Parents of Child Psychiatric Patients Report More Adverse Childhood Experiences Compared with Community Samples
1
Department of Clinical Pharmacy, Saarland University, 66123 Saarbruecken, Germany
2
SHG Clinic for Child and Adolescent Psychiatry, 66119 Saarbruecken, Germany
3
Child and Adolescent Psychiatry, Saarland University Hospital, 66421 Homburg, Germany
*
Author to whom correspondence should be addressed.
Children 2024, 11(12), 1427; https://doi.org/10.3390/children11121427
Submission received: 15 October 2024
/
Revised: 13 November 2024
/
Accepted: 21 November 2024
/
Published: 26 November 2024
(This article belongs to the Special Issue Stress and Stress Resilience in Children and Adolescents)
Abstract
Adverse childhood experiences (ACEs) have already been associated, in some studies, with various diverse psychosocial abnormalities in later life. However, it is still unclear whether ACEs reported by biological parents differ from ACE scores in community samples. Background/Objectives: The aim of this study was to investigate the extent to which parents of a patient sample differ from a community sample in terms of reporting childhood experiences. In addition, the connection between parental negative traumatic experiences and their children’s reporting of these experiences should be examined in more detail. Methods: In total, 256 child psychiatric patients (73.8% female and 26.2% male) aged 4–18 years (mean [M] = 13.26 years, standard deviation [SD] = 2.73) were retrospectively examined for post-traumatic stress symptoms (using the CATS questionnaire). In addition, 391 caregivers, 316 of whom were biological parents, completed the ACE questionnaire on adverse childhood experiences. The frequencies of ACEs of the parents, the traumatic experiences of the patients and their cumulative occurrence were evaluated descriptively. Results: A total of 139 (73%) mothers reported at least one negative experience in childhood. In contrast, 65 fathers (52%) reported at least one negative experience in childhood. Mothers most frequently mentioned separation from a parent (38.7%), while fathers cited emotional abuse as the most frequent negative experience. These ACE scores were significantly higher than those reported from community samples. Post-traumatic stress disorder was diagnosed in 75 (29.3%) of the 256 patients. A total of 44.6% of children of mothers and 53.8% of children of fathers reporting at least one ACE showed a CATS score above the cut-off. Conclusions: Parents of child psychiatric patients show higher scores of adverse childhood experiences than a community sample with the same population background. Further empirical studies in parents of child psychiatric patients and a larger sample seem mandatory in the face of these results.
1. Introduction
Adverse experiences in early childhood are a critical factor in lifelong mental and physical health, both in adults and their children [1]. The Adverse Childhood Experience (ACE) questionnaire was developed as a composite self-report of abuse, neglect and domestic problems in childhood (before age 18). Abuse can occur in physical, sexual and psychological forms. Physical abuse is the intentional use of physical force against a child that results in or can result in physical injury [2]. Sexual abuse is any completed or attempted sexual act on a child [3]. Intentional behavior by a caregiver that conveys to a child that they are worthless, defective, unloved or unwanted is referred to as psychological abuse [4]. Neglect can have a medical, emotional and/or physical background and is based on the failure of a caregiver to meet the basic needs of a child [2].
These experiences can have long-lasting effects upon the subjected individuals. For example, high ACE scores are associated with long-term cardiovascular disease in later life or with negative metabolic changes in adulthood [5]. In addition to physical health, the psychological effects of ACEs are also of concern. These can be additive and combine with other developmental stressors (e.g., sexism, medical comorbidities, racism, etc.) to increase the risk of health conditions across the lifespan [6]. Likewise, ACEs can be passed down through generations, with a high number of parental ACEs having a cumulative negative effect [7]. Physical and psychological problems in the child can arise in the areas of temperament, academic performance, behavior and infant/toddler development [8].
The intergenerational transmission of adverse childhood experiences has also been described. The epigenetic transfer of ACEs may occur due to stress during pregnancy or mother–infant interactions [9,10]. Also, fathers with higher ACE scores reported more pregnancy-related anxiety than fathers with lower ACE scores at almost all time points during pregnancy measured in one study while still reporting depressive feelings during pregnancy [11]. Thus, ACEs can be passed on not only through interactions and parenting style but also through the role model function of parents. For example, children in families with multiple stressors are at the highest risk of high negative emotionality compared to families without stress [12].
Furthermore, it has been demonstrated that ACEs can have a negative effect on the health of adults [13]. The question of how these effects can influence the children of those affected will be investigated in the following paper. In previous studies investigating the relationship between traumatized parents and traumatized children, a clinical sample of refugees and their children showed a positive correlation between violence experienced by mothers in their childhood and violence experienced by children in childhood [14]. To extend these findings, we examine the question of which trauma-specific symptoms are reported by children whose parents experienced violence or other adverse childhood experiences.
2. Materials and Methods
Participants. The sample consisted of 256 patients and 391 caregivers/parents. In total, 316 parents completed the ACE questionnaire between January 2020 and July 2024. Within the child psychiatric patient sample, there were 189 female (73.8%) and 67 male (26.2%) participants. Patients from the following countries took part in this study: America (0.4%), Bulgaria (0.4%), Germany (94.9%), Malaysia (0.4%), Poland (0.4%), Romania (0.4%), Russia (0.4%), Syria (1.2%), Ukraine (1.2%) and Venezuela (0.4%). The average age at the time of completing the first questionnaire was 13 years (SD = 2.73).
Procedure. ICD-10 diagnoses were confirmed in a routine clinical procedure using standardized, disorder-specific diagnostic procedures. These diagnoses were assigned with the help of a collaborative medical and therapeutic assessment based on various appropriate diagnostic tools. The ICD-10 is the 10th revision of the WHO International Classification of Diseases and Related Health Problems. It is used by physicians and psychotherapists to code diagnoses and symptoms. The CATS questionnaires were completed by the patients themselves, while the ACE questionnaires were answered by caregivers or parents. Patients were asked to complete the following questionnaires in a quiet environment, accompanied by a therapist in case of extensive problems with the material or other issues, and caregivers could complete the questionnaires in the clinic or at home. Patients and caregivers could ask the trained therapists at any time if they had any questions or doubts. In addition, there was no time limit for completing the questionnaires, and patients and caregivers were informed about the nature, significance and scope of this study and the resulting requirements as part of the prior consent process. Only complete and assignable questionnaires were included in this data set.
Materials and Methods. Sociodemographic data such as the age, sex, mental diagnosis, country of origin and native language of the patients were considered in the survey and are described in Table 1.
ACE. The “Adverse Childhood Experiences Questionnaire” (ACE) is a valid, reliable and economical screen for the retrospective assessment of adverse childhood experiences and consists of 10 items on child maltreatment and problems in the parental home with yes or no answers [6,15]. A total score of 4 (maximum of 10) or higher is considered as having high-risk symptoms [16]. The German version was used and an overall score was calculated [15].
CATS and CATS-2. The “Child and Adolescent Trauma Screen” (CATS) is a short, freely accessible screening instrument directly based on the DSM-5 criteria for post-traumatic stress disorder (PTSD). It is a measure of potentially traumatic events and of post-traumatic stress symptoms [17,18]. In this study, the CATS Self-report (7–17 years) was used in most cases. If the patients were under 7 years old, the CATS Caregiver-report (3–6 years) was used. Post-traumatic stress symptoms (PTEs) are assessed using a 15-item structured PTE checklist. The PTE checklist follows the definitions of traumatic events in the DSM-5 and ICD-11 and includes items assessing natural disasters, serious accidents, experiencing or seeing violence at home or in the community, sexual abuse (off- and online), bullying, cyberbullying, traumatic loss, medical procedures and war. Patients who answered yes to at least one event are then assessed using 25 items that are rated on a 4-point Likert scale with the following anchor points: 0 = “Never”, 1 = “Sometimes”, 2 = “Often”, 3 = “Almost always”. The 25 items correspond directly to the diagnostic criteria for PTSD in the DSM-5 and PTSD and complex post-traumatic stress disorder in the ICD-11 [17]. The validation of the CATS showed good psychometric properties and has a proven good to excellent internal consistency of the symptom scales, with α ranging between 0.88 and 0.94 for the different versions [19].
Statistical analyses. The IBM SPSS Statistics program (IBM SPSS Statistics 27.0, 2021) was used for statistical analysis. A purely descriptive data analysis was carried out using the SPSS and Excel (Microsoft Excel, Version 16.82) programs. Regression analyses were not used. For this reason, it was not yet possible to use p-values and other parameters at the time of publication. Methodologically, only data from respondents who completed all questionnaires were used. Likewise, only the data of subjects who had both a CATS and at least one ACE, completed by a reference person, were used.
3. Results
Table 2 shows the distribution of diagnoses in the group of child psychiatric patients. Post-traumatic stress disorder was diagnosed in 75 (29.3%) of the 256 patients. The diagnosis of “moderate depressive episode” was attested 45 times (17.6%) and an adjustment disorder 40 times (15.6%). The fourth most common diagnosis was “other emotional disorder of childhood” (15; 5.9%). A further 31.6% was distributed among other diagnoses, which are described in detail in Table 2.
Due to the length of this study, two different versions of the CATS questionnaires were used. For better clarity, codes 2 (moderate trauma-related symptoms) and 3 (increased stress symptoms) of the CATS were combined into “moderate to increased stress symptoms”. Of the 256 patients, 90 (35.2%) had a score >15 in the evaluation, which is not considered clinically noticeable. A total of 48 patients (18.8%) showed moderate to increased stress symptoms. Almost half of the patients (n = 118; 46.1%) reported high trauma-related stress symptoms, which, according to the authors, probably indicates PTSD. The frequency is shown in Figure 1.
To classify the individual traumatic experiences, we divided them into “emotional trauma experiences”, “physical trauma experiences”, “sexual trauma experiences” and the various mixed forms. Items 6, 7, 12 and 14 (CATS) and 6, 7, 10, 11 and 14 (CATS 2) were combined into emotional trauma experiences. Physical trauma experiences included items 3, 4, 5 and 11 (CATS) and 3, 4 and 5 (CATS 2). Items 8 and 9 (CATS and CATS 2) represented sexual trauma experiences. The most frequently mentioned trauma experience was emotional abuse (n = 182). Patients least frequently reported all three types of traumas at the same time (n = 73). The classification of the types of traumas is shown in Figure 2.
ACE questionnaires were completed by the patients’ caregivers. In this study, only questionnaires of biological parents were considered (n = 316). The 75 questionnaires completed by the other named caregivers were not considered in more detail in this study. There were 191 questionnaires completed by mothers and 125 questionnaires completed by fathers. A total of 139 (72.8%) mothers reported at least one adverse childhood experience. In contrast, 65 fathers (52.0%) reported at least one ACE.
Figure 3 and Table 3 show the prevalence of the individual negative childhood experiences. The most frequently mentioned ACEs among mothers were separation from a parent (38.7%), emotional neglect (37.7%), emotional abuse (36.1%) and substance problems of a household member (35.6%). The most common experiences reported by fathers were emotional abuse (24.8%), separation from a parent (24.0%), emotional neglect (20.8%) and substance problems of a household member (20.0%).
Table 4 provides an overview of the prevalence of combined adverse childhood experiences. Fifty-two mothers (27.2%) reported no such experiences, whereas more than two-thirds of the mothers reported at least one traumatic experience. Around half of the fathers (48.0%) reported no adverse childhood experiences.
A total of 33 mothers (17.3%) and 23 fathers (18.4%) reported one adverse childhood experience; 21 mothers (11.0%) and 12 fathers (9.6%) reported two adverse experiences, whereas 23 mothers (12.0%) and 11 fathers (8.8%) reported three adverse childhood experiences.
A total of 62 mothers and 19 fathers belonged to the high-risk group of people who reported four or more adverse childhood experiences. A total of 139 mothers (72.8%) and 65 fathers (52.0%), i.e., 204 parents (64.6%), reported at least one adverse childhood experience. The distribution is described in Figure 4.
The connection between the patients’ CATS and the ACE forms of the biological parents is shown in detail in Figure 5. Among mothers who did not report any adverse childhood experiences, 50.0% of the patients reported probable PTSD, whereas 44.6% of patients whose mothers also reported at least one adverse childhood experience showed a CATS above the cut-off. For fathers, an inverse connection is indicated. A total of 53.8% of the patients reported probable PTSD if the father’s ACE questionnaire reported at least one item. In contrast, only 41.7% of the patients reported probable PTSD if the fathers did not report any adverse childhood experience.
4. Discussion
Previous studies report a supportive effect of ACE assessment on treatment planning and targeted interventions and an associated impact on psychological well-being and mortality risk [20]. It has also been shown that in the German population as a whole, 43.7% of subjects report at least one ACE [21]. In particular, those who reported four or more traumatic experiences in their childhood are more susceptible to later mental health impairments [22]. This corresponds to the results of other international studies [23].
In our study, the focus was not on the German population as a whole, but on a clinical child and adolescent psychiatric sample. In particular, the question of the connection between parental ACEs and childhood trauma was the focus of this study, showing that adverse childhood experiences occur more frequently in parents of children with psychiatric illnesses. A specifically strong relationship was found between a father’s ACEs and the child’s PTSD. This intergenerational transmission is in line with previous work reporting the transfer of a traumatic life event from parents to children [24,25,26], showing among other things increased impulsiveness and reduced emotional availability in parents with a history of abuse, which can negatively impact the parenting style. An altered perception of children’s signals and a change in neurobiological processing have also been reported in endocrinological and fMRI studies on mothers with a history of abuse [27,28,29]. Other studies have already shown that children in troubled families have an increased risk of negative emotionality [12]. In addition, negative experiences in childhood seem to have a significant influence on emotional processing in adult life [30].
Our findings are consistent with the studies mentioned. Furthermore, our results suggest that parents of child psychiatric patients report more adverse childhood experiences compared with community samples. In our survey, 64.6% of parents reported having experienced at least one ACE in their childhood. This is a considerably higher score than the one reported for the general population. When parents are divided into mother and father, the percentages also exceed the number of the total German population. An interesting result is the high ACE load of fathers. At least 44.6% of patients reported possible PTSD if the mothers also reported severe stress in childhood. For fathers, the percentage was slightly higher, at 53.8%. A possible explanation for this result could be that it is not only mothers that have an influence on the development of children, but fathers also determine this and act as role models for their children. It is possible that the different parental forms of ACEs also have different impacts and may promote transmission in different ways. Paternal transmission may occur via increased impulsiveness as described above [25]. While this phenomenon is likely to occur in both genders, impulsive fathers might be perceived and experienced by children as more threatening than impulsive mothers. Another gender difference was shown with regard to the type of reported experience: For example, sexual abuse is often reported by mothers, but not by fathers, while emotional neglect and emotional abuse are reported by both parents as two of the three most common forms. However, it should be noted that more mothers than fathers completed the questionnaires, so that the fathers’ reporting of ACEs, and therefore also the relation to child psychiatric symptoms, could change as the number of questionnaires increases.
The effects of individual ACE types also require further investigation, particularly in more diverse and representative samples. It is very important to consider the reported ACEs of parents and their children individually but in relation to each other. The experiences reported by parents could have different effects on the reports of children. Furthermore, examinations about the epigenetic heritability of traumatic experiences are required. Specifically, studies focusing on parent–child interaction, also taking neurobiological and endocrine responses into account, are required [31]. On another note, further demographic data, such as the living situation or other cultures with different language backgrounds should be included in future studies. In addition, longitudinal studies could provide information on the development of ACEs over time.
5. Limitations
One limitation of our study is the lack of a control group that examines the relationship between parental ACEs and childhood trauma in a non-clinical context. As both the ACE and the CATS are self-reported, there is a possibility that they were not filled out truthfully or that the items were not understood correctly. There is also a risk of questions not being answered honestly, possibly due to shame or lack of motivation. By using questionnaires, people with insufficient German language skills were systematically excluded, so people with German citizenship were significantly over-represented and people with a migration background are potentially under-represented. This ongoing study could help to shed more light on the connection between the traumatic experiences of parents and child psychiatric disease in their children.
Author Contributions
Conceptualization, A.A., A.D. and E.M.; methodology, A.A.; formal analysis, A.A., A.D. and E.M.; investigation, A.A. and A.D.; data curation, A.A. and A.D.; writing—original draft preparation, A.A.; writing—review and editing, A.A., A.D., E.M.; visualization, A.A. All authors have read and agreed to the published version of the manuscript.
Funding
This research received no external funding.
Institutional Review Board Statement
This study was conducted in accordance with the Declaration of Helsinki and approved by Ethics Board of Medical Association Saarland, Germany (No: 110/21; date of approval: 28 May 2021).
Informed Consent Statement
Informed consent was obtained from all subjects involved in this study.
Data Availability Statement
The original contributions presented in this study are included in the article; further inquiries can be directed to the corresponding author.
Acknowledgments
The authors would like to thank the children and adolescents for their participation in this study.
Conflicts of Interest
The authors declare no conflicts of interest.
References
- Hawes, D.J.; Allen, J.L. A Developmental Psychopathology Perspective on Adverse Childhood Experiences (ACEs): Introduction to the Special Issue. Res. Child. Adolesc. Psychopathol. 2023, 51, 1715–1723. [Google Scholar] [CrossRef] [PubMed]
- Cicchetti, D.; Toth, S.L. Child Maltreatment. In Handbook of Child Psychology and Developmental Science; Lerner, R.M., Ed.; Wiley: Hoboken, NJ, USA, 2015; pp. 1–51. ISBN 978-1-118-13685-0. [Google Scholar]
- Pereda, N.; Guilera, G.; Forns, M.; Gómez-Benito, J. The prevalence of child sexual abuse in community and student samples: A meta-analysis. Clin. Psychol. Rev. 2009, 29, 328–338. [Google Scholar] [CrossRef] [PubMed]
- Kairys, S.W.; Johnson, C.F. Committee on Child Abuse and Neglect The Psychological Maltreatment of Children—Technical Report. Pediatr. 2002, 109, e68. [Google Scholar] [CrossRef] [PubMed]
- Miller, N.E.; Lacey, R.E. Childhood adversity and cardiometabolic biomarkers in mid-adulthood in the 1958 British birth cohort. SSM-Popul. Health 2022, 19, 101260. [Google Scholar] [CrossRef]
- Felitti, V.J.; Anda, R.F.; Nordenberg, D.; Williamson, D.F.; Spitz, A.M.; Edwards, V.; Koss, M.P.; Marks, J.S. Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults. Am. J. Prev. Med. 1998, 14, 245–258. [Google Scholar] [CrossRef]
- Myers, M.; Gumusoglu, S.; Brandt, D.; Stroud, A.; Hunter, S.K.; Vignato, J.; Nuckols, V.; Pierce, G.L.; Santillan, M.K.; Santillan, D.A. A role for adverse childhood experiences and depression in preeclampsia. J. Clin. Trans. Sci. 2024, 8, e25. [Google Scholar] [CrossRef]
- Zhang, L.; Mersky, J.P.; Gruber, A.M.H.; Kim, J.-Y. Intergenerational Transmission of Parental Adverse Childhood Experiences and Children’s Outcomes: A Scoping Review. Trauma. Violence Abus. 2023, 24, 3251–3264. [Google Scholar] [CrossRef]
- Kolassa, I.-T.; Schury, K. Biological memory of childhood maltreatment-current knowledge and recommendations for future research. Ann. N. Y. Acad. Sci. 2012, 1262, 93–100. [Google Scholar] [CrossRef]
- Moehler, E.; Biringen, Z.; Poustka, L. Emotional availability in a sample of mothers with a history of abuse. Am. J. Orthopsychiatry 2007, 77, 624–628. [Google Scholar] [CrossRef]
- Skjothaug, T.; Smith, L.; Wentzel-Larsen, T.; Moe, V. Prospective fathers’ adverse childhood experiences, pregnancy-related anxiety, and depression during pregnancy: Prospective Fathers’ Adverse Childhood Experiences. Infant. Ment. Health J. 2015, 36, 104–113. [Google Scholar] [CrossRef]
- Walper, S.; Ulrich, S.M.; Kindler, H. Familiale Belastungsfaktoren für die emotionale Entwicklung junger Kinder. Bundesgesundheitsbl 2023, 66, 717–726. [Google Scholar] [CrossRef] [PubMed]
- Bürgin, D.; Clemens, V.; Witt, A.; Sachser, C.; Jud, A.; Brähler, E.; Strauß, B.; Petrowski, K.; Schmid, M.; Fegert, J.M. Adverse childhood experiences increase the risk for low perceived social participation and health-related quality of life in a large-scale population-based study in Germany. Child. Abus. Negl. 2023, 144, 106382. [Google Scholar] [CrossRef] [PubMed]
- Ruf-Leuschner, M.; Roth, M.; Schauer, M. Traumatisierte Mütter–traumatisierte Kinder? Eine Untersuchung des transgenerationalen Zusammenhangs von Gewalterfahrungen und Traumafolgestörungen in Flüchtlingsfamilien. Z. Für Klin. Psychol. Und Psychother. 2014, 43, 1–16. [Google Scholar] [CrossRef]
- Wingenfeld, K.; Schäfer, I.; Terfehr, K.; Grabski, H.; Driessen, M.; Grabe, H.; Löwe, B.; Spitzer, C. Reliable, valide und ökonomische Erfassung früher Traumatisierung: Erste psychometrische Charakterisierung der deutschen Version des Adverse Childhood Experiences Questionnaire (ACE). Psychother. Psych. Med. 2011, 61, e10–e14. [Google Scholar] [CrossRef]
- Oláh, B.; Fekete, Z.; Kuritárné Szabó, I.; Kovács-Tóth, B. Validity and reliability of the 10-Item Adverse Childhood Experiences Questionnaire (ACE-10) among adolescents in the child welfare system. Front. Public Health 2023, 11, 1258798. [Google Scholar] [CrossRef]
- Sachser, C.; Berliner, L.; Risch, E.; Rosner, R.; Birkeland, M.S.; Eilers, R.; Hafstad, G.S.; Pfeiffer, E.; Plener, P.L.; Jensen, T.K. The child and Adolescent Trauma Screen 2 (CATS-2)-validation of an instrument to measure DSM-5 and ICD-11 PTSD and complex PTSD in children and adolescents. Eur. J. Psychotraumatol 2022, 13, 2105580. [Google Scholar] [CrossRef]
- Sachser, C.; Berliner, L.; Holt, T.; Jensen, T.K.; Jungbluth, N.; Risch, E.; Rosner, R.; Goldbeck, L. International development and psychometric properties of the Child and Adolescent Trauma Screen (CATS). J. Affect. Disord. 2017, 210, 189–195. [Google Scholar] [CrossRef]
- Ulmer Onlineklinik. Available online: https://ulmer-onlineklinik.de/course/view.php?id=666 (accessed on 1 October 2024).
- Suhail Usmani, S.; Mehendale, M.; Yousif Shaikh, M.; Sudan, S.; Guntipalli, P.; Ouellette, L.; Sajid Malik, A.; Siddiqi, N.; Walia, N.; Shah, K.; et al. Understanding the Impact of Adverse Childhood Experiences on Non-suicidal Self-Injury in Youth: A Systematic Review. Alpha Psychiatry 2024, 25, 150–164. [Google Scholar] [CrossRef]
- Witt, A.; Sachser, C.; Plener, P.L.; Brähler, E.; Fegert, J.M. The Prevalence and Consequences of Adverse Childhood Experiences in the German Population. Dtsch. Ärzteblatt Int. 2019, 116, 0635. [Google Scholar] [CrossRef]
- Witt, A.; Brown, R.; Plener, P.L.; Brähler, E.; Fegert, J.M.; Clemens, V. Kindesmisshandlung und deren Langzeitfolgen–Analyse einer repräsentativen deutschen Stichprobe. Z. Für Psychiatr. Psychol. Und Psychother. 2019, 67, 100–111. [Google Scholar] [CrossRef]
- Hughes, K.; Bellis, M.A.; Hardcastle, K.A.; Sethi, D.; Butchart, A.; Mikton, C.; Jones, L.; Dunne, M.P. The effect of multiple adverse childhood experiences on health: A systematic review and meta-analysis. Lancet Public Health 2017, 2, e356–e366. [Google Scholar] [CrossRef] [PubMed]
- Marysko, M.; Reck, C.; Mattheis, V.; Finke, P.; Resch, F.; Moehler, E. History of Childhood Abuse Is Accompanied by Increased Dissociation in Young Mothers Five Months Postnatally. Psychopathology 2010, 43, 104–109. [Google Scholar] [CrossRef] [PubMed]
- Möhler, E.; Matheis, V.; Poustka, L.; Marysko, M.; Finke, P.; Kaufmann, C.; Reck, C.; Cierpka, M.; Resch, F. Mothers with a history of abuse tend to show more impulsiveness. Child. Abus. Negl. 2009, 33, 123–126. [Google Scholar] [CrossRef] [PubMed]
- Möhler, E.; Matheis, V.; Marysko, M.; Finke, P.; Kaufmann, C.; Cierpka, M.; Reck, C.; Resch, F. Complications during pregnancy, peri- and postnatal period in a sample of women with a history of child abuse. J. Psychosom. Obstet. Gynecol. 2008, 29, 197–202. [Google Scholar] [CrossRef]
- Neukel, C.; Bertsch, K.; Fuchs, A.; Zietlow, A.-L.; Reck, C.; Moehler, E.; Brunner, R.; Bermpohl, F.; Herpertz, S.C. The maternal brain in women with a history of early-life maltreatment: An imagination-based fMRI study of conflictual versus pleasant interactions with children. J. Psychiatry Neurosci. 2018, 43, 273–282. [Google Scholar] [CrossRef]
- Neukel, C.; Herpertz, S.C.; Hinid-Attar, C.; Zietlow, A.-L.; Fuchs, A.; Moehler, E.; Bermpohl, F.; Bertsch, K. Neural processing of the own child’s facial emotions in mothers with a history of early life maltreatment. Eur. Arch. Psychiatry Clin. Neurosci. 2019, 269, 171–181. [Google Scholar] [CrossRef]
- Mielke, E.L.; Neukel, C.; Bertsch, K.; Reck, C.; Möhler, E.; Herpertz, S.C. Maternal sensitivity and the empathic brain: Influences of early life maltreatment. J. Psychiatr. Res. 2016, 77, 59–66. [Google Scholar] [CrossRef]
- Tognin, S.; Catalan, A.; Modinos, G.; Kempton, M.J.; Bilbao, A.; Nelson, B.; Pantelis, C.; Riecher-Rössler, A.; Bressan, R.; Barrantes-Vidal, N.; et al. Emotion Recognition and Adverse Childhood Experiences in Individuals at Clinical High Risk of Psychosis. Schizophr. Bull. 2020, 46, 823–833. [Google Scholar] [CrossRef]
- Schneider, I.; Neukel, C.; Bertsch, K.; Fuchs, A.; Möhler, E.; Zietlow, A.-L.; Brunner, R.; Wolf, R.C.; Herpertz, S.C. Early life maltreatment affects intrinsic neural function in mothers. J. Psychiatr. Res. 2021, 143, 176–182. [Google Scholar] [CrossRef]
Figure 1.
CATS scoring in child psychiatric patients.
Figure 2.
Types of traumatic experiences.
Figure 3.
Frequency of occurrence of adverse childhood experiences in children’s parents.
Figure 4.
Parental ACEs.
Figure 5.
Percentage distribution of inconspicuous and conspicious ACE questionnaires, divides into monthers and fathers.
Figure 5.
Percentage distribution of inconspicuous and conspicious ACE questionnaires, divides into monthers and fathers.
Table 1.
Description of sample and sociodemographic characteristics.
| Variable | n or M |
|---|---|
| Age (M, SD) | 13.26 (2.73) |
| Sex (n, %) | |
| Male | 67 (26.2) |
| Female | 189 (73.8) |
| Country of Origin (n, %) | |
| America | 1 (0.4) |
| Bulgaria | 1 (0.4) |
| Germany | 240 (94.9) |
| Malaysia | 1 (0.4) |
| Poland | 1 (0.4) |
| Romania | 1 (0.4) |
| Russia | 1 (0.4) |
| Syria | 3 (1.2) |
| Ukraine | 3 (1.2) |
| Venezuela | 1 (0.4) |
| Native Language (n, %) | |
| Arabic | 3 (1.2) |
| German | 240 (93.8) |
| English | 2 (0.8) |
| Italian | 1 (0.4) |
| Polish | 2 (0.8) |
| Portuguese | 1 (0.4) |
| Romanian | 1 (0.4) |
| Russian | 2 (0.8) |
| Spanish | 1 (0.4) |
| Ukrainian | 2 (0.8) |
| Urdu | 1 (0.4) |
M = mean, n = number of patients, SD = standard deviation.
Table 2.
Main diagnoses, International Statistical Classification of Diseases (ICD-10).
| Diagnoses | ICD-10 | Frequency (n) | Percent (%) |
|---|---|---|---|
| Mental and behavioral disorders due to use of alcohol, harmful use | F10.1 | 1 | 0.4 |
| Acute polymorphic psychotic disorder with symptoms of schizophrenia | F23.1 | 1 | 0.4 |
| Moderate depressive episode | F32.1 | 45 | 17.6 |
| Severe depressive episode without psychotic symptoms | F32.2 | 1 | 0.4 |
| Agoraphobia: with panic disorder | F40.01 | 2 | 0.8 |
| Social phobias | F40.1 | 6 | 2.3 |
| Specific (isolated) phobias | F40.2 | 2 | 0.8 |
| Panic disorder | F41.0 | 1 | 0.4 |
| Generalized anxiety disorder | F41.1 | 3 | 1.2 |
| Mixed anxiety and depressive disorders | F41.2 | 5 | 2.0 |
| Mixed obsessional thoughts and acts | F42.2 | 1 | 0.4 |
| Acute stress reaction | F43.0 | 4 | 1.6 |
| Post-traumatic stress disorder | F43.1 | 75 | 29.3 |
| Adjustment disorders | F43.2 | 40 | 15.6 |
| Other reactions to severe stress | F43.8 | 1 | 0.4 |
| Mixed dissociative (conversion) disorders | F44.7 | 1 | 0.4 |
| Anorexia nervosa | F50.0 | 5 | 2.0 |
| Anorexia nervosa, active type | F50.01 | 2 | 0.8 |
| Atypical anorexia nervosa | F50.1 | 1 | 0.4 |
| Eating disorder, unspecified | F50.9 | 2 | 0.8 |
| Emotionally unstable personality disorder | F60.31 | 2 | 0.8 |
| Other habit and impulsive disorders | F63.8 | 1 | 0.4 |
| Trans-sexualism | F64.0 | 1 | 0.4 |
| Childhood autism | F84.0 | 1 | 0.4 |
| Asperger syndrome | F84.5 | 1 | 0.4 |
| Disorder of activity and attention | F90.0 | 6 | 2.3 |
| Hyperkinetic conduct disorder | F90.1 | 8 | 3.1 |
| Conduct disorder confined to the family context | F91.0 | 1 | 0.4 |
| Unsocialized conduct disorder | F91.1 | 1 | 0.4 |
| Socialized conduct disorder | F91.2 | 1 | 0.4 |
| Oppositional defiant disorder | F91.3 | 4 | 1.6 |
| Other mixed disorders of conduct and emotions | F92.8 | 2 | 0.8 |
| Separation anxiety disorder of childhood | F93.0 | 1 | 0.4 |
| Phobic anxiety disorder of childhood | F93.1 | 2 | 0.8 |
| Other childhood emotional disorders | F93.8 | 15 | 5.9 |
| Elective mutism | F94.0 | 1 | 0.4 |
| Reactive attachment disorder of childhood | F94.1 | 1 | 0.4 |
| Disinhibited attachment disorder of childhood | F94.2 | 2 | 0.8 |
| Other childhood disorders of social functioning | F94.8 | 1 | 0.4 |
| Other specified behavioral and emotional disorders with onset usually occurring in childhood and adolescence | F98.8 | 1 | 0.4 |
| Attention deficit disorder without hyperactivity with onset usually occurring in childhood and adolescence | F98.80 | 2 | 0.8 |
| Other specified behavioral and emotional disorders with onset usually occurring in childhood and adolescence | F98.88 | 1 | 0.4 |
| Other problems related to lifestyle | Z72.8 | 1 | 0.4 |
Table 3.
Prevalences of individual adverse childhood experiences (ACEs) of mothers and fathers and in total.
Table 3.
Prevalences of individual adverse childhood experiences (ACEs) of mothers and fathers and in total.
| Diagnoses | Total Sample (n; %) | Mother | Father | ||
|---|---|---|---|---|---|
| Frequency (n) | Percent (%) | Frequency (n) | Percent (%) | ||
| ACE 1: emotional abuse | 100 (31.6) | 69 | 36.1 | 31 | 24.8 |
| ACE 2: physical abuse | 71 (22.5) | 52 | 27.2 | 19 | 15.2 |
| ACE 3: sexual abuse | 40 (12.7) | 37 | 19.4 | 3 | 2.4 |
| ACE 4: emotional neglect | 98 (31.0) | 72 | 37.7 | 26 | 20.8 |
| ACE 5: physical neglect | 38 (12.0) | 31 | 16.2 | 7 | 5.6 |
| ACE 6: parental divorce/separation | 104 (32.9) | 74 | 38.7 | 30 | 24.0 |
| ACE 7: witnessed domestic violence | 49 (15.5) | 37 | 19.4 | 12 | 9.6 |
| ACE 8: alcohol and drug abuse in the household | 93 (29.4) | 68 | 35.6 | 25 | 20.0 |
| ACE 9: mental illness in the household | 77 (24.4) | 59 | 30.9 | 18 | 14.4 |
| ACE 10: incarcerated family member | 23 (7.3) | 16 | 8.4 | 7 | 5.6 |
Table 4.
Prevalences of combined adverse childhood experiences (ACEs) of mothers and fathers and in total.
Table 4.
Prevalences of combined adverse childhood experiences (ACEs) of mothers and fathers and in total.
| Number of ACEs | Total Sample (n; %) | Mother | Father | ||
|---|---|---|---|---|---|
| Frequency (n) | Percent (%) | Frequency (n) | Percent (%) | ||
| 0 | 112 (35.4) | 52 | 27.2 | 60 | 48.0 |
| 1 | 56 (17.7) | 33 | 17.3 | 23 | 18.4 |
| 2 | 33 (10.4) | 21 | 11.0 | 12 | 9.6 |
| 3 | 34 (10.8) | 23 | 12.0 | 11 | 8.8 |
| ≥4 | 81 (25.6) | 62 | 32.5 | 19 | 15.2 |
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Altpeter, A.; Dixius, A.; Möhler, E. Parents of Child Psychiatric Patients Report More Adverse Childhood Experiences Compared with Community Samples. Children 2024, 11, 1427. https://doi.org/10.3390/children11121427
AMA Style
Altpeter A, Dixius A, Möhler E. Parents of Child Psychiatric Patients Report More Adverse Childhood Experiences Compared with Community Samples. Children. 2024; 11(12):1427. https://doi.org/10.3390/children11121427
Chicago/Turabian StyleAltpeter, Adriana, Andrea Dixius, and Eva Möhler. 2024. "Parents of Child Psychiatric Patients Report More Adverse Childhood Experiences Compared with Community Samples" Children 11, no. 12: 1427. https://doi.org/10.3390/children11121427
APA StyleAltpeter, A., Dixius, A., & Möhler, E. (2024). Parents of Child Psychiatric Patients Report More Adverse Childhood Experiences Compared with Community Samples. Children, 11(12), 1427. https://doi.org/10.3390/children11121427
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