[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!]
Adolescents
Chaudhary S, Hoffmann JA, Pulcini CD, et al.
Youth Suicide and Preceding Mental Health Diagnosis. JAMA Netw Open. 2024 Jul 1;7(7):e2423996. PMID: 39078631
In this retrospective study of 40,681 youth suicide decedents aged 10 to 24 years from a CDC database (58.1% aged 20-24 years; 79.2% male; 76.1% White), 40.4% had a documented mental health diagnosis and 46.8% died by firearms. “A mental health diagnosis was documented for 33.2% of youths who died by firearms; 61.6% by poisoning; 45.8% by strangulation, hanging or suffocation; and 44.2% by other mechanisms…3 of 5 youth suicide decedents did not have a documented preceding mental health diagnosis.”
Horowitz LM, Campo JV, Bridge JA.
Youth Suicide, Mental Health, and Firearm Access-Time to Focus on Upstream Prevention. JAMA Netw Open. 2024 Jul 1;7(7):e2423985. PMID: 39078637
“The important data presented by Chaudhary and colleagues [article above] sheds light on the national debate over whether screening for suicide risk in medical settings is best implemented universally or in targeted fashion…Study findings suggest that suicide risk screening targeting youth with known mental health problems and concerns is likely to overlook suicide risk in a substantial percentage of young people in the medical setting…Every trusted adult working with children and adolescents can and should be trained to recognize the warning signs of suicide risk and help young people develop the coping strategies needed to manage difficult life experiences so that suicide is never an option.”
Calegaro G, Soares PSM, Colman I, et al.
Adverse childhood experiences (ACEs) and suicidal behaviors in emerging adulthood. Child Abuse Negl. 2023;146:106517. PMID: 39491409
From a long-term study of 3050 Brazilian children, “Those who suffered financial hardship (odds ratio 2.51), parental divorce (OR 1.44) and maternal CMD [common mental disorder] (OR 1.72) at 11 years were more likely to report suicidal thoughts at 22 years. Also, those who experienced financial hardship (OR 1.71), physical abuse (OR 1.48), discrimination (OR 1.74), maternal CMD (OR 1.67), or parental divorce (OR 1.41) were more likely to report a lifetime suicide attempt.”
Barnert E, Applegarth DM, Bondoc C, et al.
Prevalent ACEs Among Young Adults Returning Home From Jail: The Need for Trauma-Informed Reentry Services. J Correct Health Care. 2024 Dec;30(6):398-405. PMID: 39474703
“Among the 85 participants, 78% reported four or more ACEs and 56% reported six or more ACEs, including divorced parents (81%), witnessing violence (74%), and household member incarceration (71%). Higher exposure to ACEs was associated with mental health diagnoses, psychiatric medication prescriptions, psychiatric hospitalizations, drug dependence, binge drinking, and cannabis misuse. High ACE exposure among young adults experiencing reentry portends worse mental health and high rates of substance use. Findings signify an opportunity to apply a trauma-focused developmental framework to support emerging adults during the crucial reentry period.”
Becker TD, Castañeda Ramirez S, Bruges Boude A, et al.
Interventions for prevention and treatment of substance use in youth with traumatic childhood experiences. Eur Child Adolesc Psychiatry. 2024;33(10):3419-38. PMID: 37480386
“Most substance use begins in adolescence. Both childhood trauma and associated post-traumatic stress disorder (PTSD) increase risk for early substance use, which is associated with greater eventual severity of substance use disorders (SUDs). When co-occurring, PTSD and SUD can reinforce and exacerbate each other, necessitating integrated treatment approaches…Youth with a history of trauma face elevated risk of SUDs and may respond differently to SUD treatments…several promising interventions have been recently developed.”
Carlberg Rindestig F, Gillander Gådin K, Semb O, Dennhag I.
Unwanted Online Sexual Solicitation Among Young People in a Swedish Psychiatric Sample: Occurrence and Associations with Depression and Anxiety. J Child Sex Abus. 2024;33(5):589-607. PMID: 39410881
Of 574 Swedish psychiatric patients aged 12-22 years, 48.61% reported unwanted online sexual solicitation (UOSS), higher than the general population, and significantly higher among girls (57.31%) than boys (20.59%). “Co-occurrence of UOSS with other types of offline and online harassment was substantial. UOSS, together with age and offline sexual harassment, predicted anxiety and depressive symptoms among both girls and boys…Preventing and treating mental health difficulties needs to consider contextual circumstances such as exposure to sexual violence online.”
Counts CJ, John-Henderson NA.
Childhood trauma and college student health: a review of the literature. J Am Coll Health. 2024;72(8):2783-97. PMID: 36595473
This research review shows the influence of childhood trauma on college students, including compromising health behaviors, substance misuse, self-harm, sleep difficulties, problematic intimate relationships, loneliness, negative social experiences, poorer mental health, negative mental processing bias, increased or blunted response to stress, and poorer reported physical health. “The findings of this review may also highlight barriers for college student retention and success.”
Kamis C, Copeland M.
Childhood maltreatment associated with adolescent peer networks: Withdrawal, avoidance, and fragmentation. Child Abuse Negl. 2024;158:107125. PMID: 39504632
From a large national adolescent study, “Experiencing any maltreatment in childhood predicts lower integration in the adolescent peer network structure across three dimensions. However, distinct types of maltreatment relate differently to separate network dimensions, with sexual abuse predicting withdrawal, emotional and physical abuse predicting avoidance and fragmentation, and physical neglect predicting lower integration on all three dimensions.”
Karsberg S, Elklit A, Pedersen MM, Pedersen MU, Vang ML.
A nationally representative survey of ICD-11 PTSD among Danish adolescents and young adults aged 15-29. Scand J Psychol. 2024;65(5):893-900. PMID: 38812284
From a national Danish study of 2434 persons aged 15-29, “Accidents and violence were the most common types of trauma exposure with females being more likely to experience sexual violence. A total of 7.7% endorsed probable PTSD with women reporting higher rates of clinical and subclinical PTSD (12.3% and 12.7%, respectively) than men (3.5% and 7.3%, respectively) …female gender was associated with higher PTSD-severity…and sexual violence displayed the strongest relationship to PTSD-severity overall. A dose-response relationship between the number of trauma types and PTSD symptomatology was found.”
Jiang DH, Lynch S, Leong A, et al.
Psychiatric crises among youth with a history of trauma during COVID-19: A retrospective study of psychiatrically hospitalized children and adolescents. Child Abuse Negl. 2024;158:107134. PMID: 39514997
“This retrospective study utilized data gathered from (n = 1101) first admissions to a child and adolescent inpatient psychiatry unit of a New York City hospital during the pandemic…The clinical severity of inpatient youth with trauma increased during the quarantine period compared to pre-pandemic. The percentage of youth admitted for psychosis increased by 3 %, and suicide attempt by 14.8 %. Clinically, patients with a history of trauma were more likely to have greater comorbidity and clinical severity. Demographically, patients with a history of trauma were more likely to be female or transgender/non-binary, and Black or Latinx.”
Mongan D, Millar SR, Brennan MM, et al.
Associations and mediating factors between adverse childhood experiences and substance use behaviours in early adulthood: A population-based longitudinal study. Addict Behav. 2024;161:108194. PMID: 39522299
For 4729 Irish children age 9 followed up at age 20, “young adults who had experienced 2 ACEs or 3 + ACEs had an approximate two-fold (OR=1.80) and approximate three-fold (OR=2.94) increased odds of problematic drug use, respectively, when compared to participants who had experienced no ACE…parent and peer attachment and liking school partially mediate relationships between ACEs and substance use behaviours.”
Gardner SM, McKnight ER, Kistler IS, Bonny AE.
Trauma, Resilience, and Treatment Outcomes in a Pediatric MOUD Clinic.Subst Use Misuse. 2024:1-5. PMID: 39573849
For 42 adolescents receiving buprenorphine-based medication for opioid use disorder over a six-month period, “reported adverse childhood experiences were high compared with the national average…Higher reported adverse childhood experience scores were associated with greater hazard of buprenorphine-based medication nonadherence…Total resilience score was not significantly associated with any treatment outcome…underscores the need for ACE screening and trauma-informed care in this population.”
Ross AJ, Russotti J, Toth SL, Cicchetti D, Handley ED.
The relative effects of parental alcohol use disorder and maltreatment on offspring alcohol use: Unique pathways of risk. Dev Psychopathol. 2024;36(4):2004-15. PMID: 37905543
From a follow-up study of 674 school children with and without maltreatment histories, “chronic maltreatment, over and above the effect of parent alcohol use disorder, was uniquely associated with greater childhood conduct problems and depressive symptomatology. Mother alcohol dependence was uniquely associated with greater affiliation with substance-using peers and siblings, which in turn predicted greater alcohol use as emerging adults. Results support peer and sibling affiliation as a key mechanism in the intergenerational transmission of substance use between mothers and offspring.”
Domestic Violence – Effects on Children
Seewald LA, Hartman HA, Stallworth P, et al.
Childhood Firearm Deaths During Intimate Partner Violence Incidents: 2004-2020. Pediatrics. 2024 Nov 1;154(Suppl 3):e2024067043Q. PMID: 39484879
From a national database 2004-2020, “464 childhood deaths from bodily force or weapon were classified as an IPV incident…43.6% and 37.1% of decedents had prior maltreatment or IPV victimization reports, respectively, and 8.0% had open CPS cases at time of death. Firearms were the most common mechanism of death (64.7%)…handguns were used most often (72.3%), with the primary caregiver (58.3%) often cited as the firearm owner. There were higher overall number of deaths during an incident when a firearm was used compared with all other mechanisms.”
Avieli H.
Parenting-related abuse among women survivors of attempted intimate partner homicide. Child Abuse Negl. 2024;158:107119. PMID: 39476469
From interviews with 9 women who survived attempted intimate partner homicide, “shared parenthood may be a platform for ongoing abuse and that this abuse is an extension of the act of attempted homicide.” The women reported issues relating to “(1) Claiming information; (2) Interfering with parental decisions; (3) Gaining economic control; and (4) Controlling by proxy using the ex-partner's family…Survivors of attempted IPH require heightened care due to their unique circumstances and the ongoing abuse by their ex-partners, which institutions often fail to address.”
Philippopoulos AJ, Brown ZE, Lewkowitz AK, et al.
The Hypocritical Oath? Unintended Consequences of Prenatal Substance Use Policies and Considerations for Health Care Providers. J Perinat Neonatal Nurs. 2024;38(4):414-9. PMID: 39527551
“Prenatal substance use (PSU) is a serious perinatal health issue in the United States with consequential health effects. To address this issue…the US government amended the Child Abuse Prevention and Treatment Act to provide funding to states to notify child protective services of PSU cases and develop treatment plans for affected families. Although well-intentioned, this statute resulted in diverse inter- and intrastate interpretations and implementation of PSU regulations nationwide, ultimately leading to mass confusion about who the policy applies to and when it should be applied. PSU policies are largely punitive in nature, which has led to null or adverse effects on perinatal outcomes.”
Rebbe R, Victor B, Cuccaro-Alamin S, Palmer L.
Child Protection Responses to Domestic Violence Exposure: Co-Occurring Safety Concerns and Investigation Outcomes. Child Maltreat. 2024:10775595241301085. PMID: 39540822
From CPS administrative data in Los Angeles County, 2018-2021, “5.9% of investigations had CEDV [child exposure to domestic violence] concerns and CEDV investigations represented 17.9% of placements. Investigations with CEDV concerns had higher co-occurring indicated safety concerns than investigations without, including substance abuse (31.1%) and mental health (14.2%). Investigation outcomes for those with CEDV concerns included the substantiation of more than one individual (36.6%), and 30.2% resulted in placements. The study underscores the importance of moving beyond punitive frameworks and exploring the use evidence-based service planning to address the complex needs of families affected by CEDV.”
Li CKW.
A qualitative study on how IPV against women changes, escalates, and persists from pre- to postseparation. Fam Process. 2024 Sep;63(3):1446-1468. PMID: 37574256
From interviews with 19 women who experienced IPV and subsequently divorced, “verbal abuse and using children were the most common forms of IPV both pre- and postseparation. Many preseparation behaviors were replaced by other forms of abuse; for example, physical abuse was not experienced after separation…stalking and economic abuse escalated after separation…The implications of the findings are discussed in terms of healthcare services, advocacy-based victim assistance, school officials, and the courts.”
Human Trafficking
Prakash J, Goel R, Mu Y, Rosner B, Stoklosa H. Risk Prediction Model for Child Sex Trafficking Among Female Child Welfare-Involved Youth. J Womens Health (Larchmt). 2024 Dec;33(12):1708-1719. PMID: 39286874
Using data from Florida Department of Children and Families, a WISER (Welfare-Involved Female Sexual Exploitation Risk Assessment) tool was created and validated to assess child sex trafficking risk among those in out-of-home placement. A few of the factors found to be significant included first out-of-home placement at ≥15 years of age, run away from home in past year especially for age <15 years, English spoken as other language, on a psychotropic drug, psychiatric facility experience, and residential facility experience.
Godoy SM, Hall WJ, Cal T, et al.
Children's Pathways into Commercial Sexual Exploitation in the United States: A Systematic Review. Trauma Violence Abuse. 2024:15248380241297420. PMID: 39569813
From a research review, “Findings indicate that boys and girls at different life stages were initiated into CSE by five pathways, including: (a) family members and caregivers' paramours; (b) romantic partners; (c) peers, friends, and acquaintances; (d) strangers; and (e) circumstantial need. Girls and boys in infancy, toddlerhood, and preadolescence and across rural-urban classifications were exploited by family members, parent's romantic partners, and acquaintances known to their family. Adolescent girls, including those with intellectual disabilities, were trafficked by boyfriends, strangers, and out of circumstantial needs. This is the first review to provide a contemporary overview of dynamics that marked children's CSE pathways from infancy through adolescence.”
Brannock MK, Quesenberry DL, Smith MG, Blackwell RL.
Familial sex trafficking in the United States: A scoping review guided by the Three Ps Framework. Child Abuse Negl. 2024;158:107143. PMID: 39546900
“Familial sex trafficking is a form of sex trafficking that involves a family member exchanging sex with a child to someone else, for something of value. Due to its covert nature, familial sex trafficking is severely under-reported.” In this research review, “identified common victim characteristics such as living in non-urban areas, frequent absences from school, being young, female, and having some form of drug and child welfare involvement…most perpetrators are biological mothers (58–66 %), however, other family members such as biological fathers (11–50 %), stepfathers or boyfriends (45 %), male cousins (16 %), uncles (11–42 %) and siblings are also traffickers…Trafficking motives included drugs (21–82 %), cash (47–51 %), and goods, like rent (30 %)…one mother exchanged her daughter for free rent and when the daughter complained, she replied “It's better than being homeless”…child welfare cases are more likely…to be identified than a high-income perpetrator who has the social standing and resources to hide their exploitation…some survivors of familial sex trafficking claim motivations come from desires for power and popularity and not from financial necessity…Researchers, law enforcement, and practitioners should consider that familial sex trafficking is not reserved for low-income families who are acting solely out of survival and may be motivated by other means.”
Connella A, Valentine C, Stone S, Reid JA.
Exploring the Role of Prior Sexual Abuse in the Commercial Sexual Exploitation of Boys and Young Men. J Child Sex Abus. 2024;33(6):714-35. PMID: 37655524
In this detailed analysis of factors relating to commercial sexual exploitation of boys and young men from a 2022 survey of service providers, “one commonality was a history of child sexual abuse as well as other forms of child maltreatment and adversity…factors that result in victim vulnerability.”
Gordon M, Evenstad J, Nathani K, Coverdale J, Nguyen P.
Neuropsychiatric Vulnerabilities and Sequelae of Human Trafficking in the United States. J Neuropsychiatry Clin Neurosci. 2024: appineuropsych20240175. PMID: 39558708
“Neuropsychiatrists are uniquely positioned to assess vulnerabilities of their patients to trafficking and to assist in the primary, secondary, and tertiary prevention of human trafficking and its consequences.” Authors detail step-by-step issues, starting with “Children born to mothers who were victims of pregnancy-related violence or who had decreased access to prenatal care, inadequate prenatal nutrition, or used substances during pregnancy may be more likely to have neurocognitive sequelae from in utero exposures or deficiencies. These neurocognitive sequelae may result in learning delays, impaired decision making, and difficulty in navigating risk. Similarly, patients with attention-deficit hyperactivity disorder may be more impulsive or more likely to engage in high-risk activities that put them in contact with traffickers.”
Greydanus DE, Nazer D, Tsitsika A, et al.
Trafficking in the child and adolescent: Application of SAFETY and CARE for a global crisis of exploitation. Disease-a-month. 2024:101825. PMID: 39572293
Authors discuss basic terminology, sociodemographics, negative effects or repercussions, “issues of screening for healthcare providers based on specific risk factors/indicators, and information regarding screening tools as well as management principles for healthcare professionals.”
Nichols AJ, Oberstaedt M, Slutsker S, Gilbert K.
Practitioners' perspectives on working with families of minors experiencing sex trafficking. Child Abuse Negl. 2024;158:107132. PMID: 39520956
“Fom 30 interviews with social service and criminal justice professionals in a Midwestern metropolitan area…parents were often unaware of their child's involvement in sex trafficking, and did not recognize warning signs…prevention of retrafficking through family based interventions include providing sex trafficking-related education to family members, facilitating development of supportive relationships, discussing the importance of providing structure following a sex trafficking situation, and providing individually tailored resources to family members to address substance use disorders, mental health challenges, and basic needs.”
LGBTQ Concerns
Duffy B, Nurre OM, Bista S, O'Malley F, Michaels NL.
Characteristics of Fatalities Among Sexual- and Gender-Diverse Youth in the United States: 2015-2020. Pediatrics. 2024 Nov 1;154(Suppl 3):e2024067043P. PMID: 39484877
From a national database 2015-2020, “176 fatalities were identified among sexual- and gender-diverse youth. Decedents' mean age was 15.3 years. A greater proportion of deaths was attributed to suicide (81%) compared with nonsexual- and gender-diverse youth (54%). Receiving prior (69%) and/or current (49%) mental health services was more common among sexual- and gender-diverse youth, compared with nonsexual- and gender-diverse youth (50% and 31%, respectively). Sexual- and gender-diverse youth were significantly more likely to experience problems in school or be victims of bullying, compared with nonsexual- and gender-diverse youth (63% versus 47% and 28% versus 15%, respectively).”
Burstein D, Purdue EL, Jones JA, Breeze JL, Chen Y, Sege R.
Protective factors associated with reduced substance use and depression among gender minority teens. J LGBT Youth. 2024;21(4):659-76. PMID: 39583960
From a large national study, gender minority (GM) youth experienced risk factors more often than their peers including bias-based bullying, peer victimization, and homelessness/foster care exposure. Several factors mitigated depression and substance use among GM students, including good financial status, feeling a sense of school/community membership, or having two or more caring adults in their life. However, GM youth experienced these protective factors less frequently than their peers.
Pagliaccio D.
Mental health disparities among sexual and gender minority students in higher education. J Am Coll Health. 2024:1-12. PMID: 39533453
“483,574 responses to the Healthy Minds Study were examined from 18 to 35-year-old U.S. college and university students…On average, ∼18% of students identified as SGM [sexual and gender minority], which included a 6-fold increase in SGM self-identification across this 15-year period. Depression rates increased over time; ∼12% of students reported major depression. SGM students were 3.18 times more likely to report depression than non-SGM students (26.85% vs. 8.53%)…SGM students were twice as likely to utilize therapy but half as likely seek help from family…Academic institutions must take concrete steps to reduce barriers to mental health care, combat discrimination, and bolster community belonging and interpersonal support for SGM students.”
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