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Adverse Childhood Experiences and Chronic Medical Conditions: Emotion Dysregulation as a Mediator of Adjustment

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Abstract

Adverse childhood experiences (ACEs) are known to contribute to long-term harmful effects on mental health in young adults. Research has demonstrated that having a chronic medical condition (CMC) can also be conceptualized as being a potentially traumatic experience, and that young adults with a CMC are also at risk for negative adjustment. Emotion dysregulation, or difficulty identifying and regulating one’s emotions, is common among individuals with ACEs, and is a predictor of young adult adjustment. Given the mediational link between ACEs, emotion dysregulation, and young adult adjustment, it is likely that emotion dysregulation may demonstrate a similar linkage to adjustment in individuals with a CMC. The current study compared the effects of ACEs and having a CMC on depressive and anxious symptoms, while also examining emotion dysregulation as a possible mediator for both ACEs and CMC on adjustment outcomes, specifically depressive and anxious symptoms. College students (N = 1911) completed online questionnaires that assessed history of ACEs, emotion regulation difficulties, adjustment, and chronic illness status. Path analyses demonstrated a significant correlation between ACEs and depressive and anxious symptoms, as well as having a CMC and depressive and anxious symptoms. Furthermore, emotion dysregulation demonstrated a significant mediation between ACEs and negative adjustment, as well as between having a CMC and negative adjustment. This study highlights the importance of emotion dysregulation in understanding outcomes for individuals with a CMC and/or ACEs.

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References

  • Afifi, T. O., Ford, D., Gershoff, E. T., Merrick, M., Grogan-Kaylor, A., Ports, K. A., … Lee, S. J. (2017). Spanking and adult mental health impairment: The case for the designation of spanking as an adverse childhood experience. Child Abuse & Neglect, 71, 24–31.

  • Agaibi, C. E., & Wilson, J. P. (2005). Trauma, PTSD, and resilience: A review of the literature. Trauma, Violence, & Abuse, 6(3), 195–216.

    Google Scholar 

  • Alcala, H. E., Keim-Malpass, J., & Mitchell, E. (2017). Colorectal cancer screening and adverse childhood experiences: Which adversities matter? Child Abuse and Neglect, 69, 145–150. https://doi.org/10.1016/j.chiabu.2017.04.026.

    Article  PubMed  Google Scholar 

  • Alessi, E. J., & Martin, J. I. (2010). Conducting an internet-based survey: Benefits, pitfalls, and lessons learned. Social Work Research, 34(2), 122–128.

    Google Scholar 

  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). American Psychiatric Association: Washington, DC.

    Google Scholar 

  • Anda, R. F., Felitti, V. J., Bremner, J. D., Walker, J. D., Whitfield, C., Perry, B. D., … Giles, W. H. (2006). The enduring effects of abuse and related adverse experiences in childhood. A convergence of evidence from neurobiology and epidemiology. European Archives of Psychiatry and Clincal Neuroscience, 256(3), 174–186. https://doi.org/10.1007/s00406-005-0624-4.

  • Andersen, J. P., & Blosnich, J. (2013). Disparities in adverse childhood experiences among sexual minority and heterosexual adults: Results from a multi-state probability-based sample. PLoS ONE, 8(1), e54691.

    PubMed  PubMed Central  CAS  Google Scholar 

  • Bowlby, J. (1969/1982) Attachment and loss, Vol. 1. Attachment. New York: Basic Books.

  • Brown, R. T., & Lambert, R. (1999). Family functioning and children’s adjustment in the presence of a chronic illness: Concordance between children with sickle cell disease and caretakers. Families, Systems, & Health, 17(2), 165.

    Google Scholar 

  • Burns, E. E., Jackson, J. L., & Harding, H. G. (2010). Child maltreatment, emotion regulation, and posttraumatic stress: The impact of emotional abuse. Journal of Aggression, Maltreatment & Trauma, 19(8), 801–819.

    Google Scholar 

  • Cameron, L. D., Carroll, P., & Hamilton, W. K. (2018). Evaluation of an intervention promoting emotion regulation skills for adults with persisting distress due to adverse childhood experiences. Child Abuse and Neglect, 79, 423–433.

    PubMed  Google Scholar 

  • Campbell, J. A., Walker, R. J., & Egede, L. E. (2016). Associations between adverse childhood experiences, high-risk behaviors, and morbidity in adulthood. American Journal of Preventative Medicine, 50(3), 344–352. https://doi.org/10.1016/j.amepre.2015.07.022.

    Article  Google Scholar 

  • Cantrell, M. A., & Lupinacci, P. (2007). Methodological issues in online data collection. Journal of Advanced Nursing, 60(5), 544–549.

    PubMed  Google Scholar 

  • Centers for Disease Control and Prevention. (2017). Leading causes of death. Retrieved from https://www.cdc.gov/nchs/fastats/leading-causes-of-death.htm.

  • Chapman, D. P., Whitfield, C. L., Felitti, V. J., Dube, S. R., Edwards, V. J., & Anda, R. F. (2004). Adverse childhood experiences and the risk of depressive disorders in adulthood. Journal of Affective Disorders, 82(2), 217–225. https://doi.org/10.1016/j.jad.2003.12.013.

    Article  PubMed  Google Scholar 

  • Cohen, M. S. (1999). Families coping with childhood chronic illness: A research review. Families, Systems, & Health, 17(2), 149.

    Google Scholar 

  • Cousino, M. K., & Hazen, R. A. (2013). Parenting stress among caregivers of children with chronic illness: A systematic review. Journal of Pediatric Psychology, 38(8), 809–828.

    PubMed  Google Scholar 

  • Dong, M., Anda, R. F., Dube, S. R., Giles, W. H., & Felitti, V. J. (2003). The relationship of exposure to childhood sexual abuse to other forms of abuse, neglect, and household dysfunction during childhood. Child Abuse and Neglect, 27(6), 625–639.

    PubMed  Google Scholar 

  • Dube, S. R., Anda, R. F., Felitti, V. J., Chapman, D. P., Williamson, D. F., & Giles, W. H. (2001). Childhood abuse, household dysfunction, and the risk of attempted suicide throughout the life span: Findings from the Adverse Childhood Experiences Study. Journal of American Medical Association, 286(24), 3089–3096.

    CAS  Google Scholar 

  • Dvir, Y., Ford, J. D., Hill, M., & Frazier, J. A. (2014). Childhood maltreatment, emotional dysregulation, and psychiatric comorbidities. Harvard Review of Psychiatry, 22(3), 149.

    PubMed  PubMed Central  Google Scholar 

  • Enders, C. K. (2010). Applied missing data analysis. New York: Guilford Press.

    Google Scholar 

  • Espeleta, H. C., Brett, E. I., Ridings, L. E., Leavens, E. L., & Mullins, L. L. (2018). Childhood adversity and adult health-risk behaviors: Examining the roles of emotion dysregulation and urgency. Child Abuse and Neglect, 82, 92–101.

    PubMed  Google Scholar 

  • Espeleta, H. C., Palasciano-Barton, S., & Messman-Moore, T. L. (2017). The impact of child abuse severity on adult attachment anxiety and avoidance in college women: The role of emotion dysregulation. Journal of Family Violence, 32(4), 399–407.

    Google Scholar 

  • Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., … Marks, J. S. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) Study. American Journal of Preventive Medicine, 14(4), 245–258.

  • Ford, D. C., Merrick, M. T., Parks, S. E., Breiding, M. J., Gilbert, L. K., Edwards, V. J., … Thompson, W. W. (2014). Examination of the factorial structure of adverse childhood experiences and recommendations for three subscale scores. Psychology of Violence, 4(4), 432.

  • Granello, D. H., & Wheaton, J. E. (2004). Online data collection: Strategies for research. Journal of Counseling & Development, 82(4), 387–393.

    Google Scholar 

  • Gratz, K. L., Bornovalova, M. A., Delany-Brumsey, A., Nick, B., & Lejuez, C. (2007). A laboratory-based study of the relationship between childhood abuse and experiential avoidance among inner-city substance users: The role of emotional nonacceptance. Behavior Therapy, 38(3), 256–268.

    PubMed  Google Scholar 

  • Gratz, K. L., & Roemer, L. (2004). Multidimensional assessment of emotion regulation and dysregulation: Development, factor structure, and initial validation of the difficulties in emotion regulation scale. Journal of Psychopathology and Behavioral Assessment, 26(1), 41–54.

    Google Scholar 

  • Groves, S., Backer, H. S., van den Bosch, W., & Miller, A. (2012). Dialectical behaviour therapy with adolescents. Child and Adolescent Mental Health, 17(2), 65–75.

    PubMed  Google Scholar 

  • Hash, K. M., & Spencer, S. M. (2009). You’ve got subjects: The promise of the internet in research with lesbian, gay, bisexual, and transgender populations. In W. Meezan & J. I. Martin (Eds.), Handbook of research with gay, lesbian, bisexual, and transgender populations (pp. 238–258). New York: Routledge.

    Google Scholar 

  • Heerman, W. J., Krishnaswami, S., Barkin, S. L., & McPheeters, M. (2016). Adverse family experiences during childhood and adolescent obesity. Obesity, 24(3), 696–702.

    PubMed  Google Scholar 

  • Herts, K. L., Wallis, E., & Maslow, G. (2014). College freshmen with chronic illness: A comparison with healthy first-year students. Journal of College Student Development, 55(5), 475–480.

    Google Scholar 

  • Hooper, D., Coughlan, J., & Mullen, M. (2008). Structural equation modelling: Guidelines for determining model fit. Articles, 2.

  • Huh, H. J., Kim, K. H., Lee, H.-K., & Chae, J. H. (2017). The relationship between childhood trauma and the severity of adulthood depression and anxiety symptoms in a clinical sample: The mediating role of cognitive emotion regulation strategies. Journal of Affective Disorders, 213, 44–50.

    PubMed  Google Scholar 

  • Ingerski, L. M., Shaw, K., Gray, W. N., & Janicke, D. M. (2010). A pilot study comparing traumatic stress symptoms by child and parent report across pediatric chronic illness groups. Journal of Developmental and Behavioral Pediatrics, 31(9), 713.

    PubMed  PubMed Central  Google Scholar 

  • Isohookana, R., Riala, K., Hakko, H., & Räsänen, P. (2013). Adverse childhood experiences and suicidal behavior of adolescent psychiatric inpatients. European Child and Adolescent Psychiatry, 22(1), 13–22.

    PubMed  Google Scholar 

  • Kahana, S. Y., Feeny, N. C., Youngstrom, E. A., & Drotar, D. (2006). Posttraumatic stress in youth experiencing illnesses and injuries: An exploratory meta-analysis. Traumatology, 12(2), 148–161.

    Google Scholar 

  • Kays, K., Gathercoal, K., & Buhrow, W. (2012). Does survey format influence self-disclosure on sensitive question items? Computers in Human Behavior, 28(1), 251–256.

    Google Scholar 

  • Kazak, A. E., Schneider, S., & Kassam-Adams, N. (2009). Pediatric medical traumatic stress. In M. C. Roberts & R. G. Steele (Eds.), Handbook of pediatric psychology (pp. 205–215). New York: The Guilford Press.

    Google Scholar 

  • Kim, J., & Cicchetti, D. (2010). Longitudinal pathways linking child maltreatment, emotion regulation, peer relations, and psychopathology. Journal of Child Psychology and Psychiatry, 51(6), 706–716.

    PubMed  Google Scholar 

  • Klinnert, M. D., McQuaid, E. L., McCormick, D., Adinoff, A. D., & Bryant, N. E. (2000). A multimethod assessment of behavioral and emotional adjustment in children with asthma. Journal of Pediatric Psychology, 25(1), 35–46.

    PubMed  CAS  Google Scholar 

  • La Greca, A. M. (1990). Social consequences of pediatric conditions: Fertile area for future investigation and intervention? Journal of Pediatric Psychology, 15(3), 285–307.

    PubMed  Google Scholar 

  • Lansing, A. H., & Berg, C. A. (2014). Topical review: Adolescent self-regulation as a foundation for chronic illness self-management. Journal of Pediatric Psychology, 39(10), 1091–1096.

    PubMed  PubMed Central  Google Scholar 

  • Linehan, M. (2015). DBT skills training manual (2nd ed.). New York: The Guilford Press.

    Google Scholar 

  • Martin, L. M., Leff, M., Calonge, N., Garrett, C., & Nelson, D. E. (2000). Validation of self-reported chronic conditions and health services in a managed care population. American Journal of Preventive Medicine, 18(3), 215–218.

    PubMed  CAS  Google Scholar 

  • Maxwell, S. E., & Cole, D. A. (2007). Bias in cross-sectional analyses of longitudinal mediation. Psychological Methods, 12(1), 23.

    PubMed  Google Scholar 

  • Messman-Moore, T. L., & Bhuptani, P. H. (2017). A review of the long-term impact of child maltreatment on posttraumatic stress disorder and its comorbidities: An emotion dysregulation perspective. Clinical Psychology: Science and Practice, 24(2), 154–169.

    Google Scholar 

  • Morris, A. S., Silk, J. S., Steinberg, L., Myers, S. S., & Robinson, L. R. (2007). The role of the family context in the development of emotion regulation. Social Development, 16(2), 361–388.

    PubMed  Google Scholar 

  • Newacheck, P. W., Budetti, P. P., & Halfon, N. (1986). Trends in activity-limiting chronic conditions among children. American Journal of Public Health, 76(2), 178–184.

    PubMed  PubMed Central  CAS  Google Scholar 

  • O’Donohue, W. T., & Fisher, J. E. (Eds.). (2009). General principles and empirically supported techniques of cognitive behavior therapy. Hoboken, NJ: Wiley.

    Google Scholar 

  • Okura, Y., Urban, L. H., Mahoney, D. W., Jacobsen, S. J., & Rodeheffer, R. J. (2004). Agreement between self-report questionnaires and medical record data was substantial for diabetes, hypertension, myocardial infarction and stroke but not for heart failure. Journal of Clinical Epidemiology, 57(10), 1096–1103.

    PubMed  Google Scholar 

  • Olatunji, B. O., Deacon, B. J., Abramowitz, J. S., & Tolin, D. F. (2006). Dimensionality of somatic complaints: Factor structure and psychometric properties of the Self-Rating Anxiety Scale. Journal of Anxiety Disorders, 20(5), 543–561.

    PubMed  Google Scholar 

  • Perrin, J. M., Bloom, S. R., & Gortmaker, S. L. (2007). The increase of childhood chronic conditions in the United States. Journal of American Medical Association, 297(24), 2755–2759.

    CAS  Google Scholar 

  • Radloff, L. S. (1977). The CES-D scale: A self-report depression scale for research in the general population. Applied Psychological Measurement, 1(3), 385–401.

    Google Scholar 

  • Riley, A. W. (2004). Evidence that school-age children can self-report on their health. Ambulatory Pediatrics, 4(4), 371–376.

    PubMed  Google Scholar 

  • Ritschel, L. A., Lim, N. E., & Stewart, L. M. (2015). Transdiagnostic applications of DBT for adolescents and adults. American Journal of Psychotherapy, 69(2), 111–128.

    PubMed  Google Scholar 

  • Sacks, V., & Murphey, D. (2018). The prevalence of adverse childhood experiences, nationally, by state, and by race or ethnicity. Child Trends; Bethesda, MD. Retrieved from https://www.childtrends.org/publications/prevalence-adverse-childhood-experiences-nationally-state-race-ethnicity.

  • Schmidt, S., Nachtigall, C., Wuethrich-Martone, O., & Strauss, B. (2002). Attachment and coping with chronic disease. Journal of Psychosomatic Research, 53(3), 763–773.

    PubMed  Google Scholar 

  • Schmidt, S., Petersen, C., & Bullinger, M. (2003). Coping with chronic disease from the perspective of children and adolescents—A conceptual framework and its implications for participation. Child Care, Health and Development, 29(1), 63–75.

    PubMed  CAS  Google Scholar 

  • Schuppert, H. M., Giesen-Bloo, J., van Gemert, T. G., Wiersema, H. M., Minderaa, R. B., Emmelkamp, P. M., & Nauta, M. H. (2009). Effectiveness of an emotion regulation group training for adolescents—A randomized controlled pilot study. Clinical Psychology & Psychotherapy: An International Journal of Theory & Practice, 16(6), 467–478.

    Google Scholar 

  • Sharkey, C. M., Bakula, D. M., Baraldi, A. N., Perez, M. N., Suorsa, K. I., Chaney, J. M., & Mullins, L. L. (2017). Grit, illness-related distress, and psychosocial outcomes in college students with a chronic medical condition: A path analysis. Journal of Pediatric Psychology, 43(5), 552–560.

    Google Scholar 

  • Sharkey, C. M., Espeleta, H. C., Bakula, D. M., Roberts, C., Ruppe, N., Chaney, J. M., & Mullins, L. L. (2018). Adverse childhood experiences: Non-medical trauma in the context of pediatric illness. Children’s Health Care. https://doi.org/10.1080/02739615.2018.1553677.

    Article  Google Scholar 

  • Shipman, K., Zeman, J., Penza, S., & Champion, K. (2000). Emotion management skills in sexually maltreated and nonmaltreated girls: A developmental psychopathology perspective. Development and Psychopathology, 12(1), 47–62.

    PubMed  CAS  Google Scholar 

  • Simpson, C. F., Boyd, C. M., Carlson, M. C., Griswold, M. E., Guralnik, J. M., & Fried, L. P. (2004). Agreement between self-report of disease diagnoses and medical record validation in disabled older women: Factors that modify agreement. Journal of the American Geriatrics Society, 52(1), 123–127.

    PubMed  Google Scholar 

  • Spirito, A., Stark, L. J., Gil, K. M., & Tyc, V. L. (1995). Coping with everyday and disease-related stressors by chronically ill children and adolescents. Journal of the American Academy of Child and Adolescent Psychiatry, 34(3), 283–290.

    PubMed  CAS  Google Scholar 

  • Tottenham, N., & Sheridan, M. A. (2010). A review of adversity, the amygdala and the hippocampus: A consideration of developmental timing. Frontiers in Human Neuroscience, 3, 68.

    PubMed  PubMed Central  Google Scholar 

  • Turkel, S. (2007). Late consequences of chronic pediatric illness. Psychiatric Clinics of North America, 30(4), 819–835.

    PubMed  Google Scholar 

  • Van Der Lee, J. H., Mokkink, L. B., Grootenhuis, M. A., Heymans, H. S., & Offringa, M. (2007). Definitions and measurement of chronic health conditions in childhood: A systematic review. Journal of American Medical Association, 297(24), 2741–2751.

    Google Scholar 

  • Wallander, J. L., & Varni, J. W. (1998). Effects of pediatric chronic physical disorders on child and family adjustment. The Journal of Child Psychology and Psychiatry and Allied Disciplines, 39(1), 29–46.

    CAS  Google Scholar 

  • Wing, R., Gjelsvik, A., Nocera, M., & McQuaid, E. L. (2015). Association between adverse childhood experiences in the home and pediatric asthma. Annals of Allergy, Asthma & Immunology, 114(5), 379–384.

    Google Scholar 

  • Zich, J. M., Attkisson, C. C., & Greenfield, T. K. (1990). Screening for depression in primary care clinics: The CES-D and the BDI. The International Journal of Psychiatry in Medicine, 20(3), 259–277.

    PubMed  CAS  Google Scholar 

  • Zung, W. W. (1971). A rating instrument for anxiety disorders. Psychosomatics: Journal of Consultation and Liaison Psychiatry, 12(6), 371–379.

    CAS  Google Scholar 

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  1. Department of Psychology, Oklahoma State University, 116 N Murray Hall, Stillwater, OK, 74078, USA

    Hannah C. Espeleta, Christina M. Sharkey, Dana M. Bakula, Kaitlyn L. Gamwell, Megan N. Perez, Caroline M. Roberts, John M. Chaney & Larry L. Mullins

  2. Department of Psychology, Vanderbilt University, Nashville, TN, USA

    Camille Archer

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  1. Hannah C. Espeleta
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  2. Christina M. Sharkey
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  3. Dana M. Bakula
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Correspondence to Hannah C. Espeleta.

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Hannah C. Espeleta, Christina M. Sharkey, Dana M. Bakula, Kaitlyn L. Gamwell, Camille Archer, Megan N. Perez, Caroline M. Roberts, John M. Chaney, and Larry L. Mullins declare that they have no conflict of interest.

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Espeleta, H.C., Sharkey, C.M., Bakula, D.M. et al. Adverse Childhood Experiences and Chronic Medical Conditions: Emotion Dysregulation as a Mediator of Adjustment. J Clin Psychol Med Settings 27, 572–581 (2020). https://doi.org/10.1007/s10880-019-09639-x

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