In the Journals

Early adverse events spur depression, health concerns in teens

Joan Luby, MD
Joan L. Luby

Children who experience an increase of zero to three adverse childhood events, including poverty or traumatic events, were 25% more likely to have physical health problems and increased depression in adolescence.

“Health care professionals need to start attending to psychosocial adversity as a tangible risk factor for disease,” Joan L. Luby, MD, the Samuel and Mae S. Ludwig Professor of Child Psychiatry and director of the early emotional development program at Washington University School of Medicine, said in an interview with Infectious Diseases in Children. “They should assess how much adversity the adolescent is still experiencing and address these ongoing stressors as health risks in the same way they might address diet or exercise.”

To analyze the neurodevelopmental path between early adverse childhood events (ACEs) and the general and emotional health outcomes of adolescents, the researchers conducted a prospective longitudinal study that included children aged 3 to 6 years. These children later received neuroimaging between the ages of 7 and 12 years. Between the ages of 9 and 15 years, these children also had their physical and emotional health observed by the researchers.

Links between early ACEs, emotion development, health outcomes and brain structure — including the volume of a subregion of the prefrontal cortex and the inferior frontal gyrus — were examined using sequential mediation models.

The average age of the children receiving brain scans was 9.65 (1.31). The mean ACE score was 5.44 (3.46) for the 199 children included. There was a range of depression severity scores depending on age, with preschoolers having a score of 2.61 (1.78). Children at their brain scan exhibited a depression severity score of 1.77 (1.58), and adolescents observed at later dates had a score of 2.16 (1.64).

The researchers noted that physical health scores were 0.30 (0.38) at the time of the scan and 0.33 (0.42) during later observation. They observed sequential mediation between early ACEs and emotional and physical health outcomes, with smaller inferior frontal gyrus volumes and poor emotional awareness mediating ACEs and poor general health during adolescence (model parameter estimate = 0.007; 95% CI, 0.001-0.021). When children experienced an increase from zero to three early ACEs, depression increased 15% and physical health problems increased by 25%.

“Protective factors are very important, and there is a growing literature documenting that social support in the form of caregivers and supportive relationships mitigate some of the negative effects of adversity on aspects of brain development and health,” Luby said. “Therefore, asking about the level of psychosocial support and supportive relationships, as well as trying to prioritize this in a child’s care plan, should also become a part of standard medical practice.”– by Katherine Bortz

Disclosures: The authors report no relevant financial disclosures.

Joan Luby, MD
Joan L. Luby

Children who experience an increase of zero to three adverse childhood events, including poverty or traumatic events, were 25% more likely to have physical health problems and increased depression in adolescence.

“Health care professionals need to start attending to psychosocial adversity as a tangible risk factor for disease,” Joan L. Luby, MD, the Samuel and Mae S. Ludwig Professor of Child Psychiatry and director of the early emotional development program at Washington University School of Medicine, said in an interview with Infectious Diseases in Children. “They should assess how much adversity the adolescent is still experiencing and address these ongoing stressors as health risks in the same way they might address diet or exercise.”

To analyze the neurodevelopmental path between early adverse childhood events (ACEs) and the general and emotional health outcomes of adolescents, the researchers conducted a prospective longitudinal study that included children aged 3 to 6 years. These children later received neuroimaging between the ages of 7 and 12 years. Between the ages of 9 and 15 years, these children also had their physical and emotional health observed by the researchers.

Links between early ACEs, emotion development, health outcomes and brain structure — including the volume of a subregion of the prefrontal cortex and the inferior frontal gyrus — were examined using sequential mediation models.

The average age of the children receiving brain scans was 9.65 (1.31). The mean ACE score was 5.44 (3.46) for the 199 children included. There was a range of depression severity scores depending on age, with preschoolers having a score of 2.61 (1.78). Children at their brain scan exhibited a depression severity score of 1.77 (1.58), and adolescents observed at later dates had a score of 2.16 (1.64).

The researchers noted that physical health scores were 0.30 (0.38) at the time of the scan and 0.33 (0.42) during later observation. They observed sequential mediation between early ACEs and emotional and physical health outcomes, with smaller inferior frontal gyrus volumes and poor emotional awareness mediating ACEs and poor general health during adolescence (model parameter estimate = 0.007; 95% CI, 0.001-0.021). When children experienced an increase from zero to three early ACEs, depression increased 15% and physical health problems increased by 25%.

“Protective factors are very important, and there is a growing literature documenting that social support in the form of caregivers and supportive relationships mitigate some of the negative effects of adversity on aspects of brain development and health,” Luby said. “Therefore, asking about the level of psychosocial support and supportive relationships, as well as trying to prioritize this in a child’s care plan, should also become a part of standard medical practice.”– by Katherine Bortz

Disclosures: The authors report no relevant financial disclosures.