Adverse Childhood Experiences and Implications of Perceived Stress, Anxiety, and Cortisol Among Women in Pakistan

Abstract Background: Adverse Childhood Experiences (ACEs) are linked to poor maternal mental health. By disrupting stress regulation systems, ACEs are hypothesized to impact perceived stress, anxiety, and cortisol. This study explores the associations of ACEs with different manifestations of stress. Methods: Participants were part of the Bachpan study, a longitudinal birth cohort in rural Pakistan. Data were collected at the 36-month postpartum wave. ACEs were captured retrospectively using an adapted version of the ACE International Questionaire, and represented in the following ways: as a continuous variable, binary indicator, categoric levels, and subdomains (neglect, home violence, family psychological distress, community violence). Outcomes included: perceived stress (N=889) measured with the Cohen Perceived Stress Scale (PSS), anxiety (N=623) measured with the Generalized Anixety Disorder-7 scale (GAD-7), and hair-derived cortisol (N=90). Multivariable linear mixed models estimated associations between ACEs and the outcome variables. Results: All models featured positive associations between ACE items and PSS. Both the continuous total ACE score (B=0.4; 95% CI=0.0, 0.8) and the presence of any ACEs (B=1.0; 95% CI=-1.0, 0.3) were associated with higher anxiety symptoms on the GAD-7. Home violence (B=6.7; 95% CI=2.7, 10.8) and community violence (B=7.5; 95% CI=1.4,13.6) were associated with increased hair cortisol. Conclusions: All four ACE domains were associated with elevated levels of perceived stress, anxiety, and cortisol, with varying precision and strength of estimates, indicating that the type of ACE has a differential impact. This study disentangled adversity to understand the impact of specific adverse events on hypothalamic pituitary adrenal (HPA) axis functioning and mental health conditions.

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Impact of maternal adverse childhood experiences on child socioemotional function in rural Kenya: Mediating role of maternal mental health

Developmental Science ◽

10.1111/desc.12833 ◽

2019 ◽

pp. e12833 ◽

Cited By ~ 4

Author(s):

Amber D. Rieder ◽

Sophia L. Roth ◽

Christine Musyimi ◽

David Ndetei ◽

Roberto B. Sassi ◽

...

Keyword(s):

Mental Health ◽

Adverse Childhood Experiences ◽

Maternal Mental Health ◽

Childhood Experiences ◽

Mediating Role ◽

Adverse Childhood ◽

Rural Kenya

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The impact of adverse childhood experiences (ACEs) and combat exposure on mental health conditions among new post-9/11 veterans.

Psychological Trauma Theory Research Practice and Policy ◽

10.1037/tra0000614 ◽

2020 ◽

Vol 12 (7) ◽

pp. 698-706 ◽

Cited By ~ 1

Author(s):

Keith R. Aronson ◽

Daniel F. Perkins ◽

Nicole R. Morgan ◽

Julia A. Bleser ◽

Dawne Vogt ◽

...

Keyword(s):

Mental Health ◽

Adverse Childhood Experiences ◽

Combat Exposure ◽

Health Conditions ◽

Childhood Experiences ◽

Mental Health Conditions ◽

Adverse Childhood ◽

The Impact

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Addressing Adverse Childhood Experiences: It’s All about Relationships

Societies ◽

10.3390/soc8040115 ◽

2018 ◽

Vol 8 (4) ◽

pp. 115

Author(s):

Paula Zeanah ◽

Karen Burstein ◽

Jeanne Cartier

Keyword(s):

Community Violence ◽

Family Caregiving ◽

Adverse Childhood Experiences ◽

Protective Role ◽

Toxic Stress ◽

Adult Health ◽

Childhood Experiences ◽

Adverse Childhood ◽

Global Prevention ◽

The Impact

Recognition that economic, environmental, and social adversity affects health is not new; adversity may result from social determinants such as poverty, community violence, or poor nutrition; from within the family/caregiving environment; or interactions between these complex environs. However, compelling new research demonstrating the profound impact of cumulative early adversity and toxic stress on development and adult health is leading to the mobilization of global prevention and intervention efforts to attain and assure better health for populations across the world. In this paper, we begin with a global population perspective on adversity and discuss priorities for global health. We then turn to studies of adverse childhood experiences to consider current understanding of how early experiences impact brain development and short- and long-term health. Factors that build resilience and buffer the effects of toxic stress and adversity are described, with emphasis on the foundationally protective role of safe and nurturing caregiving relationships. We discuss the implications of these findings in terms of community health and present a participatory research paradigm as a relationship-based method to improve community engagement in identifying and mitigating the impact of adverse childhood experiences on health.

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Troubled beginnings: the adverse childhood experiences and placement histories of a detained adolescent population with developmental disorders

Advances in Mental Health and Intellectual Disabilities ◽

10.1108/amhid-01-2020-0003 ◽

2020 ◽

Vol 14 (6) ◽

pp. 181-197

Author(s):

Deborah J. Morris ◽

Elanor Lucy Webb ◽

Emma Parmar ◽

Grace Trundle ◽

Anne McLean

Keyword(s):

Mental Health ◽

Adverse Childhood Experiences ◽

Developmental Disorders ◽

Developmental Disorder ◽

Convenience Sample ◽

Childhood Experiences ◽

Content Type ◽

Adolescent Population ◽

Adverse Childhood ◽

The Impact

Purpose People with developmental disorders are significantly more likely to experience adverse childhood experiences (ACEs), although the impact of ACEs on this population is not well understood. Furthermore, considerably less is known about the exposure to, and impact of, ACEs in detained adolescents with complex developmental disorder needs. This paper aims to explore the exposure to ACEs in an adolescent population detained in a secure specialist developmental disorder service. Design/methodology/approach A retrospective file review was used to explore ACEs and placement histories within a specialist developmental disorder inpatient service. Data was collated for a convenience sample of 36 adolescents, 9 of whom were female, aged 13–20 years (M = 17.28 years). Findings A total of 33 participants (91.7%) had experienced at least 1 ACE, with 58% experiencing 4 or more ACEs and 36% experiencing 6 or more ACEs. The most common ACEs reported were physical abuse (61.6%), parental separation (58.3%) and emotional abuse (55.6%). The majority of participants had also experienced high levels of disruption prior to admission, with an average of four placement breakdowns (range 1–13, standard deviation = 3.1). ACEs held a significant positive association with the total number of placement breakdowns and total number of mental health diagnoses. Practical implications Adolescents detained in specialist developmental disorder secure care had, at the point of admission, experienced high levels of adversities and had been exposed to high levels of experienced and observed abuse. The level of exposure to adversity and ongoing disruptions in care suggests that Child and Adolescent Mental Health Services’ developmental secure services should consider adopting dual treatment frameworks of developmental disorder and trauma-informed care. Originality/value This study explored the early-life and placement experiences of a marginalised and understudied population.

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The Impact of Adverse Childhood Experiences (ACE) on Health-Related Quality of Life, Mental Health, and Hospitalizations in Delaware

Delaware Journal of Public Health ◽

10.32481/djph.2016.12.017 ◽

2016 ◽

Vol 2 (5) ◽

pp. 54-57

Author(s):

Khaleel S. Hussaini ◽

Tabatha Offutt Powell ◽

Mathew Christensen ◽

Leah Woodall

Keyword(s):

Quality Of Life ◽

Mental Health ◽

Adverse Childhood Experiences ◽

Health Related Quality ◽

Childhood Experiences ◽

Adverse Childhood ◽

Related Quality ◽

Health Related ◽

The Impact

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Using a participatory method to test a strategy supporting the implementation of a state policy on screening children for adverse childhood experiences (ACEs) in a Federally Qualified Health Center system: a stepped-wedge cluster randomized trial

Implementation Science Communications ◽

10.1186/s43058-021-00244-4 ◽

2021 ◽

Vol 2 (1) ◽

Author(s):

Monica Perez Jolles ◽

Wendy J. Mack ◽

Christina Reaves ◽

Lisa Saldana ◽

Nicole A. Stadnick ◽

...

Keyword(s):

Mental Health ◽

Adverse Childhood Experiences ◽

Implementation Strategy ◽

Cluster Randomized Trial ◽

Stepped Wedge ◽

Childhood Experiences ◽

Federally Qualified Health Center ◽

Adverse Childhood ◽

Cluster Randomized ◽

The Impact

Abstract Background Adverse childhood experiences (ACEs) are potentially traumatic events occurring before age 18, such as maltreatment or exposure to violence. ACE screening is increasingly recommended to prevent and address physical and mental health conditions associated with ACEs. To promote ACE screening uptake, the state of California issued the “ACEs Aware” policy that provides Medicaid reimbursement for ACE screening annually for child primary care visits. However, policy directives alone often do not translate into effective screening efforts and greater access to care. Few rigorous studies have developed and tested implementation strategies for ACE pediatric screening policies. This study will fill this gap by testing a multifaceted implementation strategy in partnership with a Federally Qualified Health Center (FQHC) system serving low-income families in Southern California to support the ACE Aware policy. Methods We will use Implementation Mapping, with study process and consideration of determinants and mechanisms guided by the EPIS framework, to co-create and refine an implementation strategy. The proposed strategy is comprised of online training videos, a customized algorithm and use of technology to improve workflow efficiency, implementation training to internal FQHC personnel, clinic support and coaching, and written implementation protocols. A hybrid type 2, stepped-wedge cluster randomized trial design with five primary care clinics will test whether a multifaceted implementation strategy improves (a) fidelity to the ACE screening protocol, (b) reach defined as the proportion of eligible children screened for ACEs, and (c) the impact of the ACE policy on child-level mental health referrals and symptom outcomes. The study will use mixed methods with data to include electronic health records, surveys, and interviews with clinic personnel and caregivers. Discussion This study is designed to increase the capacity of FQHCs’ inner context to successfully implement an outer context-initiated ACE policy designed to benefit pediatric patients. It capitalizes on a rare opportunity to use a co-creation approach to develop, adapt, refine, and pilot test an implementation strategy to maximize the impact of a new state-wide policy intended to improve ACE assessment and subsequent care to improve child health, particularly those from underserved communities. Trial registration Trial # NCT04916587 registered at ClinicalTrials.gov on June 4, 2021.

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