304996
“This research explored the characteristics, presenting issues, and engagement of 242 children aged 4-12 years attending a therapeutic service for PSB [problem sexual behavior]. Most frequently, PSB occurred within sibling relationships. Girls were more likely to engage in PSB alone (self-directed or non-targeted behaviors), while boys were more likely to involve other young people (interpersonal PSB). One-third (35%) of clients engaged in completion of therapy. Parental noninvolvement and self-directed or non-targeted PSB predicted early disengagement.”
Frasier KM, Fritts HA, Li V, Dudzik C, Sobotka M, Click K, et al. Advancing Understanding of Dermatological Manifestations in Munchausen Syndrome by Proxy. Cureus. 2024;16(10):e71616. PMID: 39553065
This comprehensive review critically examines the complex relationship between Munchausen Syndrome by Proxy [medical child abuse] and its dermatological manifestations. “The lesions may resemble common skin diseases such as infections, autoimmune disorders, or allergic reactions. However, inconsistent clinical histories, unusual distribution of lesions, and a lack of response to conventional treatments often raise suspicion…exaggerated symptomatology that doesn’t align with clinical findings, and frequent hospital visits for unexplained symptoms are red flags that should prompt a deeper investigation. Further complicating the diagnosis is the fact that perpetrators often possess extensive medical knowledge, which enables them to fabricate symptoms in a way that mimics real conditions, thus delaying accurate diagnosis and treatment.” Authors underscore the importance of a multidisciplinary approach.
Madigan S, Thiemann R, Deneault AA, et al.
Prevalence of Adverse Childhood Experiences in Child Population Samples: A Systematic Review and Meta-Analysis. JAMA Pediatr. 2024 Nov 11:e244385. PMID: 39527072
Using data from 65 studies, representing 490,423 children from 18 countries, “The mean age of children across studies was 11.9 years, the age range across samples was 0 to 18 years, and 50.5% were female. The estimated mean prevalences were 42.3% for 0 ACEs, 22.0% for 1 ACE, 12.7% for 2 ACEs, 8.1% for 3 ACEs, and 14.8% for 4 or more ACEs. The prevalence of 4 or more ACEs was higher among…children in residential care (1.26), with a history of juvenile offending (1.29), and in Indigenous peoples (1.63)…The prevalence of 0 ACEs was lower in questionnaire-based studies where children vs. parents were informants.”
Lee RY, Landau AY, Heider PM, et al.
Estimating the Prevalence of Child Abuse and Neglect Among Adolescents in Primary Care Through Diagnoses Codes and Free-Text EHR Clinical Notes. J Pediatr Health Care. 2024 Nov 22:S0891-5245(24)00319-5. PMID: 39580745
“We retrospectively analyzed data from 8,157 adolescents, using ICD-10 codes and a natural language processing algorithm to identify child abuse and neglect cases…The natural language processing approach identified more cases of child abuse and neglect cases (n = 294) compared to ICD-10 codes (n = 111). Additionally, topic modeling of clinical notes showed the multifaceted nature of child abuse and neglect as captured in clinical narratives.”
Sánchez Vázquez AR.
Are adverse childhood experiences the hidden iceberg of emotional distress in children and adolescents? An Pediatr (Engl Ed). 2024 Nov;101(5):299-302. PMID: 39510859
Editorial discusses ACEs within the framework of toxic stress and nurturing relationships.
Harris LG, Higgins DJ, Willis ML, et al. Dimensions of Child Maltreatment in Australians With a History of Out-of-Home Care. Child Maltreat. 2024:10775595241297944. PMID: 39499703
From an Australian study of children who experienced maltreatment, and comparing those in out-of-home care and those non-care-experienced, “the out-of-home care-experienced group reported a higher intensity of maltreatment, being younger when maltreatment first started, experiencing greater variety of maltreatment types, for longer periods, more times and by more perpetrators, than maltreated people with no care experience.”
Jural LA, Fagundes FA, Risso PA, et al.
Adverse Childhood Experiences and Oral Health of Children and Adolescents: A Systematic Review and Meta-Analysis. Trauma Violence Abuse. 2024:15248380241297423. PMID: 39569792
From a research review, “The meta-analysis revealed associations between ACEs and lower use of dental services, toothache, gingival bleeding, and dental cavities. Cumulative exposure to more than three ACEs was associated with poorer oral health.”
Adult Manifestations of Child abuse
Merkel EC, Vandeleur DM, Cheng X, Littman AJ, Baker KS.
Association between ACEs and health related quality of life in adult cancer survivors in the United States. J Cancer Surviv. 2024 May 3:10.1007/s11764-024-01603-5. PMID: 38700620
Of 5,780 cancer survivors, 62.0% female and 67.8% ≥ 65 years, “Prevalence of worse overall health was 22.5% for individuals with no ACEs compared to 30.2% for 2-3 ACEs and 38.5% for ≥ 4 ACEs. Prevalence of ≥ 14 unhealthy days was 18.1% with no ACEs compared to 21.0% for 1 ACE, 29.0% for 2-3 ACEs, and 44.8% for ≥ 4 ACEs…Screening for ACEs is warranted in all patients to guide targeted interventions to mitigate the impact of ACEs on health-related quality of life in cancer survivors.”
Ogbu CE, Stouras I, Oparanma CO, Ogbu SC, Umerah C.
The Impact of Adverse Childhood Experiences on Asthma Severity in US Adults. Med Sci (Basel). 2024;12(4). PMID: 39584913
“The prevalence of persistent asthma among US adults with asthma was 45.3%...About 22% of adults with asthma had no ACEs, 19% had one ACE, 14% had two ACEs, and 45% had three or more ACEs.” For women, “experiencing ≥ three ACEs compared to no ACEs was associated with 31% increased odds of persistent vs. intermittent asthma…experiencing household physical violence (compared to no household physical violence) was associated with persistent asthma in men (aOR = 1.69)…A plausible explanation supporting this thesis is that the victims of childhood adversity tend to adopt risky health behaviors (e.g., smoking) that increase the risk—and possibly the severity—of developing chronic diseases in adulthood, including asthma. Apart from this behavioral aspect, research has revealed that stress derived from experiencing ACEs might contribute to chronic health conditions.”
Berndt SL, Ribeiro LW, Rowlands I, Doust J, Mishra GD.
Childhood adversity and risk of endometriosis, fibroids, and polycystic ovary syndrome: a systematic review. Fertil Steril. 2024 Nov 8:S0015-0282(24)02356-2. PMID: 39521113
“A small number of studies have shown an association between childhood adversity and the development of endometriosis and fibroids in later life. These initial findings warrant further investigation in larger studies using standardized measures.”
Maeda Y, Tabuchi T, Fujiwara T.
Association between adverse childhood experiences and pregnancy morbidities: A nationwide online-based cross-sectional study. J Obstet Gynaecol Res. 2024 Dec;50(12):2231-2238. PMID: 39414244
Of 5444 Japanese pregnant women in 2021, 51.0% reported 0 ACE and 6.9% 4+ ACEs. A dose-response association was found between total ACE score and preterm birth and preeclampsia, with women with 4+ ACEs experiencing 3.06 times increased risk of preeclampsia. No association was found between ACEs and babies small-for-gestational age.
Sa Mendez L, Li J, Heish CT, Zhang L, Britt J, Crockett A, et al.
Examining childhood and adulthood stressors as risk factors for gestational diabetes mellitus in working pregnant individuals: A prospective cohort study. Prev Med. 2024:108163. PMID: 39505116
For 1163 working pregnant women in South Carolina, “maternal work stressors were associated with an increased risk of gestational diabetes [diabetes that develops during pregnancy] (adjusted OR = 2.11) and the association became much stronger among those with childhood abuse experiences (aOR = 3.80).”
Sanderson M, Cook M, Brown LL, Mallett V, Coker AL.
Lifetime Interpersonal Violence or Abuse and Diabetes Rates by Sex and Race. Am J Prev Med. 2023;65(5):783-91. PMID: 37302511
Of 25,251 adults in the Southeastern US, after adjustment for potentially confounding factors, adult interpersonal violence or abuse was associated with a 23% increased risk of diabetes. Diabetes risks associated with childhood were 15% for neglect and 26% for abuse. “When combining adult interpersonal violence or abuse and childhood abuse or neglect, the risk of diabetes was 35% higher than those experiencing no violence, abuse, or neglect. This pattern held among Black and White participants, and among women and men.”
Jiang W, He Y, Liu Q, Peng S, Ni Y, Zhong X, Guo L.
Associations between childhood maltreatment, peripheral immune biomarkers, and psychiatric symptoms in adults: A cohort study of over 138,000 participants. Brain Behav Immun. 2025 Jan;123:840-850. PMID: 39477077
Using data from 77,937 participants in the UK Biobank, 56.10 % female, with a mean age of 55.91 years at baseline, “There were dose-response relationships between the accumulation of childhood maltreatment indicators and all seven assessed psychiatric symptoms and multimorbidity in adulthood…Emotional abuse and physical neglect showed the strongest average effects on psychiatric symptoms. Levels of C-reactive protein (CRP) and counts of leukocytes and neutrophils [blood measures of inflammation] were positively associated with depressive symptoms, anxiety symptoms, PTSD, and psychotic experiences.”
Chong D, Qu D, Xi Y, Chen R.
Complex posttraumatic stress disorder (CPTSD) is uniquely linked to suicidality beyond posttraumatic stress disorder (PTSD) in adults with childhood maltreatment: A multinational study across four countries. Soc Sci Med. 2024;362:117406. PMID: 39405662
Among the 1324 participants (from US, UK, China and Malaysia) who experienced childhood maltreatment, meeting the criteria for CPTSD (complex PTSD), which includes an additional symptom cluster of disturbances in self-organization (DSO = affect dysregulation, negative self-concept and disturbances in relationships), was significantly associated with higher suicidality compared to PTSD…These associations remained consistent across different cultural settings…Targeting DSO symptoms may be essential for effective intervention strategies.”
Iwata Y, Ono M, Ishii Y, et al.
Effects of Peer Victimization in Childhood and Trait Anxiety on Job Stress in Adulthood. Neuropsychiatr Dis Treat. 2024 May 23;20:1131-1138. PMID: 38803820
From surveys of 566 adult Japanese workers, “childhood peer victimization has a negative impact on job stress in adulthood, which is influenced by trait anxiety. Interventions to address peer victimization in childhood and trait anxiety may reduce job stress in adulthood, and thus contribute to improved occupational mental health and productivity in the workplace.”
DeSantis AJ, Eshelman LR, Messman TL.
Emotional Dysregulation, Anger, and Masculinity in Men Who Have Experienced Lifetime Sexual Violence. J Interpers Violence. 2024:8862605241301790. PMID: 39610308
Data were collected from 532 community and 185 college men, and 27.1% reported lifetime sexual violence (LSV) experiences. “Results suggest men with LSV reported significantly higher scores on conformity to masculine norms, anger, and emotion dysregulation…trauma interventions need to target masculine ideology and emotion dysregulation to help reduce anger as a traditionally acceptable emotional outlet for men.”
Müller R, Kenney M.
The evolution of ACEs: From coping behaviors to epigenetics as explanatory frameworks for the biology of adverse childhood experiences. Hist Philos Life Sci. 2024;46(4):33. PMID: 39470844
“Epigenetics [heritable chemical modifications to DNA that affect gene expression and cell development] provides distinctly different discursive possibilities than previous frameworks: firstly, it offers one distinct molecular mechanism for how ACEs work, lending ‘molecular credibility’ to epidemiological findings; secondly, it raises the possibility of reversing the negative effects of ACEs on the biological level…it facilitates novel interdisciplinary collaborations and attracts those in health advocacy who are interested in non-deterministic readings of ACEs that counteract stigma and support positive health interventions and healing.”
Gaertner RJ, Burkart M, Richter L, et al.
Early life adversity blunts the subjective and physiological relaxation response in healthy adults. Scientific reports. 2024;14(1):27992. PMID: 39543303
For 103 participants, 63.11% female and mean age 22.73 years, subjective feeling of relaxation with a paced respiration exercise or a nature video was blunted in those with lower scores of paternal care, and higher scores of paternal overprotection, physical abuse, physical neglect, and emotional abuse. “Experiencing early life adversity negatively affects the relaxation capability in a healthy sample and emphasizes the importance of assessing relaxation at a physiological and subjective level.”
Keator DB, Salgado F, Madigan C, et al.
Adverse childhood experiences, brain function, and psychiatric diagnoses in a large adult clinical cohort. Frontiers in psychiatry. 2024;15:1401745. PMID: 39469474
From an analysis of brain scans of 7250 adults with mental health diagnoses, “Higher ACEs increased the risk of anxiety-related disorders, substance abuse, and depression. Several brain regions were identified as potential mediators between ACEs and adult psychiatric diagnoses…highlighting potential targets for therapeutic interventions.”
Kisely S, Leske S, Ogilvie J, Thompson C, Siskind D, Allard T.
A longitudinal birth cohort study of child maltreatment and mental disorders using linked statewide child protection and administrative health data for 83,050 Queensland residents from 1983 to 2014. Epidemiology and psychiatric sciences. 2024;33:e69. PMID: 39563143
Using linked Australian databases of two groups of newborns followed to age 30, “On adjusted analyses, the 4,703 participants (5.7%) who had been notified to the statewide child protection authority had three to eight times the odds of being admitted for any of the following psychiatric diagnoses by age 30: schizophrenia-spectrum disorders, bipolar affective disorders, depression, anxiety, and post-traumatic stress disorders (PTSD). There were similar findings for all the child maltreatment subtypes. Associations were especially strong for PTSD with between a seven - and nine-fold increase in the odds of admission…This is one of the largest studies of the long-term effects of child maltreatment, covering an entire jurisdiction. All types of maltreatment are significantly related to a range of psychiatric disorders requiring hospitalisation.”
Abate BB, Sendekie AK, Merchaw A, et al.
Adverse Childhood Experiences are associated with Mental Health Problems later in life: An Umbrella Review of Systematic Review and Meta-analysis. Neuropsychobiology. 2024:1-20. PMID: 39557030
From a review of studies around the world, “This umbrella review revealed that ACEs are significantly associated (66% increased risk) with anxiety and depression later in life in a global context… Childhood periods are a critical window of opportunity for reducing the risk of developing mental illness in the future and for implementing intervention measures.”
Chaudhari G, Vora D, Trivedi C, et al.
Association Between Adverse Childhood Experiences and Cognitive Decline. J Nerv Ment Dis. 2024;212(11):569-74. PMID: 39471105
From an adult survey (N = 3900, mean age: 60.9 years, male: 46%), “SCD [subjective cognitive decline] was positively correlated with the number of ACEs…Of the various subtypes of ACEs, emotional abuse was noted to have the strongest association with SCD, followed by household substance abuse.”
Gillespie KM, Schweitzer D, Watson E, et al.
Integrating early life stress in neurological disease: advancing preventive neurology. BMJ Ment Health. 2024;27(1). PMID: 39515846
“In 2021, an estimated 43% of the world's population had been diagnosed with a neurological disorder. Early life stress (ELS) is now a well-established risk factor for later-life neurological disorders…The current paper reviews existing literature relating to ELS and neurological disorders and provides an overview and clinical perspective of the gaps in knowledge and future directions required to improve clinical care for patients.”
Güler A, Bush HM, Schill K, Kussainov N, Coker AL.
Association Between Lifetime IPV and Post-COVID-19 Condition Among Women in Kentucky, 2020-2022. Public Health Rep. 2025 Jan-Feb;140(1_suppl):9S-19S. PMID: 38785343
Of 938 Kentucky females over 18 years old, 36.5% disclosed a history of lifetime interpersonal violence…While experiencing lifetime interpersonal violence was not significantly associated with either receiving COVID-19 vaccinations or developing COVID-19, experiencing lifetime interpersonal violence was associated with a 2.09 times increased rate of developing symptoms of post-COVID-19 condition (long covid).
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