Annual Research Review: Rethinking childhood trauma‐new research directions for measurement, study design and analytical strategies

Danese, Andrea

doi:10.1111/jcpp.13160

Cited by 109 publications

(94 citation statements)

References 97 publications

(123 reference statements)

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“…I would suggest that it is not enough to simply acknowledge this issue but to make all efforts to design research that includes both subjective and objective measures of adverse childhood experiences. This work by Kraav et al reinforces the concerns expressed in a paper by Danese (2020) and an editorial by Widom (2019) that prospective and retrospective accounts of ACES cannot be considered interchangeably. Studies show that retrospective reports of ACES more strongly predict mental health problems (Newbury et al, 2018), indicating that perceptions of childhood experiences are very important in understanding mental health.…”

supporting

confidence: 70%

Rejoinder to Kraav, Tolmunen, Kauhanen, and Lehto Letter to the Editor

Widom

2020

Psychol. Med.

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The results of the Kraav et al. study are particularly encouraging in an era when there is so much concern about non-replications in science (Open Science Collaboration, 2015). This replication is even more notable because these new findings represent a complex set of relationships that extend the work of Osborn and Widom (2019) and similarly presents findings that contradict previous research. Replications of findings that challenge existing assumptions are important and warrant serious attention. The authors found that documented records of ACEs were associated with the elevated levels of CRP that remained significant even controlling for smoking, alcohol use, and depression, whereas retrospective self-reports were not. These findings are similar to our study (Osborn & Widom, 2019) despite a number of differences between the two studies. First, Osborn and Widom compared the results of retrospective self-reports of childhood physical and sexual abuse and neglect with child protective agency (official) reports of childhood physical and sexual abuse and neglect for the same time period. Kraav et al. compared nurses' reports at the time and retrospective reports based on different indicators of adverse childhood experiences, that is, they defined ACES as childhood experiences of poverty, paternal alcohol problems, or parental divorce that might be considered more subtle forms of adverse childhood experiences than childhood maltreatment. Second, they examined the consequences in a substantially longer follow-up period of a group of older middle-age men. Third, the participants were from a different country (Finland) and more homogeneous racially so that the sample was all white Caucasian males, whereas the Osborn and Widom study included males, females, Blacks, and Whites. Fourth, although blood was collected in both studies, there were vast differences between the protocols for blood collection. In the Finnish study, blood tests were conducted during baseline investigations (1984-1986) when the participants (mean age 50.9) were requested to fast overnight, abstain from smoking for 12 h, and avoid alcohol use for 3 days before obtaining blood samples. This was not a possibility with the Osborn and Widom study. Because of these differences, the similarity of the findings is even more striking. The documented ACES in the Finnish study were retrieved from school health records from nurses' reports based on the 'health and behavior of pupils, home visits and familiarity with the family backgrounds and home conditions of the pupils'. The authors noted that nurses could have missed milder cases and only recorded a case when an ACE was brought to their attention. Although this is a real possibility, the documentation of the childhood experiences is the critical factor given that it predicts this long-term health consequence. Furthermore, this potential limitation has been expressed in relation to the Osborn and Widom study where child protective agency records may have missed milder cases. But as these findings show, relia...

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supporting

confidence: 70%

Rejoinder to Kraav, Tolmunen, Kauhanen, and Lehto Letter to the Editor

Widom

2020

Psychol. Med.

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“…A focus on subjective experience will open new opportunities for multidisciplinary investigations in cognitive neuroscience, psychology, and epidemiology to test whether manipulation of subjective appraisal of childhood maltreatment and related cognitions could alleviate psychopathology. Answers to these questions have the potential to significantly expand the way we understand, prevent, and treat child maltreatment-related psychopathology 13,14,29 .…”

Section: Discussionmentioning

confidence: 99%

Objective and subjective experiences of child maltreatment and their relationships with psychopathology

2020

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Does psychopathology develop as a function of the objective or subjective experience of childhood maltreatment? To address this question, we studied a unique cohort of 1,196 children with both objective, court-documented evidence of maltreatment and subjective reports on their childhood maltreatment histories made once they reached adulthood, along with extensive psychiatric assessment. We found that, even for severe cases of childhood maltreatment identified through court records, risk of psychopathology linked to objective measures was minimal in the absence of subjective reports. In contrast, risk of psychopathology linked to subjective reports of childhood maltreatment was high, whether or not the reports were consistent with objective measures. These findings have important implications for how we study the neurobiological effects of child maltreatment and how we prevent or treat maltreatment-related psychopathology. Interventions for psychopathology associated with childhood maltreatment can benefit from deeper understanding of the subjective experience.

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“…For instance, the combination of parental mental illness and parental separation (ACE score of 2) is treated as the same as physical and sexual abuse (also an ACE score of 2) -which is unlikely to be the case. Moreover, as discussed elsewhere (Danese, 2019;Kelly-Irving and Delpierre, 2019), there are concerns regarding the potential misuse of ACE questionnaires and the resulting score.…”

Section: Ace Scores and Single Adversity Approachesmentioning

confidence: 99%

Adverse childhood experiences and adult inflammation: Single adversity, cumulative risk and latent class approaches

Lacey

Pereira

et al. 2019

Psychoneuroendocrinology

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Background: Adverse childhood experiences (ACEs) have long been known to be related to poorer health across the life course. Previous studies typically relied on cumulative risk scores or individual adversities measured through retrospective self-reports. However, these approaches have important limitations. Cumulative risk scores assume equal weighting of adversities and the single adversity approach ignores the high probability that adversities co-occur. In contrast, latent class analysis (LCA) offers an alternative approach to operationalise ACEs that respects the clustering of adversities and may identify specific patterns of ACEs important for health outcomes. Furthermore, prospective and retrospective reports of ACEs show poor agreement. Therefore, it is important to compare findings based on prospective and retrospective measures in the same individuals. Despite an increasing number of studies applying LCA to ACEs data, no studies have yet simultaneously investigated LCA to cumulative risk and single adversity approaches in their relationships with adult inflammation. Identifying the specific ACEs or combinations of ACEs which are strongly related to inflammation is important for investigating the mechanisms involved and the planning of effective interventions. Methods: Using data on 8810 members of the 1958 British birth cohort we investigated 12 ACEs-physical, psychological and sexual abuse, physical and emotional neglect, parental mental health problems, witnessing abuse, parental conflict, parental divorce, parental offending, parental substance misuse and parental death. LCA was applied to explore the clustering of prospectively and retrospectively reported ACEs separately. Associations between latent classes, cumulative risk scores and individual adversities with three inflammatory markers (C-Reactive Protein, fibrinogen and von Willebrand Factor) were tested using linear regression. Results: There was co-occurrence between adversities, and particularly for retrospectively reported adversities. Three latent classes were identified in the prospective data-'Low ACEs' (95.7%), 'Household dysfunction' (2.8%) and 'Parental loss' (1.5%) which were related to increased inflammation in mid-life, as were high ACE scores and individual measures of offending, death, divorce, physical neglect and family conflict. Four latent classes were identified in the retrospective data-'Low ACEs', 'Parental mental health and substance misuse', 'Maltreatment and conflict' and 'Polyadversity.' The latter two (5.2%) were related to raised inflammation in mid-life, as was a retrospective ACE score of 4+ (8.3%) and individual measures of family conflict, psychological and physical abuse, emotional neglect and witnessing abuse. Conclusions: Specific ACEs or ACE combinations might be important for chronic inflammation. LCA is an alternative approach to operationalising ACEs data but further research is needed.

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Annual Research Review: Rethinking childhood trauma‐new research directions for measurement, study design and analytical strategies

Cited by 109 publications

References 97 publications

Rejoinder to Kraav, Tolmunen, Kauhanen, and Lehto Letter to the Editor

Rejoinder to Kraav, Tolmunen, Kauhanen, and Lehto Letter to the Editor

Objective and subjective experiences of child maltreatment and their relationships with psychopathology

Adverse childhood experiences and adult inflammation: Single adversity, cumulative risk and latent class approaches

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