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Identifying Distinct Latent Classes of Adverse Childhood Experiences Among US Children and Their Relationship with Childhood Internalizing Disorders

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Abstract

This study aimed to determine the relationship between latent classes of adverse childhood experience (ACEs) and internalizing disorders (anxiety and depression) among US children. The 2016 National Survey of Children’s Health data for children aged 6–17 was used. Latent class analysis was performed to identify distinct sub-types of ACE exposures and survey-weighted logistic regression models were employed to determine whether these classes were associated with any or comorbid childhood internalizing disorders, after controlling for meaningful covariates. Four latent classes were identified: income hardship, divorce, mental health or substance abuse exposure, and high ACEs overall. Children in three of the four classes were significantly more likely to have any childhood internalizing disorder when compared to children reporting no ACEs, while children in all classes were significantly more likely to have a comorbid history of anxiety and depression. Thus, children exposed to ACEs should receive necessary mental health screenings and treatments.

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References

  1. Perou R, Bitsko RH, Blumberg SJ et al (2013) Mental health surveillance among children–United States, 2005–2011. Morb Mortal Wkly Rep Surveill Summ 62(2):1–35

    Google Scholar 

  2. Soni A (2014) The Five Most Costly Children’s Conditions, 2011: estimates for U.S. Civilian Noninstitutionalized Children, Ages 0–17. Rockville, MD. http://www.meps.ahrq.gov/mepsweb/data_files/publications/st434/stat434.shtml. Accessed 1 Dec 2018

  3. O’Connell ME, Boat TF, Warner KE. (2009) Preventing mental, emotional, and behavioral disorders among young people: progress and possibilities. In: National Research Council and Institute of Medicine (eds). The National Academies Press Washington, DC. http://books.nap.edu/openbook.php?record_id=12480&page=530. Accessed 1 Dec 2018

  4. Kovacs M, Devlin B (1998) Internalizing disorders in childhood. J Child Psychol Psychiatry Allied Discip 39(1):47–63. https://doi.org/10.1017/S0021963097001765

    Article  Google Scholar 

  5. Zahn-Waxler C, Klimes-Dougan B, Slattery MJ (2000) Internalizing problems of childhood and adolescence: prospects, pitfalls, and progress in understanding the development of anxiety and depression. Dev Psychopathol 12(3):443–466. https://doi.org/10.1017/S0954579400003102

    Article  PubMed  Google Scholar 

  6. Jenson WR, Harward S, Bowen JM (2011) Externalizing disorders in children and adolescents: behavioral excess and behavioral deficits. In: Jenson WR, Harward S, Bowen JM (eds) The oxford handbook of school psychology. Oxford University Press, Oxford. https://doi.org/10.1093/oxfordhb/9780195369809.013.0141

    Chapter  Google Scholar 

  7. Ege MA, Messias E, Thapa PB, Krain LP (2015) Adverse childhood experiences and geriatric depression: results from the 2010 BRFSS. Am J Geriatr Psychiatry 23(1):110–114. https://doi.org/10.1016/j.jagp.2014.08.014

    Article  PubMed  Google Scholar 

  8. Choi NG, Dinitto DM, Marti CN, Choi BY (2017) Association of adverse childhood experiences with lifetime mental and substance use disorders among men and women aged 50+ years. Int Psychogeriatr 29(3):359–372. https://doi.org/10.1017/S1041610216001800

    Article  PubMed  Google Scholar 

  9. Barboza GE (2017) Latent classes and cumulative impacts of adverse childhood experiences. Child Maltreat. https://doi.org/10.1177/1077559517736628

    Article  PubMed  Google Scholar 

  10. Curran E, Adamson G, Stringer M, Rosato M, Leavey G (2016) Severity of mental illness as a result of multiple childhood adversities: US National Epidemiologic Survey. Soc Psychiatry Psychiatr Epidemiol 51(5):647–657. https://doi.org/10.1007/s00127-016-1198-3

    Article  PubMed  Google Scholar 

  11. Substance Abuse and Mental Health Services Administration (2015) The role of adverse childhood experiences in substance abuse and related behavioral health problems. Substance Abuse and Mental Health Services Administration, Rockville

    Google Scholar 

  12. Centers for Disease Control and Prevention. ACEs Infographic. 1997

  13. Schilling EA, Aseltine RH, Gore S (2007) Adverse childhood experiences and mental health in young adults: a longitudinal survey. BMC Public Health 7:1–10. https://doi.org/10.1186/1471-2458-7-30

    Article  Google Scholar 

  14. Björkenstam E, Vinnerljung B, Hjern A (2017) Impact of childhood adversities on depression in early adulthood: a longitudinal cohort study of 478,141 individuals in Sweden. J Affect Disord 223:95–100. https://doi.org/10.1016/j.jad.2017.07.030

    Article  Google Scholar 

  15. Clark C, Caldwell T, Power C, Stansfeld SA (2010) Does the influence of childhood adversity on psychopathology persist across the lifecourse? A 45-year prospective epidemiologic study. Ann Epidemiol 20(5):385–394. https://doi.org/10.1016/j.annepidem.2010.02.008

    Article  PubMed  Google Scholar 

  16. O’Rand AM, Hamil-Luker J (2005) Processes of cumulative adversity: childhood disadvantage and increased risk of heart attack across the life course. J Gerontol Ser B 60(Special_Issue_2):S117–S124. https://doi.org/10.1093/geronb/60.Special_Issue_2.S117

    Article  Google Scholar 

  17. Wickrama KAS, Conger RD, Abraham WT (2005) Early adversity and later health: the intergenerational transmission of adversity through mental disorder and physical illness. J Gerontol Ser B 60(Special_Issue_2):S125–S129. https://doi.org/10.1093/geronb/60.Special_Issue_2.S125

    Article  Google Scholar 

  18. Benjet C, Borges G, Medina-Mora ME (2010) Chronic childhood adversity and onset of psychopathology during three life stages: childhood, adolescence and adulthood. J Psychiatr Res 44(11):732–740. https://doi.org/10.1016/j.jpsychires.2010.01.004

    Article  PubMed  Google Scholar 

  19. Fothergill K, Ensminger ME, Doherty EE, Juon H-S, Green KM (2016) Pathways from early childhood adversity to later adult drug use and psychological distress. J Health Soc Behav 57(2):223–239. https://doi.org/10.1177/0022146516646808

    Article  PubMed  PubMed Central  Google Scholar 

  20. Rapsey CM, Scott KM, Patterson T (2019) Childhood sexual abuse, poly-victimization and internalizing disorders across adulthood and older age: findings from a 25-year longitudinal study. J Affect Disord 244:171–179

    Article  Google Scholar 

  21. Wade R, Shea JA, Rubin D, Wood J (2014) Adverse childhood experiences of low-income urban youth. Pediatrics 134(1):e13–e20. https://doi.org/10.1542/peds.2013-2475

    Article  PubMed  Google Scholar 

  22. Menard C, Bandeen-Roche KJ, Chilcoat HD (2004) Epidemiology of multiple childhood traumatic events: child abuse, parental psychopathology, and other family-level stressors. Soc Psychiatry Psychiatr Epidemiol 39(11):857–865. https://doi.org/10.1007/s00127-004-0868-8

    Article  PubMed  Google Scholar 

  23. Youssef NA, Belew D, Hao G et al (2017) Racial/ethnic differences in the association of childhood adversities with depression and the role of resilience. J Affect Disord 208(June 2016):577–581. https://doi.org/10.1016/j.jad.2016.10.024

    Article  PubMed  Google Scholar 

  24. Cecil CAM, Viding E, Barker ED, Guiney J, McCrory EJ (2014) Double disadvantage: the influence of childhood maltreatment and community violence exposure on adolescent mental health. J Child Psychol Psychiatry Allied Discip 55(7):839–848. https://doi.org/10.1111/jcpp.12213

    Article  Google Scholar 

  25. Porche MV, Costello DM, Rosen-Reynoso M (2016) Adverse family experiences, child mental health, and educational outcomes for a national sample of students. School Ment Health 8(1):44–60. https://doi.org/10.1007/s12310-016-9174-3

    Article  Google Scholar 

  26. Bright MA, Knapp C, Hinojosa MS, Alford S, Bonner B (2016) The comorbidity of physical, mental, and developmental conditions associated with childhood adversity: a population based study. Matern Child Health J 20(4):843–853. https://doi.org/10.1007/s10995-015-1915-7

    Article  PubMed  Google Scholar 

  27. Halfon N, Larson K, Son J, Lu M, Bethell C (2017) Income inequality and the differential effect of adverse childhood experiences in US children. Acad Pediatr 17(7):S70–S78. https://doi.org/10.1016/j.acap.2016.11.007

    Article  PubMed  Google Scholar 

  28. Stempel H, Cox-Martin M, Bronsert M, Dickinson LM, Allison MA (2017) Chronic school absenteeism and the role of adverse childhood experiences. Acad Pediatr 17(8):837–843. https://doi.org/10.1016/j.acap.2017.09.013

    Article  PubMed  Google Scholar 

  29. Wing R, Gjelsvik A, Nocera M, McQuaid EL (2015) Association between adverse childhood experiences in the home and pediatric asthma. Ann Allergy Asthma Immunol 114(5):379–384. https://doi.org/10.1016/j.anai.2015.02.019

    Article  PubMed  Google Scholar 

  30. Flaherty EG, Thompson R, Litrownik AJ et al (2006) Effect of early childhood adversity on child health. Arch Pediatr Adolesc Med 160(12):1232. https://doi.org/10.1001/archpedi.160.12.1232

    Article  PubMed  Google Scholar 

  31. Kerker BD, Zhang J, Nadeem E et al (2015) Adverse childhood experiences and mental health, chronic medical conditions, and development in young children. Acad Pediatr 15(5):510–517. https://doi.org/10.1016/j.acap.2015.05.005

    Article  PubMed  PubMed Central  Google Scholar 

  32. Bethell C, Gombojav N, Solloway M, Wissow L (2016) Adverse childhood experiences, resilience and mindfulness-based approaches: common denominator issues for children with emotional, mental, or behavioral problems. Child Adolesc Psychiatr Clin N Am 25(2):139–156. https://doi.org/10.1016/j.chc.2015.12.001

    Article  PubMed  PubMed Central  Google Scholar 

  33. Raposo SM, Mackenzie CS, Henriksen CA, Afifi TO (2014) Time does not heal all wounds: Older adults who experienced childhood adversities have higher odds of mood, anxiety, and personality disorders. Am J Geriatr Psychiatry 22(11):1241–1250. https://doi.org/10.1016/j.jagp.2013.04.009

    Article  PubMed  Google Scholar 

  34. Chapman DP, Whitfield CL, Felitti VJ, Dube SR, Edwards VJ, Anda RF (2004) Adverse childhood experiences and the risk of depressive disorders in adulthood. J Affect Disord 82(2):217–225. https://doi.org/10.1016/j.jad.2003.12.013

    Article  PubMed  Google Scholar 

  35. Lanier P, Maguire-Jack K, Lombardi B, Frey J, Rose RA (2017) Adverse childhood experiences and child health outcomes: comparing cumulative risk and latent class approaches. Matern Child Health J 0(0):1–10. https://doi.org/10.1007/s10995-017-2365-1

    Article  Google Scholar 

  36. McChesney GC, Adamson G, Shevlin M (2015) A latent class analysis of trauma based on a nationally representative sample of US adolescents. Soc Psychiatry Psychiatr Epidemiol 50(8):1207–1217. https://doi.org/10.1007/s00127-015-1075-5

    Article  Google Scholar 

  37. Xian H, Shah KR, Potenza MN et al (2008) A latent class analysis of DSM-III-R pathological gambling criteria in middle-aged men: association with psychiatric disorders. J Addict Med 2(2):85–95. https://doi.org/10.1097/ADM.0b013e31816d699f

    Article  PubMed  PubMed Central  Google Scholar 

  38. McLafferty M, Armour C, McKenna A, O’Neill S, Murphy S, Bunting B (2015) Childhood adversity profiles and adult psychopathology in a representative Northern Ireland study. J Anxiety Disord 35:42–48. https://doi.org/10.1016/j.janxdis.2015.07.004

    Article  PubMed  Google Scholar 

  39. Roos LE, Afifi TO, Martin CG, Pietrzak RH, Tsai J, Sareen J (2016) Linking typologies of childhood adversity to adult incarceration: findings from a nationally representative sample. Am J Orthopsychiatry 86(5):584–593. https://doi.org/10.1037/ort0000144

    Article  PubMed  Google Scholar 

  40. Rebbe R, Nurius PS, Ahrens KR, Courtney ME (2017) Adverse childhood experiences among youth aging out of foster care: a latent class analysis. Child Youth Serv Rev 74:108–116. https://doi.org/10.1016/j.childyouth.2017.02.004

    Article  PubMed  PubMed Central  Google Scholar 

  41. Brown S, Rienks S, McCrae J, Watamura S (2017) The co-occurrence of adverse childhood experiences among children investigated for child maltreatment: a latent class analysis—ClinicalKey. Child Abus Negl. https://doi.org/10.1016/j.chiabu.2017.11.010

    Article  Google Scholar 

  42. United States Census Bureau (2016) National Survey of Children’s Health [data file]. 2017. https://www.census.gov/programs-surveys/nsch/data/nsch2016.html. Accessed 1 Aug 2018

  43. The United States Census Bureau Associate Director of Demographic Programs. 2016 National Survey of Children’s Health Frequently Asked Questions. 2017

  44. United States Census Bureau (2016) National Survey of Children’s Health: source and accuracy statement, 2017. United States Census Bureau, Washington, DC

    Google Scholar 

  45. Beesdo K, Knappe S, Pine DS (2011) Anxiety and anxiety disorders in children and adolescents: Developmental issues and implications for DSM-V. Psychiatr Clin North Am 32(3):483–524. https://doi.org/10.1016/j.psc.2009.06.002

    Article  Google Scholar 

  46. United States Census Bureau. (2016) National Survey of Children’s Health—Topical Questionnaire 2. United States Census Bureau, Washington, DC

    Google Scholar 

  47. Cavanaugh CE, Petras H, Martins SS (2015) Gender-specific profiles of adverse childhood experiences, past year mental and substance use disorders, and their associations among a national sample of adults in the United States. Soc Psychiatry Psychiatr Epidemiol 50(8):1257–1266. https://doi.org/10.1007/s00127-015-1024-3

    Article  PubMed  PubMed Central  Google Scholar 

  48. Pirkola S, Isometsä E, Aro H et al (2005) Childhood adversities as risk factors for adult mental disorders. Results from the Health 2000 study. Soc Psychiatry Psychiatr Epidemiol 40(10):769–777. https://doi.org/10.1007/s00127-005-0950-x

    Article  PubMed  Google Scholar 

  49. Wade R, Cronholm PF, Fein JA et al (2016) Household and community-level adverse childhood experiences and adult health outcomes in a diverse urban population. Child Abus Negl 52:135–145. https://doi.org/10.1016/j.chiabu.2015.11.021

    Article  Google Scholar 

  50. Bright MA, Thompson LA (2017) Association of adverse childhood experiences with co-occurring health conditions in early childhood. J Dev Behav Pediatr 39(1):1. https://doi.org/10.1097/DBP.0000000000000514

    Article  Google Scholar 

  51. Klasen F, Otto C, Kriston L, Patalay P, Schlack R, Ravens-Sieberer U (2015) Risk and protective factors for the development of depressive symptoms in children and adolescents: results of the longitudinal BELLA study. Eur Child Adolesc Psychiatry 24(6):695–703. https://doi.org/10.1007/s00787-014-0637-5

    Article  PubMed  Google Scholar 

  52. R Core Team (2016) R: A Language and environment for statistical computing. https://www.r-project.org/. Accessed 1 Oct 2018

  53. Linzer DA, Lewis JB (2011) poLCA: An R package for polytomous variable latent class analysis. J Stat Softw 42(10):1–29. https://doi.org/10.18637/jss.v042.i10

    Article  Google Scholar 

  54. McLafferty M, Armour C, O’Neill S, Murphy S, Ferry F, Bunting B (2016) Suicidality and profiles of childhood adversities, conflict related trauma and psychopathology in the Northern Ireland population. J Affect Disord 200:97–102. https://doi.org/10.1016/j.jad.2016.04.031

    Article  PubMed  Google Scholar 

  55. Ballard ED, Van Eck K, Musci RJ et al (2015) Latent classes of childhood trauma exposure predict the development of behavioral health outcomes in adolescence and young adulthood. Psychol Med 45(15):3305–3316. https://doi.org/10.1017/S0033291715001300

    Article  PubMed  Google Scholar 

  56. Shin SH, McDonald SE, Conley D (2018) Patterns of adverse childhood experiences and substance use among young adults: a latent class analysis. Addict Behav 78(November 2017):187–192. https://doi.org/10.1016/j.addbeh.2017.11.020

    Article  PubMed  Google Scholar 

  57. Grimm P. (2010) Social desirability bias. In: Sheth JN, Malhotra NK (eds) Wiley international encyclopedia of marketing. John Wiley & Sons, Inc, Hoboken. https://doi.org/10.1002/9781444316568.wiem02057

    Chapter  Google Scholar 

  58. Fryers T, Brugha T (2013) Childhood determinants of adult psychiatric disorder. Clin Pract Epidemiol Ment Health 9(1):1–50. https://doi.org/10.2174/1745017901309010001

    Article  PubMed  PubMed Central  Google Scholar 

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  1. Department of Epidemiology and Biostatistics, College for Public Health and Social Justice, Salus Center, Saint Louis University, 3545 Lafayette Avenue, 63104, Saint Louis, MO, USA

    Daphne Lew & Hong Xian

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Lew, D., Xian, H. Identifying Distinct Latent Classes of Adverse Childhood Experiences Among US Children and Their Relationship with Childhood Internalizing Disorders. Child Psychiatry Hum Dev 50, 668–680 (2019). https://doi.org/10.1007/s10578-019-00871-y

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