Exposure to Childhood Adversities and Psychiatric …...Childhood Adversities and Psychiatric...

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Exposure to Childhood Adversities and Psychiatric Disorders

Transcript of Exposure to Childhood Adversities and Psychiatric …...Childhood Adversities and Psychiatric...

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Exposure to Childhood Adversities and Psychiatric Disorders

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Cristiane S. Duarte, PhD, MPHLambert Associate Professor of Child PsychiatryDivision of Child and Adolescent PsychiatryColumbia UniversityNew York State Psychiatric InstituteNY, NY

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Cristiane S. Duarte, PhD, MPH

● Dr. Duarte has no disclosures to report.Disclosures

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Learning Objective

Outline the prevalence of childhood adversities in the general population

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Learning Objective

Describe mechanisms by which childhood adversities may lead to psychiatric disorders

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Learning Objective

Review strategies for the prevention and treatment of psychiatric disorders

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Agenda● Childhood Adversities: Definition and Prevalence

● Childhood Adversities and Psychiatric Disorders

● Prevention and Treatment

● Expanding developmental reach: The Next Generation

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Adverse Childhood Experiences (ACES)*: Definition● Maltreatment (physical,

sexual and emotional abuse; neglect by parents or caregivers)

● Parental death and divorce/separation

● Parental maladjustment (parental alcoholism, drug use, mental illness or suicide attempt, incarceration)

ACES – EXPANDED (WHO and others*)All ACES in CDC/Kaiser, plus:● Peer violence● Witnessing/exposure

community and collective violence

● Being discriminated against

Felitti VJ, et al. Am J Prev Med. 1998;14(4):245-258.Cronholm PF, et al. Am J Prev Med. 2015;49(3):354-361.

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ACEs and Risk for Behavioral, Physical and Mental Problems

*Having an ACE score of zero does not imply an individual could not have other risk factorsfor these health behaviors/diseases.Felitti VJ, et al. Am J Prev Med. 1998;14(4):245-258.

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Prevalence of ACEs: Adults

23.3%

10.6%

28.3%

20.7%

12.7%

26.9%

14.8%

9.9%

19.4%

4.7%

0% 5% 10% 15% 20% 25% 30%

Divorce/separationEmotional abuse

Physical abuseSexual abuse

Mother treated violentlyParental substance abuse

Emotional neglectPhysical neglect

Household mental illnessIncarcerated household member

Felitti VJ, et al. Am J Prev Med. 1998;14(4):245-258.

Percent

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ACES: Mechanisms

Felitti VJ, et al. Am J Prev Med. 1998;14(4):245-258.

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Childhood Adversities & Genes

Caspi A, et al. Science. 2002;297(5582):851-854. Caspi A, et al. Science. 2003;301(5631):386-389.

Childhood Maltreatment Number of Stressful Life Events

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Interaction Between the Serotonin Transporter Gene (5-HTTLPR), Stressful Life Events, and Risk of Depression: A Meta-analysis

Childhood Adversities & Genes

Risch N, et al. JAMA. 2009;301(23):2462-2471.

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Biological Consequences● Stress-response system dysregulation

- HPA axis

● Changes in the brain- Limbic (amygdala, hippocampus) system- Cortical areas

● Neurotransmitter systems - e.g., corticotrophin releasing factor [CRF]

● Cellular Aging- Short telomere length

● Epigenetics● Modifications of HPA and neuroplasticity-related methylation patterns

- e.g. , greater methylation of glucocorticoid receptor and Demethylation of FKBP5

● Inflammation- Dysregulation of the immune system: peripheral C-reactive protein, IL-6 and TNF-α- Physical and sexual abuse: IL-6 and TNF-α; Parental absence: CRP

IL-6 = interleukin-6; TNF-α = tumor necrosis factor-α; CRP = C-reactive protein; HPA = hypothalamic-pituitary adrenal-axis.

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A Dimensional Model of Childhood AdversityDeprivation and threat as distinct dimensions of early experience

McLaughlin KA, et al. Curr Dir in Psychol Sci. 2016;25(4):239-245.

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NYC-WTC: Department of Education Study

● February-March 2002● Representative sample

of NYC public school students (Grades 4-12)

● 94 schools, N = 8,236

NYC-WTC = New York City-World Trade Center.Hoven CW, Duarte, CS et al. Arch Gen Psychiatry. 2005;62(5):545-552.

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0 6 123 Kilometers

0 4 82 Miles

Fifteen Mile Radius From Ground Zero

Hoven CW, et al. Arch Gen Psychiatry. 2005;62(5):545-552.

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Impact of WTC Attack on NYC Public School Students

8%11% 10%

12%15%

9%

13%

7%

0%2%4%6%8%

10%12%14%16%18%20%

MDD PTSD GAD SAD Agoraphobia Panic Conduct Alcohol

Prevalence of Psychiatric Disorders Post WTC Among NYC Public School Students (N = 8,236)

MDD = major depressive disorder; PTSD = post traumatic stress disorder; GAD = generalized anxiety disorder, SAD = seasonal affective disorder.Hoven CW, Duarte CS, et al. Arch Gen Psychiatry. 2005;62(5):545-552.

Prev

alen

ce (%

)

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Childhood Adversities and Psychiatric Disorders Among Adolescents (NCS-A)

00

1.11.2

1.5*1.4*

1.11.4*

1.5*1.9*

1.3*1.5*

0 0.5 1 1.5 2

DiscriminationExposure to Violence

Divorce/separationDeath

Family violenceParental criminal

Parental substance abuseParental mental Illness

NeglectSexual abuse

Physical AbuseEmotional abuse

Childhood Adversities

*

*p < .05McLaughlin KA, et al. Arch Gen Psychiatry. 2012;69(11):1151-1160.

Hazard Ratio

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Childhood Adversities and Psychiatric Disorders

Keyes KM, et al. Br J Psychiatry. 2012;200(2):107-115.

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Childhood Adversities and Psychiatric Disorders

Keyes KM, et al. Br J Psychiatry. 2012;200(2):107-115.

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Boricua Youth Study● Probability samples of households in Metropolitan San Juan in

Puerto Rico and the South Bronx in New York City (N = 2,491). Initiated by Hector Bird and Glorisa Canino

● Inclusion criteria (at enumeration)● Children 5 – 13 years● A caretaker of Puerto Rican background

● Participation rates● South Bronx: 80.5%● San Juan, PR: 88.7%

● 3 waves (yearly) of data between 2001-2004 and 4th wave about 10 years later● >85% of Wave 1 participated in Wave 3● ~79% of Wave 1 participated so far in Wave 4 (ongoing)

Bird HR, et al. J Am Acad Child Adolesc Psych. 2006;45:1032-1041.

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Sample Selection: South Bronx, NYC

Bird HR, et al. J Am Acad Child Adolesc Psych. 2006;45:1032-1041.

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Sample Selection: Puerto Rico, San Juan Standard Metropolitan Area

Bird HR, et al. J Am Acad Child Adolesc Psych. 2006;45:1032-1041.

AGILLA

MAYAGUEZ BAYAMON

VIEQUES

CULEBRA

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The Boricua Youth Study (BYS)

Wave 1 Wave 2 Wave 3

5-13 6-14 7-15

Wave 4

2000 - 2004 2013 -2017

16-29Ages

BYS COHORT (N=2,491)

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Early Initiation of Alcohol Use

00.10.20.30.40.50.60.70.80.9

1

8 9 10 11 12 13 14

BYS Waves 1-3

Note. There were no significant differences by gender (Hazard Ratio = 0.98[0.71;1.36]) or social context in the hazard for early alcohol use (Hazard Ratio = 0.94[0.73;1.21]).

Ramos-Olazagasti, et al. J Youth Adolesc. 2017;46(1):28-44.

33%

Age at first alcohol use

Failu

re P

roba

bilit

y

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Adversities and Early Alcohol Use

2.5**

1.6*

1.6**

1.7***

0 0.5 1 1.5 2 2.5 3

Exposure to violence *girl

Parental antisocial personality

Physical Abuse

Emotional abuse

Analyses adjust for gender, age, site, and poverty, *P < .05, ** P <.01, *** P <.001.Ramos-Olazagasti, et al. J Youth Adolesc. 2017;46(1):28-44.

Hazard Ratio

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Parenting

Wei, CM, et al. Development of youth antisocial behaviors: Longitudinal, integrative model of parental factors and youth cultural stress. (In preparation).

Parental Risks Externalizing

Parenting

Youth Cultural Stress

The Role of Cultural Stress

.

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.35 (.03)*** .37 (.04)***

-.11 (.02)*** -.11 (.02)***

W1 Youth Antisocial Behaviors

W2 Youth Antisocial Behaviors

W3 Youth Antisocial Behaviors

W1 Parent Risk Composite

W1 Effective Parenting

W2 Effective Parenting

W3 Effective Parenting

W1 Youth Cultural Stress

W2 Youth Cultural Stress

W2 Parent Risk Composite

W3 Parent Risk Composite

-.12 (.02)***

-.54 (.04)***

-.23 (.05)***

.08 (.03)*

Effects of Parental Factors and Youth Cultural Stress on Youth Antisocial Behaviors

Wei, CM, et al. Development of youth antisocial behaviors: Longitudinal, integrative model of parental factors and youth cultural stress. (In preparation).

Cultural stress: interaction term estimate=0.432, SE=0.199, p=0.030

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Prevention and Treatment

McLaughlin KA, et al. Curr Opin Psychol. 2017;1429-1434.

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What Can Be Done About ACES?

VetoViolence. https://vetoviolence.cdc.gov/apps/phl/resource_center_infographic.html. Accessed May 30, 2017.

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Psychosocial Treatments● Well-established

• Individual CBT with parent involvement• Individual CBT and • Group CBT

● Probably efficacious • Group CBT with parent involvement• Eye movement desensitization and

reprocessing (EMDR)

CBT = cognitive behavioral therapy.Dorsey S, et al. J Clin Child Adolesc Psychol. 2017;46(3):303-330.

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The Next Generation: Boricua Youth Study - ECHO

Le#CA RightCA

FStracts

Infant Diffusion MRI. Data from 3 infants scanned atUPR. Tractography shows left (blue) and right (red)frontostriatal white matter tracts derived from left and rightcaudate (CA) seeds.

Environmental influences on Child Health Outcomes (ECHO) Program: New NIH program ($157 million awarded in 2016)

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Prenatal/Birth Cohort(n=500)

Wave 1 Wave 2 Wave 35-13 6-14 7-15

Wave 419-34

G2 Probands born before ECHO

Child Cohort(3-10 years old; n=829)

2017-232000-04 2013-17

16-27

G1 non-BYS Parents

G1 BYS Ages:

ECHO

G1 BYS COHORT (N=2,491) G1 BYS Parents

G2 BYS-ECHO Cohort (N~1,300)

Boricua Youth Study-ECHO

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Main Hypothesis and Potential Mechanisms

● Parents’ adverse childhood experiences (ACEs) may affect offspring development independent of:

- exposure to maternal distress during pregnancy and - adverse experiences that may be part of the postnatal rearing environment.

● Potential Mechanisms● Alterations in parental caregiving arising from their own early adverse

experiences● Women’s childhood experiences influence the gestational environment

through adaptations in immune, metabolic, endocrine and oxidative stress processes

● Father to child transmission: ‘parent of origin’ effects involving imprinted genes, and germline epigenetic mutations originating from stressed males

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Focus on the Building Blocks of Executive Functioning and Early Neurodevelopment

Why study early EF dysfunctions in disadvantaged children? ● Protracted development ● Vulnerable to childhood adversities

(poverty, neglect, abuse, poor nutrition, and restricted cognitive stimulation)● Predictive of future academic, social, and emotional success● Associated with neuropsychiatric disorders● Amenable to early interventions

BG

PTA

Thal

PFC

Adverse Exposures

Impaired EFPoor academic, social, & emotional functioning, neuropsychiatric disorders

Executive Functions (EF)Inhibitory control, attention, working memory, problem solving, planning

EF-Related Neural CircuitsPrefrontal cortex (PFC), Parietotemporalassociation cortex (PTA), Basal ganglia (BG), Thalamus (Thal)

Intact EFPromotes social & academic functions, and mental health

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Intergenerational Transmission of Disadvantage

● Beyond Prenatal and Childhood exposure to stress● To date, most studies and developmental theories have

assumed that a child's own experiences of adversity are primarily influencing future negative outcomes.

● This lens may be too narrow: the intergenerational, cyclic nature of disadvantage suggests the possibility that the effects of adversities may extend beyond the exposed child, influencing the offspring, through a number of potential sources.

● A new perspective on exposure to childhood adversity and disadvantage across generations

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SMART Goals● Acknowledge frequency and types of ACEs in

specific groups ● Be aware of the relationship between ACEs

and psychiatric disorders● Initiate psychosocial treatments in children

and adolescents exposed to ACES● Prevent ACEs before they happen

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Boricua Youth Study – Current AssessmentWave 4 Ancillary Studies BYS-ECHO

Substance Abuse &

Sexual Risk(2012-2018)

Depression/Anxiety

(2012-2017)

Gambling & ImpulsiveBehaviors

(2014-2019)

Early CVD Risk(2014- 2019)

Intergenerational Transmission(2016-2023)

Substance Use/Abuse & HIV/STI Risk Behaviors in Puerto Rican Youth [R01 DA033172]

PI: CristianeDuarte

NYSPI - Columbia UniversityUniversity of Puerto Rico

Effects of Social Context, Culture and Minority Status on Depression and Anxiety[1R01MH098374]

MPI: Maggie AlegriaGlorisa CaninoCristiane Duarte

Mass General Hospital University of Puerto RicoNYSPI-Columbia University

Predictors of Impulsive Behaviors among Youth[R01 HD060072]

MPI: Silvia MartinsCarlos BlancoGlorisa CaninoCristiane Duarte

MSPH Columbia UniversityNYSPIUniversity of Puerto Rico

Childhood Adversity and Cardiovascular Health among Puerto Rican Youth [R01HL125761]

PI: Shakira SugliaCoI: Glorisa CaninoCristiane Duarte

MSPH Columbia UniversityNYSPIUniversity of Puerto Rico

Breaking The Cycle of Intergenerational Disadvantage: Neurodevelopment Among Puerto Rican Children[UG3OD023328]

MPI: Cristiane DuarteGlorisa CaninoCatherine MonkJonathan Posner

NYSPI - Columbia UniversityUniversity of Puerto Rio

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Questions Answers &


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