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Article ; Online: All adverse childhood experiences are not equal: The contribution of synergy to adverse childhood experience scores.

Briggs, Ernestine C / Amaya-Jackson, Lisa / Putnam, Karen T / Putnam, Frank W

2021 Volume 76, Issue 2, Page(s) 243–252

Abstract: The operationalization of childhood trauma and adversity into checklists commonly known as adverse childhood experiences, or ACEs, has become the most widely adopted methodology linking traumatic childhoods to adult outcomes. As the number of self- ... ...

Abstract	The operationalization of childhood trauma and adversity into checklists commonly known as adverse childhood experiences, or ACEs, has become the most widely adopted methodology linking traumatic childhoods to adult outcomes. As the number of self-reported ACEs increase from 0 to 4 or more (4+), most studies find a roughly stepwise progression in risk for a wide range of negative medical and mental health outcomes. A score of 4+ ACEs, has become a de facto cutpoint, increasingly used clinically to define "high risk" status for a myriad of outcomes. Comparisons across studies using a 4+ cutpoint, however, find considerable heterogeneity in the degree of risk for the same outcomes. In addition to sample and methodological differences, certain pairs of ACEs comprising the cumulative ACE score interact synergistically to significantly increase the overall risk beyond the sum (or product) of the contributions of each ACE to the outcome. This article reviews the empirical literature on synergistic ACEs including results from a general population adult and a mixed trauma, youth sample both sufficiently powered to examine over 20 different ACE pairings for possible synergy. Synergistic pairs of ACEs vary by gender and age group. About 30-40% of the variance in outcomes is accounted for by additive synergistic interactions between certain pairs of ACEs. Across studies, sexual abuse is the most synergistically reactive ACE. The article concludes with a discussion of the implications of synergistic ACE pairings for psychologists and other allied professionals across clinical practice, prevention, research, and policy. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
Language	English
Publishing date	2021-03-18
Publishing country	United States
Document type	Journal Article ; Research Support, U.S. Gov't, P.H.S.
ZDB-ID	209464-2
ISSN	1935-990X ; 0003-066X
ISSN (online)	1935-990X
ISSN	0003-066X
DOI	10.1037/amp0000768
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Zs.A 997: Show issues

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Article ; Online: Self-compassion training to improve well-being for surgical residents.

Kratzke, Ian M / Barnhill, Jessica L / Putnam, Karen T / Rao, Sanjana / Meyers, Michael O / Meltzer-Brody, Samantha / Farrell, Timothy M / Bluth, Karen

Explore (New York, N.Y.)

2022 Volume 19, Issue 1, Page(s) 78–83

Abstract: Context: Burnout remains prevalent among surgical residents. Self-compassion training may serve to improve their well-being.: Objective: To evaluate the impact on well-being of a self-compassion program modified for surgical residents.: Design: ... ...

Abstract	Context: Burnout remains prevalent among surgical residents. Self-compassion training may serve to improve their well-being. Objective: To evaluate the impact on well-being of a self-compassion program modified for surgical residents. Design: This is a 3-year, mixed-methods study using pre-post surveys and focus groups to identify areas for programmatic improvement and the subsequent impact of the modifications. Setting: A single academic institution. Participants: Surgical residents participating in a self-compassion program. Interventions: A self-compassion program adapted from a larger course to fit the needs of surgical residents. Main outcome measures: Themes relating to the program's strengths and weaknesses were identified through participant focus groups. Well-being was assessed through validated measurement tools, including The Maslach Burnout Inventory (MBI), Patient Health Questionnaire-9, Perceived Stress Scale, and Spielberger State-Trait Anxiety Inventory-6. Results: 95 residents participated in the self-compassion program, of which 40 residents completed both surveys (total response rate: 42%). All participants demonstrated severe burnout pre-program, based on scores of at least one of the MBI subscales. Emotional exhaustion scores improved post-program, with larger improvements seen after program modifications (2018: 58% vs 2020: 71%). Focus group findings demonstrated that residents need a safe and distraction-free space to practice self-compassion, and program engagement improved following modifications.
MeSH term(s)	Humans ; Self-Compassion ; Internship and Residency ; Burnout, Professional/prevention & control ; Burnout, Professional/psychology ; Surveys and Questionnaires
Language	English
Publishing date	2022-05-02
Publishing country	United States
Document type	Journal Article
ZDB-ID	2183945-1
ISSN	1878-7541 ; 1550-8307
ISSN (online)	1878-7541
ISSN	1550-8307
DOI	10.1016/j.explore.2022.04.008
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Zs.A 6635: Show issues

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Article ; Online: The international postpartum depression: action towards causes and treatment (PACT) consortium.

Guintivano, Jerry / Putnam, Karen T / Sullivan, Patrick F / Meltzer-Brody, Samantha

International review of psychiatry (Abingdon, England)

2019 Volume 31, Issue 3, Page(s) 229–236

Abstract: The International Postpartum depression: Action towards Causes and Treatment (PACT) Consortium was founded with the overarching goal of creating an international perinatal psychiatry consortium to conduct novel investigations with large sample sizes to ... ...

Abstract	The International Postpartum depression: Action towards Causes and Treatment (PACT) Consortium was founded with the overarching goal of creating an international perinatal psychiatry consortium to conduct novel investigations with large sample sizes to understand the genetic signature of perinatal mood disorders. PACT uses a collaborative and team science approach that includes investigators across 19 institutions and seven continents. The large sample sizes allow for statistically rigorous analyses to investigate perinatal psychiatric disorders, with an initial focus on postpartum depression (PPD). Our current aims are to identify clinical sub-types of PPD that contribute diagnostic heterogeneity, and to elucidate the genetic basis of PPD by conducting the first large genome-wide association study of PPD. To accomplish the latter aim, we are partnering with the Major Depressive Disorder Working Group of the Psychiatric Genomics Consortium. To date, our consortium members have recruited 17,912 participants and 11,344 participants have been identified using the
MeSH term(s)	Depression, Postpartum/classification ; Depression, Postpartum/genetics ; Female ; Genome-Wide Association Study/trends ; Humans ; Internationality ; Perinatal Care ; Pregnancy ; Psychiatry/trends
Language	English
Publishing date	2019-02-27
Publishing country	England
Document type	Journal Article
ZDB-ID	1018090-4
ISSN	1369-1627 ; 0954-0261
ISSN (online)	1369-1627
ISSN	0954-0261
DOI	10.1080/09540261.2018.1551191
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Zs.A 2819: Show issues

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Article ; Online: Synergistic adversities and behavioral problems in traumatized children and adolescents.

Putnam, Frank W / Amaya-Jackson, Lisa / Putnam, Karen T / Briggs, Ernestine C

Child abuse & neglect

2020 Volume 106, Page(s) 104492

Abstract: Objective: This study investigated synergy of commonly co-occurring pairs of childhood traumas/adversities to determine: 1) if synergistic pairings differ by gender and/or age grouping; and 2) if some traumas/adversities were more synergistically ... ...

Abstract	Objective: This study investigated synergy of commonly co-occurring pairs of childhood traumas/adversities to determine: 1) if synergistic pairings differ by gender and/or age grouping; and 2) if some traumas/adversities were more synergistically reactive. Methods: A sample of 10,355 clinic-referred youth (1.5-18 years) from the National Child Traumatic Stress Network Core Data Set was divided by gender and categorized into salient age groups (1.5-5 years, 6-12 years, and 13-18 years). Attributable Proportion (AP), a biomedically relevant metric, was calculated to assess additive synergy for behavior problems on the CBCL. Results: Overall, only four pairs of adversities were synergistic. Three involved sexual abuse with physical abuse, parental loss, and domestic violence. When the sample was analyzed by Gender X Age group, however, a more complicated picture emerges. Twelve of the twenty-one possible pairings (57 %) show additive synergy in one or more categories. The mean AP accounted for approximately 40 % of outcome variance. Males had more synergistic pairings (16) than females (7). The average synergistic effect was higher for males (42 % of variance) than females (36 % of variance). The vast majority of synergy occurs in the 6-12 and 13-18 age groups. Sexual abuse was the most synergistically reactive trauma, pairing most frequently (16) followed by physical abuse (10) or neglect (9). Conclusion: Sexual abuse was malignantly synergistic, frequently pairing with other adversities, followed by physical abuse, neglect, and domestic violence. The findings underscore that all ACEs are not equal in their contributions to commonly assessed outcomes. The findings also have considerable implications for prevention, intervention, and future research.
MeSH term(s)	Adolescent ; Adverse Childhood Experiences/psychology ; Child ; Child Abuse/psychology ; Child, Preschool ; Domestic Violence/psychology ; Female ; Humans ; Infant ; Male ; Parent-Child Relations ; Problem Behavior ; Wounds and Injuries/psychology
Language	English
Publishing date	2020-05-21
Publishing country	England
Document type	Journal Article ; Research Support, U.S. Gov't, P.H.S.
ZDB-ID	799143-5
ISSN	1873-7757 ; 0145-2134
ISSN (online)	1873-7757
ISSN	0145-2134
DOI	10.1016/j.chiabu.2020.104492
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Zs.A 1437: Show issues

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Article ; Online: Seasonality of cerebrospinal fluid monoamine metabolite concentrations and their associations with meteorological variables in humans.

Brewerton, Timothy D / Putnam, Karen T / Lewine, Richard R J / Risch, S Craig

Journal of psychiatric research

2018 Volume 99, Page(s) 76–82

Abstract: Seasonal variations in neurotransmitter parameters have been previously reported in humans. However, these studies have involved small sample sizes and have not examined possible relationships with meteorological variables. We compared cerebrospinal ... ...

Abstract	Seasonal variations in neurotransmitter parameters have been previously reported in humans. However, these studies have involved small sample sizes and have not examined possible relationships with meteorological variables. We compared cerebrospinal fluid (CSF) concentrations of the major monoamine neurotransmitter metabolites (5-HIAA, HVA, and MHPG) in 188 healthy controls (80 men, 108 women) in relationship to age, sex, BMI, and available meteorological variables. All subjects had a lumbar puncture (LP) performed at 9 a.m. after overnight stay. Meteorological data for the day prior to LP were obtained from the National Climatic Association and included the photoperiod, percent sunshine, temperature (max, min, mean), barometric pressure, relative humidity, amount of precipitation and sky cover. Results revealed differences across seasons and cross-seasons for CSF 5-HIAA (p ≤ .05), with post-hoc differences emerging between spring versus summer and fall and between x-spring and x-summer (p ≤ .05). Differences were also found across seasons for CSF HVA (p ≤ .05) with post-hoc differences between spring versus fall. CSF 5-HIAA was significantly inversely correlated with maximum (r = -.28, p ≤ .02), minimum (r = -.24, p ≤ .04), and mean temperature (r = -.28, p ≤ .02) in men. In women, 5-HIAA (r = -.22, p ≤ .02) and HVA (r = -.28, p ≤ .003) were significantly correlated with relative humidity. These data confirm previous findings of variations in serotonin and dopamine metabolites across the year and highlight possible underlying mechanisms involving meteorological changes, which may result in alterations in neurophysiology and behavior.
MeSH term(s)	Adult ; Female ; Homovanillic Acid/cerebrospinal fluid ; Humans ; Hydroxyindoleacetic Acid/cerebrospinal fluid ; Male ; Methoxyhydroxyphenylglycol/cerebrospinal fluid ; Middle Aged ; Seasons ; Sex Factors ; Weather ; Young Adult
Chemical Substances	Methoxyhydroxyphenylglycol (534-82-7) ; Hydroxyindoleacetic Acid (54-16-0) ; Homovanillic Acid (X77S6GMS36)
Language	English
Publishing date	2018-01-12
Publishing country	England
Document type	Journal Article
ZDB-ID	3148-3
ISSN	1879-1379 ; 0022-3956
ISSN (online)	1879-1379
ISSN	0022-3956
DOI	10.1016/j.jpsychires.2018.01.004
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Article ; Online: Synergistic childhood adversities and complex adult psychopathology.

Putnam, Karen T / Harris, William W / Putnam, Frank W

Journal of traumatic stress

2013 Volume 26, Issue 4, Page(s) 435–442

Abstract: Numerous studies find a cumulative effect of different types of childhood adversities on increasing risk for serious adult mental and medical outcomes. This study uses the National Comorbidity Survey-Replication sample to investigate the cumulative ... ...

Abstract	Numerous studies find a cumulative effect of different types of childhood adversities on increasing risk for serious adult mental and medical outcomes. This study uses the National Comorbidity Survey-Replication sample to investigate the cumulative impact of 8 childhood adversities on complex adult psychopathology as indexed by (a) number of lifetime diagnoses according to the Diagnostic and Statistical Manual of Mental Disorders (4th ed., DSM-IV; American Psychiatric Association, 1994); (b) number of 4 DSM-IV disorder categories (mood, anxiety, impulse control, and substance abuse disorders); and (c) coexistence of internalizing and externalizing disorders. Seven of the 8 childhood adversities were significantly associated with complex adult psychopathology. Individuals with 4 or more childhood adversities had an odds ratio of 7.3, 95% confidence interval [4.7, 11.7] for 4 disorder categories. Additive and multiplicative synergistic effects increasing adult psychopathology were found for specific pairwise combinations of childhood adversities. Synergistic patterns differed by gender suggesting that women are more impacted by sexual abuse and men by economic hardship. The absence of childhood adversities was protective, in that it significantly decreased an individual's risk for subsequent adult mental illness. The results support the clinical impression that increased childhood adversity is associated with more complex adult psychopathology.
MeSH term(s)	Adolescent ; Adult ; Adult Survivors of Child Abuse/psychology ; Adult Survivors of Child Abuse/statistics & numerical data ; Child ; Child Abuse, Sexual/psychology ; Child Abuse, Sexual/statistics & numerical data ; Child of Impaired Parents/psychology ; Child, Preschool ; Crime Victims/psychology ; Depression/psychology ; Diagnostic and Statistical Manual of Mental Disorders ; Family Characteristics ; Female ; Health Surveys ; Humans ; Male ; Mental Disorders/diagnosis ; Mental Disorders/epidemiology ; Mental Disorders/psychology ; Poverty/psychology ; Risk Factors ; Substance-Related Disorders/psychology ; United States/epidemiology
Language	English
Publishing date	2013-08
Publishing country	United States
Document type	Journal Article
ZDB-ID	639478-4
ISSN	1573-6598 ; 0894-9867
ISSN (online)	1573-6598
ISSN	0894-9867
DOI	10.1002/jts.21833
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Zs.A 2386: Show issues

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Article ; Online: Implementing Trauma and Grief Component Therapy for Adolescents and Think Trauma for Traumatized Youth in Secure Juvenile Justice Settings.

Olafson, Erna / Boat, Barbara W / Putnam, Karen T / Thieken, Lacey / Marrow, Monique T / Putnam, Frank W

Journal of interpersonal violence

2016 Volume 33, Issue 16, Page(s) 2537–2557

Abstract: We describe a multiyear pilot dissemination of a trauma-focused group treatment, Trauma and Grief Component Therapy for Adolescents, coupled with a trauma-informed staff training, Think Trauma, to six residential juvenile justice (JJ) facilities. All ... ...

Abstract	We describe a multiyear pilot dissemination of a trauma-focused group treatment, Trauma and Grief Component Therapy for Adolescents, coupled with a trauma-informed staff training, Think Trauma, to six residential juvenile justice (JJ) facilities. All staff members were trained in Think Trauma. Seventy-seven youth from four facilities completed the treatment groups and 69 completed all pre- and postgroup assessment measures. The aims of this study were to determine whether trauma-focused interventions (a) could be implemented in complex JJ systems, (b) would be associated with a decrease in posttraumatic symptoms and reactions in youth, and (c) might contribute to reduced Incident Reports in facilities. A related question was whether we would receive feedback that youth who participated in the trauma and/or grief narrative components of the intervention were adversely affected. Pre- and postgroup assessments indicated significant reductions in symptoms of posttraumatic stress, depression, and anger, but not in anxiety or sexual concerns. There were significantly greater reductions in posttraumatic stress disorder (PTSD) among incarcerated youth who completed all modules of the group treatment intervention relative to incarcerated youth who received an abbreviated version. Two of the facilities tracked their Incident Reports and reported reductions. No Incident Reports or therapist feedback documented that the trauma/grief processing components of the intervention were destabilizing to the youth.
MeSH term(s)	Adolescent ; Anxiety/therapy ; Depression/therapy ; Female ; Grief ; Health Plan Implementation ; Humans ; Juvenile Delinquency/rehabilitation ; Male ; Narration ; Psychological Trauma/therapy ; Stress Disorders, Post-Traumatic/therapy ; Treatment Outcome
Language	English
Publishing date	2016-02-12
Publishing country	United States
Document type	Journal Article ; Research Support, U.S. Gov't, P.H.S.
ZDB-ID	2028900-5
ISSN	1552-6518 ; 0886-2605
ISSN (online)	1552-6518
ISSN	0886-2605
DOI	10.1177/0886260516628287
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Article ; Online: HPA axis reactivity to pharmacologic and psychological stressors in euthymic women with histories of postpartum versus major depression.

Ferguson, Elizabeth H / Di Florio, Arianna / Pearson, Brenda / Putnam, Karen T / Girdler, Susan / Rubinow, David R / Meltzer-Brody, Samantha

Archives of women's mental health

2017 Volume 20, Issue 3, Page(s) 411–420

Abstract: It is unclear whether women with a history of postpartum depression (PPD) have residual, abnormal hypothalamic-pituitary-adrenal (HPA) axis reactivity, as has been reported in major depression (MDD). Further unclear is whether the abnormalities in HPA ... ...

Abstract	It is unclear whether women with a history of postpartum depression (PPD) have residual, abnormal hypothalamic-pituitary-adrenal (HPA) axis reactivity, as has been reported in major depression (MDD). Further unclear is whether the abnormalities in HPA axis reactivity associated with MDD represent a stable, underlying predisposition or a state-dependent phenomenon. This study sought the following: (1) to determine if euthymic postpartum women with a history of depression have an abnormal HPA axis reactivity to pharmacologic and psychological challenges and (2) to compare HPA reactivity in women with histories of PPD versus MDD. As a secondary objective, we wanted to determine the influence of trauma history on HPA axis function. Forty-five parous (12-24 months postpartum), euthymic women with history of MDD (n = 15), PPD (n = 15), and controls (n = 15) completed pharmacologic (dexamethasone/corticotropin-releasing hormone (CRH) test [DEX/CRH]) and psychological (Trier social stress test [TSST]) challenges during the luteal phase. Outcome measures were cortisol and adrenocorticotropic hormone (ACTH) response after DEX/CRH, and blood pressure, heart rate, epinephrine, norepinephrine, and cortisol response during the TSST. All groups had robust cortisol and ACTH response to DEX/CRH and cortisol response to TSST. Groups did not differ significantly in cortisol or ACTH response to DEX/CRH or in blood pressure, heart rate, epinephrine, norepinephrine, or cortisol response to TSST. Cortisol/ACTH ratio did not differ significantly between groups. Trauma history was associated with decreased cortisol response to DEX/CRH in women with histories of MDD, which was not significant after correction (F
Language	English
Publishing date	2017-06
Publishing country	Austria
Document type	Journal Article
ZDB-ID	1480651-4
ISSN	1435-1102 ; 1434-1816
ISSN (online)	1435-1102
ISSN	1434-1816
DOI	10.1007/s00737-017-0716-y
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Article ; Online: An Online Educational Program for Individuals With Dissociative Disorders and Their Clinicians: 1-Year and 2-Year Follow-Up.

Brand, Bethany L / Schielke, Hugo J / Putnam, Karen T / Putnam, Frank W / Loewenstein, Richard J / Myrick, Amie / Jepsen, Ellen K K / Langeland, Willemien / Steele, Kathy / Classen, Catherine C / Lanius, Ruth A

Journal of traumatic stress

2019 Volume 32, Issue 1, Page(s) 156–166

Abstract: Individuals with dissociative disorders (DDs) are underrecognized, underserved, and often severely psychiatrically ill, characterized by marked dissociative and posttraumatic stress disorder (PTSD) symptoms with significant disability. Patients with DD ... ...

Abstract	Individuals with dissociative disorders (DDs) are underrecognized, underserved, and often severely psychiatrically ill, characterized by marked dissociative and posttraumatic stress disorder (PTSD) symptoms with significant disability. Patients with DD have high rates of nonsuicidal self-injury (NSSI) and suicide attempts. Despite this, there is a dearth of training about DDs. We report the outcome of a web-based psychoeducational intervention for an international sample of 111 patients diagnosed with dissociative identity disorder (DID) or other complex DDs. The Treatment of Patients with Dissociative Disorders Network (TOP DD Network) program was designed to investigate whether, over the course of a web-based psychoeducational program, DD patients would exhibit improved functioning and decreased symptoms, including among patients typically excluded from treatment studies for safety reasons. Using video, written, and behavioral practice exercises, the TOP DD Network program provided therapists and patients with education about DDs as well as skills for improving emotion regulation, managing safety issues, and decreasing symptoms. Participation was associated with reductions in dissociation and PTSD symptoms, improved emotion regulation, and higher adaptive capacities, with overall sample \|d\|s = 0.44-0.90, as well as reduced NSSI. The improvements in NSSI among the most self-injurious patients were particularly striking. Although all patient groups showed significant improvements, individuals with higher levels of dissociation demonstrated greater and faster improvement compared to those lower in dissociation \|d\|s = 0.54-1.04 vs. \|d\|s = 0.24-0.75, respectively. These findings support dissemination of DD treatment training and initiation of treatment studies with randomized controlled designs.
MeSH term(s)	Adult ; Cognitive Behavioral Therapy/methods ; Dissociative Disorders/classification ; Dissociative Disorders/complications ; Dissociative Disorders/therapy ; Education, Distance/methods ; Emotional Regulation/physiology ; Female ; Humans ; Longitudinal Studies ; Male ; Mental Health/education ; Middle Aged ; Prospective Studies ; Self-Injurious Behavior/complications ; Self-Injurious Behavior/therapy ; Stress Disorders, Post-Traumatic/complications ; Stress Disorders, Post-Traumatic/therapy ; Suicide, Attempted/prevention & control
Language	English
Publishing date	2019-01-30
Publishing country	United States
Document type	Journal Article ; Multicenter Study
ZDB-ID	639478-4
ISSN	1573-6598 ; 0894-9867
ISSN (online)	1573-6598
ISSN	0894-9867
DOI	10.1002/jts.22370
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Article ; Online: Childhood sexual abuse and adolescent pregnancy: a meta-analytic update.

Noll, Jennie G / Shenk, Chad E / Putnam, Karen T

Journal of pediatric psychology

2008 Volume 34, Issue 4, Page(s) 366–378

Abstract: Objective: Recent increases in adolescent pregnancies have sparked a renewed impetus to identify risk factors, such as childhood sexual abuse (CSA), associated with adolescent pregnancy. Given mixed evidence regarding the strength of the relationship ... ...

Abstract	Objective: Recent increases in adolescent pregnancies have sparked a renewed impetus to identify risk factors, such as childhood sexual abuse (CSA), associated with adolescent pregnancy. Given mixed evidence regarding the strength of the relationship between CSA and adolescent pregnancy (Blinn-Pike, Berger, Dixon, Kuschel, & Kaplan, 2002), our objective was to provide an estimate of the effect size of this relationship using updated literature and meta-analytic techniques. Methods: Meta-analyses of 21 studies were conducted using a random effects model of binary outcomes to determine aggregate effect-size estimates controlling for study heterogeneity. Results: CSA significantly increased the odds of experiencing an adolescent pregnancy by 2.21-fold (95% CI: 1.94-2.51). A supplemental analysis suggested that 4.5 out of 10 pregnant adolescents may have a prior history of CSA. Conclusions: CSA places females at increased risk for subsequent adolescent pregnancy. Addressing conditions associated with CSA might impact the overall adolescent pregnancy rate.
MeSH term(s)	Adolescent ; Adolescent Behavior/psychology ; Child Abuse, Sexual/psychology ; Child Abuse, Sexual/statistics & numerical data ; Child, Preschool ; Crime Victims/psychology ; Crime Victims/statistics & numerical data ; Female ; Humans ; Odds Ratio ; Ohio ; Pregnancy ; Pregnancy in Adolescence/psychology ; Pregnancy in Adolescence/statistics & numerical data ; Risk Factors
Language	English
Publishing date	2008-09-15
Publishing country	United States
Document type	Journal Article ; Meta-Analysis ; Research Support, N.I.H., Extramural
ZDB-ID	625329-5
ISSN	1465-735X ; 0146-8693
ISSN (online)	1465-735X
ISSN	0146-8693
DOI	10.1093/jpepsy/jsn098
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