Framework Convention on Climate Change

Context Although significant associations of childhood adversities (CAs) with adult mental disorders have been documented consistently in epidemiological surveys, these studies generally have examined only 1 CA per study. Because CAs are highly clustered, this approach results in overestimating the importance of individual CAs. Multivariate CA studies have been based on insufficiently complex models. Objective To examine the joint associations of 12 retrospectively reported CAs with the first onset of DSM-IV disorders in the National Comorbidity Survey Replication using substantively complex multivariate models. Design Cross-sectional community survey with retrospective reports of CAs and lifetime DSM-IV disorders. Setting Household population in the United States. Participants Nationally representative sample of 9282 adults. Main Outcome Measures Lifetime prevalences of 20 DSM-IV anxiety, mood, disruptive behavior, and substance use disorders assessed using the Composite International Diagnostic Interview. Results The CAs studied were highly prevalent and intercorrelated. The CAs in a maladaptive family functioning (MFF) cluster (parental mental illness, substance abuse disorder, and criminality; family violence; physical abuse; sexual abuse; and neglect) were the strongest correlates of disorder onset. The best-fitting model included terms for each type of CA, number of MFF CAs, and number of other CAs. Multiple MFF CAs had significant subadditive associations with disorder onset. Little specificity was found for particular CAs with particular disorders. Associations declined in magnitude with life course stage and number of previous lifetime disorders but increased with length of recall. Simulations suggest that CAs are associated with 44.6% of all childhood-onset disorders and with 25.9% to 32.0% of later-onset disorders. Conclusions The fact that associations increased with length of recall raises the possibility of recall bias inflating estimates. Even considering this, the results suggest that CAs have powerful and often subadditive associations with the onset of many types of largely primary mental disorders throughout the life course.

https://jamanetwork.com/journals/jamapsychiatry/articlepdf/210584/yoa90080_113_123.pdf

Childhood Adversities and Adult Psychiatric Disorders in the National Comorbidity Survey Replication I: Associations With First Onset of DSM-IV Disorders

Background 

Although significant associations of childhood adversities with adult mental disorders are widely documented, most studies focus on single childhood adversities predicting single disorders.

Aims 

To examine joint associations of 12 childhood adversities with first onset of 20 DSM–IV disorders in World Mental Health (WMH) Surveys in 21 countries.

Method 

Nationally or regionally representative surveys of 51 945 adults assessed childhood adversities and lifetime DSM–IV disorders with the WHO Composite International Diagnostic Interview (CIDI).

Results 

Childhood adversities were highly prevalent and interrelated. Childhood adversities associated with maladaptive family functioning (e.g. parental mental illness, child abuse, neglect) were the strongest predictors of disorders. Co-occurring childhood adversities associated with maladaptive family functioning had significant subadditive predictive associations and little specificity across disorders. Childhood adversities account for 29.8% of all disorders across countries.

Conclusions 

Childhood adversities have strong associations with all classes of disorders at all life-course stages in all groups of WMH countries. Long-term associations imply the existence of as-yet undetermined mediators.

/pdf/childhood-adversities-and-adult-psychopathology-in-the-who-21qhoa8jah.pdf

Childhood adversities and adult psychopathology in the WHO World Mental Health Surveys

Context Although childhood adversities (CAs) are known to be highly co-occurring, most research examines their associations with psychiatric disorders one at a time. However, recent evidence from adult studies suggests that the associations of multiple CAs with psychiatric disorders are nonadditive, arguing for the importance of multivariate analysis of multiple CAs. To our knowledge, no attempt has been made to perform a similar kind of analysis among children or adolescents. Objective To examine the multivariate associations of 12 CAs with first onset of psychiatric disorders in a national sample of US adolescents. Design A US national survey of adolescents (age range, 13-17 years) assessing DSM-IV anxiety, mood, behavior, and substance use disorders and CAs. The CAs include parental loss (death, divorce, and other separations), maltreatment (neglect and physical, sexual, and emotional abuse), and parental maladjustment (violence, criminality, substance abuse, and psychopathology), as well as economic adversity. Setting Dual-frame household-school samples. Participants In total, 6483 adolescent-parent pairs. Main Outcome Measures Lifetime DSM-IV disorders assessed using the World Health Organization Composite International Diagnostic Interview. Results Overall, exposure to at least 1 CA was reported by 58.3% of adolescents, among whom 59.7% reported multiple CAs. The CAs reflecting maladaptive family functioning were more strongly associated than other CAs with the onset of psychiatric disorders. The best-fitting model included terms for the type and number of CAs and distinguished between maladaptive family functioning and other CAs. The CAs predicted behavior disorders most strongly and fear disorders least strongly. The joint associations of multiple CAs were subadditive. The population-attributable risk proportions across DSM-IV disorder classes ranged from 15.7% for fear disorders to 40.7% for behavior disorders. The CAs were associated with 28.2% of all onsets of psychiatric disorders. Conclusions Childhood adversities are common, highly co-occurring, and strongly associated with the onset of psychiatric disorders among US adolescents. The subadditive multivariate associations of CAs with the onset of psychiatric disorders have implications for targeting interventions to reduce exposure to CAs and to mitigate the harmful effects of CAs to improve population mental health.

/pdf/childhood-adversities-and-first-onset-of-psychiatric-xletiqvlxp.pdf

Childhood Adversities and First Onset of Psychiatric Disorders in a National Sample of US Adolescents

This paper describes the well-being of participants in the Midwest Evaluation of the Adult Functioning of Former Foster Youth (n = 603), a study of youth leaving out-of-home care in the USA, at the point where they have been ‘young adults’ for about 1 year. Although some of these young adults are in stable situations and either moving forward with their education or employed in promising jobs, more of them are having significant difficulties during the early stages of the transition to adulthood. Too many are neither employed nor in school, have children that they are not able to parent, suffer from persistent mental illness or substance use disorders, find themselves without basic necessities, become homeless, or end up involved with the criminal justice system. They are doing worse than other young adults across a number of important dimensions. Most of these young adults continue to maintain relations with members of their family of origin, with many finding themselves living with family at age 19. Importantly, those young people who chose to remain under the care and supervision of the child welfare system experienced better outcomes than those who either chose to or were forced to leave care.

Early outcomes for young adults transitioning from out-of-home care in the USA

The well-being of youths who age out of the out-of-home care system in the US has long been of great interest to child welfare practitioners and policymakers In spite of this interest, however, very little is known about how these youths fare when they must make the transition to independence The Foster Youth Transitions to Adulthood Study is tracking the experiences of 141 young adults who left care in Wisconsin in 1995 and 1996 This article describes these youths and their experiences in the first 12 to 18 months after leaving care The findings suggest that the transition to independence is a difficult time for youth leaving the out-of-home care system

Foster youth transitions to adulthood: A longitudinal view of youth leaving care.

Children of incarcerated parents: Challenges and resiliency, in their own words

Smoothing the transition to adulthood: Creating ongoing supportive relationships among foster youth

Environmental injustice is a growing human rights issue as climate change and environmental degradation rapidly increases. As a social justice problem, it is relevant to the social work profession, yet not integrated into our curricula. This study of 373 social work professionals found that environmental justice is a significant practice issue across broad client populations and that professionals felt unprepared to address it. Qualitative and quantitative data revealed high levels of client exposure to environmental hazards with little power to change it. Respondents reported dissatisfaction with their education to help them understand environmental issues. Moreover, they indicated that they would like to see environmental justice integrated into social work education and better-prepared graduates entering the profession. Implications for practice and education are discussed.

Environmental Justice and Social Work Education: Social Workers' Professional Perspectives

With rising attention toward the plight of children with incarcerated parents, there has, as yet, been little focus placed on the adults who care for them, individuals who may have a profound impact on the children's relationships with their incarcerated parent. This study explores unique parenting challenges the caregivers faced, from their perspectives and presents their voices. Caregivers discussed the strain of serving as a gatekeeper between the child and imprisoned parent, coping with stigma and isolation, and negotiating a predominantly child-unfriendly visitation system. The findings suggest that caregivers need information about raising a child in this context, connections with others in similar situations, and a more child-friendly and transparent judicial and visitation process.

/pdf/caregivers-of-children-with-incarcerated-parents-2p8ank9igk.pdf

Ande Nesmith

Papers

Foster youth transitions to adulthood: A longitudinal view of youth leaving care.

Children of incarcerated parents: Challenges and resiliency, in their own words

Smoothing the transition to adulthood: Creating ongoing supportive relationships among foster youth

Environmental Justice and Social Work Education: Social Workers' Professional Perspectives

Caregivers of Children with Incarcerated Parents