Faculty of Health, Education and Life Sciences

ABSTRACT

Topic: What is the impact of childhood emotional abuse on depressive symptoms among young adults aged 18-25?

Aim: To investigate the association between childhood emotional abuse and depressive symptoms in young adults.

Background: Accumulated evidence suggests that child emotional abuse is associated with adverse long-term consequences for mental health issues with an increased risk of depression.

Methods: The study comprised of 8 research articles 7 primary and 1 meta-analysis. The PIO question has also been implemented for the purpose of understanding the outcome that needs to be maintained within the study.

Results: Childhood emotional abuse has a strong association with depressive symptoms in young adulthood Kisely et al (2018). Different themes also developed for the purpose of highlighting the impact of emotional abuse and depressive disorder among young adult

Implementation of findings: Findings will help clinicians and nurses should offer the valuable clinical guidance, medications, counseling and the family or the relatives would need to offer encouragement and validation for recovery and boosting of self-esteem (Norman, 2012).

Conclusion: The study provides important evidence and recommendation which highlights that the intervention strategies can be implemented in order to reduce the impact as well as a long-term impact of depressive disorder. Christ et al (2019)

Introduction:

One of the major public health problems is the childhood abuse that eventually leads to the development of varied psychological disorders and demonstrates negative impact upon the mental health of the individuals when they reach adulthood phase of their life (Salwen, 2014). It is observed that the maltreatment that the child receives at their childhood phase is correlated with the emotional crisis because of the inimitable directive strategies of emotions (Salwen, 2014). Several studies have also demonstrated a relationship in between the childhood abuse and the development of depressive disorder in their adulthood though the underpinning psychological mechanistic pathway is still unclear (Wingo, 2010; Christ, et al 2019). Varied investigations have specifically focused about the impact of sexual abuse as well as emotional abuse that have been autonomously correlated with the emotional malfunctioning, problematic relationships and depressive disorder (Appel, 2011). Here it should be mentioned that the term “trauma” is defined as the concept that forms a connection in between the outer world happenings with the inner spiritual realism (Appel, 2011). Moreover, it is also evident the psychological disorder, depression is considered to be one of the major concern all over the world not only in Europe and it is anticipated that by the end of 2020 it will be in the second position within the world rank (Negele, et al, 2015). It should be noted that depression is not equivalent to sadness, as when an individual suffers from depressive disorder, the person is unable to overcome the sensation of persistent trauma or intense sadness for a prolonged duration of time that eventually depicts its symptoms through mood fluctuations, irritability, and also demonstrates functional disturbances within the physiological system such as extreme loss of appetite, and insomnia (Elbejjani, 2015). According to the statistical reports of Crime Survey for England and Wales (CSEW, 2020) one out of five adults who belongs to the age range of 18 to 74 years had encountered one or the other kind of child abuses which can be physical, mental, emotional, sexual or even witnessing domestic violence prior to their age of 16 years (CSEW, 2020). Therefore, the statistical data on the child abuse and development of any kind of psychological disorders especially major depressive disorder (MDD) as they are considered as the “vulnerable group” demands potential strategies to spot any forms of maltreatment along with the immediate execution of management strategies to safeguard these children or adults to prevent any further worsening happenings mostly suicides (Wingo, 2010). Therefore, this literature review will critically appraise the selected eight research investigations comprising of 7 primary and 1 secondary research papers to answer the question raised within the topic of the research and to formulate significant recommendations that could be implemented within the field of clinical routine nursing practice, including considerations for nursing dissertation help.

Literature Review- Methodology

The research question was framed using the PEO framework which stands for P: Population/Problem/Patient, E: Exposure, O: Outcome (Aveyard,2019).

For the present assignment the following are:

Population: Young adults aged 18-25

Exposure: Childhood emotional abuse

Outcome: Depressive disorder (Taylor, 2014)

Research Question:

What is the impact of childhood emotional abuse on depressive symptoms among young adults aged 18-25?

The study is based on specifically on the primary research articles on the selected research question or topic to assort evidences from the existing data from the existing databases. The screened evidences have been included based on the evaluation of the significance of the focused research question and topic and the screened eight articles were selected from the assortment of high ranking peer reviewed articles available on varied electronic scholarly databases such as CINAHL, PubMed, Google Scholar, Medline, Taylor, EMBASE, Karger, Ovid, EBSCO host, and Francis Online. The Grey literature databases were also screened for collecting rational evidences through the Open Gray, GreyNet International and Med Nar. The screenings of the articles were done till the ongoing year, 2020 so that the most updated preliminaries can be considered for the review purpose. Moreover, all the intext citations were also considered while conducting the review (Machi, et al, 2016). Truncated search approach was considered for screening of articles so that a vast number of articles can be screened such as childhood abuse*, adult depressive disorder*, neglected childhood*, emotional trauma*, childhood abuse and depression*. Application of Boolean search operators were done like “AND” “OR” for overall narrowing down the query collections. Overall a detailed analysis of cross sectional, cohort, case control primary investigations of at least past ten years were specifically considered for the review purpose. The inclusion and the exclusion criteria were developed in relation to the focus question and to categorise the criteria the catchphrases or the keywords was used to match with the title, or the keywords of the articles screened. Any examinations not conversed in English language or not matching with the scope of research question were summarily rejected from the review purpose (Machi, et al, 2016).

The Critical Appraisal Skill Programme (CASP) tool was used to screen the articles and to ensure a qualitative research study (Aveyard,2019) This tool helps to conduct a critical analysis of the articles as it contains a separate checklist of 10 -12 questions for the Case Control Studies, Randomised Controlled Trials (RCT), Clinical Prediction Rule, Systematic Reviews, Diagnostic Studies, Cohort Studies and Qualitative investigations. The checklist can offer guidance to any researcher with the appraisal and the outcomes of the investigations screened (Singh, 2013). The data extracted from the chosen 8 articles are given within the data extraction table (Refer Table: ii), Appendix) and the themes generated are also given with theme table (Refer Table: iii), Appendix).

Results

The study findings have been critically appraised under the following themes in accordance to the focused research questions. As mentioned above the methodological standard and the validity or reliability of the studies were analysed using the CASP tool. The recognized two themes are: Theme 1 Childhood Emotional Abuse and Emotional Dysregulation are the key elements in the development of depressive disorders among young adults; Theme 2 Child abuse, emotional maltreatment and the associated brain mechanism linked to Major Depressive Disorder among adults.

Theme 1: Childhood Emotional Abuse and Emotional Dysregulation are the key elements in the development of depressive disorders among young adults.

The study conducted by the authors, Li, et al (2019)Christ et al (2019) specifically highlighted about the relation in between the childhood abuse and the development of depressive symptoms along with emotional dysregulation eventually leading to behavioral disorders and severe problems among the relationships of the individuals. The investigation design was a cross sectional one with a sample population of 205 adult individuals (aged overmore than 16 years) who were mostly female (80.5%) who underwent evaluation via the online mode. This could be considered as a potential weakness in the study design as there is a gender bias observed among the study participants recruited by the researchers of the investigation. The researchers conducted an online questionnaire assessment to comprehend the autonomous effect of child abuse on the depressive disorders in their adulthood phase and conducted statistical validation of the findings to rate the study power and reliability. In this respect it must be mentioned that the online data collection methodology is an honest and robust strategy that offered flexibility to the study design and the anonymity or confidentiality to all the participants(Lefever, et al, 2007). Moreover, the above mentioned strategy is also advantageous as the methodology is economically beneficial, usually demonstrates high rate of response, the investigation is not dependent on geographical boundaries, the response obtained from the participants reveals few errors in comparison to other strategy of data collection, and the data remains stored within a password protected system, so the dignity of the participants are also maintained while conducting the investigation (Lefever, et al, 2007). The investigation acknowledged that childhood abuse is a severe public health problem and all the other investigations such as Negele, et al (2015), O’Mahen, et al (2015), Li, et al (2019), Frodl, et al (2017), Kilicaslan, et al (2017), Kisely, et al (2018), and Infurna, et al (2016) have strengthened the findings and are part of the selected articles identified for this assignment. all agreed that it contributes significantly to the development of varied psychological disorders and even causes suicidal mentality among the adults via both prospective and retrospective investigations. Evidence have revealed that there are several categories of abuse that can be referred to as childhood emotional abuse (CEA) such as assaulting a child verbally, aggressive attitude towards a child, humiliating a child and all these can cumulatively affect negatively the mental health of a child resulting in development of varied psychological disorders such as mood fluctuations, negative emotional expression or hardening of emotions, anxiety disorders, suicidal tendencies along with MDD in their adulthood phase (Bell, 2009). The mediation analysis conducted by the researchers in the study of Christ et al (2019) potentially associated the impact of CEA with the symptomatic manifestations of depressions among the adult populations with the aid of simple mediation model (Refer Fig. 1). The study findings were analyzed using the multiple regression analyses and the data was found to be significant with regard to the overall models for depressive disorders having P value < 0.001. Here also another important feature that had to be considered is that the study participants were all females (N = 276) and they were all college goers with mean age of 21.7 years (SD = 2.38). The participants were predominantly of the country Netherland (91.7%), either lived single (66.3%), with their guardians (42.0%) or with roommates (35.1%) (Christ et al.,2019). Thus there few factors like gender bias and study population predominantly one nation that are considered to be potential weakness of the study design as the findings could not be generalized.

Similarly, the study findings of O’Mahen, et al (2015) also depicted that any kind of maltreatment in the childhood results in the formation of behavioral evasion and rumination and this behavioral evasion acts as mediation between the CEA and the depression. This study also had a sample size of 140 pregnant women participants, where 55 of them were suffering from MDD and 85 of them had elevated score of depression. The study participants were recruited from the clinic of obstetrics settings and they were offered with CBT for perinatal depression. The ages of the participants were above 18 years and they are pregnant for more than 24 weeks (O’Mahen, et al., 2015). However, these patients are currently not receiving any treatment for depression (O’Mahen, et al., 2015). The limitation for this study can be considered the small sample size which would statistically validate the results and similar to some of the previous investigations, a potential weakness in the study design is the gender bias observed among the study participants. Therefore, at present there are hand full of evidences that have already established the direct association of any kind of adversity phased during the childhood with the development of depression in their adulthood as those adversaries are strongly categorized as the internalizing symptoms (Nanni, 2012; Wiersma, 2009; Nelson, 2017). Therefore, the primary outcomes of all these studies along with other related investigations is that childhood emotional abuse has a direct impact upon the development of depressive disorders in the introductory adulthood phase of the individuals.

The term “emotional dysregulation” describes that it is the process that is responsible for supervising, comprehending and altering the reaction attitudes to emotions especially the severe or intense temporal ones to accomplish one’s own target (Thompson, 1994). It is evidently recently that emotional dysregulation plays a significant role in between the childhood abuse and development of depression. Moreover, it was also evident from the scientific background that emotional dysregulation demonstrates a cross sectional mediation in between the severe level of childhood abuse and depressive disorder (Christ, et al, 2019). The study conducted by the authors, Christ et al (2019) and Li, et al (2019) also highlighted about this aspect by conducting estimation both via direct and indirect measures with the aid of bootstrapping strategies and confirmed their findings with the help of statistical multiple regression analysis. The study participants in the investigation of Li, et al (2019) were 205 adult individuals (aged over 16 years) and among them maximum were female whereas within the investigation of the Christ et al (2019) number of participants were also all females (N = 276) and they were all college goers with mean age of 21.7 years. The indirect effect observed via the bootstrap analysis was thought to be noteworthy and positive and the direct effect was also found to be significant with p value < 0. 001.

Therefore, the findings depicted that both hypomentalizing and hypermentalizing are showing noteworthy effect in the establishment of CEA and depression among adults. This particular study investigated the association among the three parameters mentalizing incapacity, CEA and adult depressive symptomatic manifestations. The findings highlighted that CEA acted as the potential predictor for the adult depression along with mentalizing incapacity when compared with the other forms of childhood maltreatment. Even after controlling the mentalizing incapacity, CEA acted as the most potent predictor for depression (Li, et al, 2019). This can be considered as the primary strength of the investigations as a mediator which is modifiable can possibly formulate psychotherapeutic regime for depressive among the adult populace (Li, et al, 2019). Moreover, the study of the Li, et al (2019) has also established the fact that CEA strongly potentiates for depression in comparison to the other category of physical and sexual abuses. To point out the limitations of the study of the Li, et al (2019) is the possible gender bias. Though the study was a cross sectional online platform-based investigation, the authors themselves noted that the outcomes of the investigation have to be done with caution for generalization. The other study of the Christ et al (2019) reported the entire findings based on the self- report instruments and retrospective accounts of the variables of childhood and the outcomes are the exposure of single measurement so further studies need to be conducted for validation (Campbell-Sills, et al., 2009). However, other scientific evidences have already revealed that there is specifically a negative impact of CEA on the parameter emotional dysregulation. It was noted that with the past history of CEA the individual faces challenges to comprehend emotions and eventually in majority of the cases fails to deal with it (Bell, 2015; Burns, 2012). Though there is no clear evidence of the underpinning mechanism of depression related to CEA still emotion dysregulation is considered to be a significant part that establishes the link in between the two factors. Therefore, several primary investigations have used the Emotion Dysregulation Scale to estimate the regulation of emotion as a latent factor (McLaughlin, 2011).

The study of Li, et al (2019) reported that the child who receives maltreatment at their childhood phase is very much prone to develop depressive symptoms (they are twice as likely to develop depressive symptomstwo times). The researchers have focused about the silent forms of maltreatment or negligence which can be referred to as “emotional abuse” is the potential triggers for depression. It is evident that emotional support is required for cognitive development. In this respect, the study findings of Frodl, et al (2017) have highlighted about the negative impact of adversaries encountered at childhood on the structure and volumes of brain especially females in comparison to males which contributes to MDD. The investigation had been conducted with a huge sample population of 3036 individuals and among them 958 was patients of MDD and 2078 was the healthy controls. Among the patients the male/female ratio was 614/344 and within the healthy control it was 994/1084 (Frodl, et al 2017). The investigation utilized the magnetic resonance imaging to comprehend the sub-cortical differences in the structure of brain and its volumes that can be correlated with the adversaries faced at childhood. Interestingly, the study findings revealed an association in between the following parameters such as childhood maltreatment, diagnosis of MDD, gender and region. Moreover, all types of childhood maltreatments were negatively related with the caudate volumes of the females especially for the physical and emotional negligence (Frodl, et al, 2017). Therefore, particularly this investigation confirmed the aspect that childhood maltreatments causes alterations within the sub-cortical regions of brain and that eventually leads to the development of psychological disorders, especially depression. The investigation possessed the strength in the following parameters like the size of the sample population, the harmonization of the processing of the image, and the quality control of the investigation. However, there are certain limitations within the investigation as stated by the researchers such as varied sites were used for different images, and few methodological differentiations that might had impacted the findings of the investigation (Frodl, et al, 2017). Moreover, the development of depressive disorder is also dependent on certain other risk factors such as the gender, hereditary vulnerability, the psychopathology of the parents, along with varied stressful situations of life that the individual phases while growing up and the support of the society achieved during that point of time (Pagliaccio, 2016). In this regard, all the selected eight articles have claimed the association in between the childhood emotional or physical abuse with the development of several psychological disorders especially depression. The study findings of O’Mahen, et al (2015), Negele, et al (2015), Christ, et al (2019), Kilicaslan, et al (2017), Kisely, et al (2018) and the Infurna, et al (2016) have all specifically stressed upon the fact that there is potential association in between childhood abuse of any kind and development of major depressive disorders along with other mental health problems that can result in suicidal mentality.

In the above given bar diagram the values represents the mean and SD of the estimated variables such as age, sex, the field site and strength as covariates for the patients of MDD who were on antidepressants at that time in comparison to non-medicated MDD patients and healthy controls. The diagram demonstrated that patients who were on medications had significantly larger volumes of thalamus in comparison to those not undertaking any medications and healthy controls. Moreover, those patients who were not medicated revealed smaller volumes of hippocampus in comparison to the medicated patients and the healthy controls (Frodl, et al, 2017). In this respect, the study of the Kisely, et al (2018) is a significant one as the researchers conducted a prospective record associated analysis of the degree of exposure of maltreatment at the childhood phase and the negative mental health outcome in their adulthood. In total of 3778 mothers and their child participated within the cohort investigation in Brisbane, Australia. The childhood maltreatment was estimated from the findings of State child protection agency and the essential outcomes were evaluated using the internalising and externalising scales of the Youth Self-Report and the Centre for Epidemiological Studies-Depression scales (CES-D), particularly at the age of 21 years. The findings of the investigation highlighted that 45% of the child had a history of varied abuses such as physical, sexual and emotional ones. There was a potential correlation in between depressive symptoms among adulthood with the varied forms of abuses encountered at childhood phase except the sexual ones. Moreover, the data also showed statistical validation (Kisely, et al, 2018). However, the investigation had few limitations as stated by the authors of the study. The findings of the study could not be generalized to twins or triplets born to Mater-University of Queensland Study of Pregnancy (MUSP) mothers who were excluded from the cohort population. Only two third of the study participants had finished the process of interview and there were high rate of attrition among those population who were experiencing social disadvantage. Apart from these, the investigation highlighted that emotional neglect and abuse could result in a varied range of psychological outcomes in the early phase of childhood. The authors also stated that varied types of abuse have a strong correlation with anxiety disorders particularly PTSD (Kisely, et al, 2018).

It is evident from the study of Frodl, et al (2017) and other past scientific evidences that individuals suffering from MDD demonstrate sub-cortical volumes of brain in a consistent manner when compared to healthy subjective controls. It is also evident that due to stress or with the administration of cortisol results in the development of neuronal atrophy within the hippocampus (Teicher, 2016). Childhood adversaries lead to the formation of structural changes within the brain and also it had been experimentally proved that with the administration of persistent stress induction of the glucocorticoid occurs that mediates the pyramidal retraction of the dendritic cells within the hippocampus of the brain and these kind of alterations within the dendrite arborization occurs within the pre frontal cortex of the brain only among the vulnerable individuals (Chaney, 2014). A meta- analysis conducted by the Nanni et al, (2012) reported that those who have a background history of abuse at their childhood are evident to suffer from chronic depressive disorder and frequent relapses. The study findings of Infurna, et al (2016) with a sample population of 4372 participants have demonstrated that among varied types of abuses the psychological or the emotional abuse at the childhood results in the development of shame, guilt and further depression among the adults. The study design was a systematic literature review that utilized a three-step detailed systematic review strategy. The study inclusion and exclusion criteria included only those articles that considered only the clinical depression instead of depressive symptoms. This resulted in narrowing down the search articles with restricted analysis focused to the research question. However, one limitation can be comprehended that the investigation did not detail about the degree and the duration of the maltreatment. Thus, specifically this investigation and the biological explanation illustrated by Frodl, et al (2017) confirmed about the mechanism that relates childhood abuse and depression in adulthood.

Implementation of the Findings:

As a clinical practitioner or mental health nurse, one may understand that any violent or persistent frightening events can leave an indelible scar in the life of any individual (Manning, 2009). These events can be referred to as childhood traumas. It has been already described how stress or traumatic events can alterations within the preliminary physiological functioning of the body affecting the brain, nervous system, endocrine system and even the immunological system that eventually leads to emotional dysregulation and development of varied mental health problems (Bell, 2015; Frodl, et al, 2017). It is also evident that many people remain undiagnosed or untreated for the condition, however the healthcare professionals and the organizations must up take the trauma informed care (TIC) (Hanson, 2016). TIC is based on certain principles and the procedures that assist in the identification and therapy of the traumatic experiences towards successful healing and also to let them feel secured. In accordance to the Substance Abuse and Mental Health Services Administration the four major parts of TIC are: to comprehend the vast impact of the trauma along with the potential pathways to recovery; to identify the subtle signs and indications of trauma within the clients and their family members; the healthcare practitioners must possess the detailed information about the policies, practice therapies and the procedures involved within the clinical environment and ultimately must be able to hinder the relapses (Hanson, 2016). In this aspect, the Trauma Focused Cognitive Behavioral Therapy (TF-CBT) is considered as the evidence-based approach for the therapy of the individuals who are suffering from the persistent symptoms of trauma like depression (Pollio, 2017). The methodology allows the individuals to cope with the stress by letting the traumatic story out to a safe and secured environment who will be also able to provide protection (Pollio, 2017). It is evident that when CBT was applied within a controlled clinical environment to adult patients with post traumatic disorders, it can diminish the sufferings and symptoms of the patients to a significant level in comparison to control group that received no such treatment. It could improve the symptoms of nightmares, anxiety attacks, sleep disorders, and it shows more pronounced effect when combined with pharmacotherapy classified as selective serotonin reuptake inhibitors (Norman, 2012). The resources that are necessary for the implementation of the suggested therapy are the overall family and the community support. Clinicians and nurses will offer the valuable clinical guidance, medications, counseling and the family or the relatives would need to offer encouragement and validation for recovery and boosting of self-esteem (Norman, 2012).

Change Management theory describes the process that how to create transitions within an individual teams and in turn within the organizations from the current persisting state to the desired future state via a structured approach. The key perspective that is involved is the perfect style of leadership among the healthcare professionals (Šuc, et al, 2009). Therefore, for a particular organization to establish TIC model in overall needs to acclimatize a trauma-informed organizational mission and supply the required resources to the unit. This would require a wide workforce development dedicated with values and ethics with the transformation of the organization principles (Center for Substance Abuse Treatment, 2014).

Conclusion

Childhood abuse is one of the major public health problems that negatively impact upon the mental health of the individuals when they reach adulthood phase of their life. Several studies have also demonstrated a relationship in between the childhood abuse and the development of depressive disorder in their adulthood though the underpinning psychological mechanistic pathway is still unclear. It is established that the relation in between the childhood abuse and the development of depressive symptoms along with emotional dysregulation eventually leading to behavioral disorders and severe problems among the relationships of the individuals. Trauma Focused Cognitive Behavioral Therapy is considered as the evidence-based approach for the therapy of the individuals who are suffering from the persistent symptoms of trauma like depression. More pronounced effect is observed when combined with pharmacotherapy along with encouragement and validation from overall family and the community.

References

1. Appel, K., Schwahn, C., Mahler, J., Schulz, A., Spitzer, C., Fenske, K., Stender, J., Barnow, S., John, U., Teumer, A. and Biffar, R., (2011). Moderation of adult depression by a polymorphism in the FKBP5 gene and childhood physical abuse in the general population. Neuropsychopharmacology, 36(10), pp.1982-1991.
2. Aveyard, H. (2019) Doing a Literature review in Health and Social Care
3. Fourth Edition, McGraw-Hill Education. London United Kingdom
4. Bell, K.M. and Higgins, L., (2015). The impact of childhood emotional abuse and experiential avoidance on maladaptive problem solving and intimate partner violence. Behavioral Sciences, 5(2), pp.154-175.
5. Bell, M.C., (2009). Antisocial Personality Disorder and romantic relationship functioning in an epidemiologically based sample (Doctoral dissertation, University of Maryland, Baltimore County).
6. Burns, E.E., Fischer, S., Jackson, J.L. and Harding, H.G., (2012). Deficits in emotion regulation mediate the relationship between childhood abuse and later eating disorder symptoms. Child abuse & neglect, 36(1), pp.32-39.
7. Chaney, A., Carballedo, A., Amico, F., Fagan, A., Skokauskas, N., Meaney, J. and Frodl, T., (2014) Effect of childhood maltreatment on brain structure in adult patients with major depressive disorder and healthy participants. Journal of psychiatry & neuroscience: JPN, 39(1), p.50.
8. Christ, C., De Waal, M.M., Dekker, J.J., van Kuijk, I., Van Schaik, D.J., Kikkert, M.J., Goudriaan, A.E., Beekman, A.T. and Messman-Moore, T.L., (2019). Linking childhood emotional abuse and depressive symptoms: The role of emotion dysregulation and interpersonal problems. PloS one, 14(2), p.e0211882.
9. Crime Survey for England and Wales (CSEW), 2020. Source: www.ons.gov.uk [Accessed on 27 April 2020].
10. Elbejjani, M., Fuhrer, R., Abrahamowicz, M., Mazoyer, B., Crivello, F., Tzourio, C. and Dufouil, C., (2015). Depression, depressive symptoms, and rate of hippocampal atrophy in a longitudinal cohort of older men and women. Psychological medicine, 45(9), p.1931.
11. Frodl, T., Janowitz, D., Schmaal, L., Tozzi, L., Dobrowolny, H., Stein, D.J., Veltman, D.J., Wittfeld, K., van Erp, T.G., Jahanshad, N. and Block, A., (2017). Childhood adversity impacts on brain subcortical structures relevant to depression. Journal of psychiatric research, 86, pp.58-65.
12. Hanson, R.F. and Lang, J., (2016). A critical look at trauma-informed care among agencies and systems serving maltreated youth and their families. Child maltreatment, 21(2), pp.95-100.
13. Hanson, R.F. and Lang, J., (2016). A critical look at trauma-informed care among agencies and systems serving maltreated youth and their families. Child maltreatment, 21(2), pp.95-100.
14. Kilicaslan, E.E., Esen, A.T., Kasal, M.I., Ozelci, E., Boysan, M. and Gulec, M., (2017). Childhood trauma, depression, and sleep quality and their association with psychotic symptoms and suicidality in schizophrenia. Psychiatry research, 258, pp.557-564.
15. Kisely, S., Abajobir, A.A., Mills, R., Strathearn, L., Clavarino, A. and Najman, J.M., (2018) Child maltreatment and mental health problems in adulthood: birth cohort study. The British Journal of Psychiatry, 213(6), pp.698-703.
16. Li, E.T., Carracher, E. and Bird, T., (2020) Linking childhood emotional abuse and adult depressive symptoms: the role of mentalizing incapacity. Child Abuse & Neglect, 99, p.104253.
17. Machi, L.A. and McEvoy, B.T., (2016) The literature review: Six steps to success. Corwin Press.
18. McLaughlin, K.A., Hatzenbuehler, M.L., Mennin, D.S. and Nolen-Hoeksema, S., (2011) Emotion dysregulation and adolescent psychopathology: A prospective study. Behaviour research and therapy, 49(9), pp.544-554.
19. Manning, C. and Stickley, T. (2009) Childhood abuse and psychosis; a critical review of the literature. Journal of Research in Nursing, 14(6), pp.531-547.
20. Nanni, V., Uher, R. and Danese, A., (2012) Childhood maltreatment predicts unfavorable course of illness and treatment outcome in depression: a meta-analysis. American Journal of Psychiatry, 169(2), pp.141-151.
21. Negele, A., Kaufhold, J., Kallenbach, L. and Leuzinger-Bohleber, M., (2015) Childhood trauma and its relation to chronic depression in adulthood. Depression research and treatment.
22. Nelson, J., Klumparendt, A., Doebler, P. and Ehring, T. (2017). Childhood maltreatment and characteristics of adult depression: meta-analysis. The British Journal of Psychiatry, 210(2), pp.96-104.
23. Norman, R.E., Byambaa, M., De, R., Butchart, A., Scott, J. and Vos, T., (2012) The long-term health consequences of child physical abuse, emotional abuse, and neglect: a systematic review and meta-analysis. PLoS Med, 9(11), p.e1001349.
24. O’Mahen, H.A., Karl, A., Moberly, N. and Fedock, G., (2015) The association between childhood maltreatment and emotion regulation: two different mechanisms contributing to depression. Journal of affective disorders, 174, pp.287-295.
25. Pagliaccio, D. and Barch, D.M., (2016) Early life adversity and risk for depression: Alterations in cortisol and brain structure and function as mediating mechanisms. In Systems neuroscience in depression (pp. 29-77). Academic Press.
26. Pollio, E. and Deblinger, E. (2017) Trauma-focused cognitive behavioural therapy for young children: clinical considerations. European journal of psychotraumatology, 8(sup7), p.1433929.
27. Singh, J., (2013) Critical appraisal skills programme. Journal of pharmacology and Pharmacotherapeutics, 4(1), p.76.
28. Salwen, J.K., Hymowitz, G.F., Vivian, D. and O’Leary, K.D., (2014). Childhood abuse, adult interpersonal abuse, and depression in individuals with extreme obesity. Child abuse & neglect, 38(3), pp.425-433.
29. Taylor, M.J., McNicholas, C., Nicolay, C., Darzi, A., Bell, D. and Reed, J.E., (2014) Systematic review of the application of the plan–do–study–act method to improve quality in healthcare. BMJ quality & safety, 23(4), pp.290-298.
30. Thompson, R.A., (1994). ER: A theme in search of a definition. The development of emotion regulation: Biological and behavioral considerations. Monographs of the Society for Research in Child Development, 59, pp.25-52
31. Teicher, M.H., Samson, J.A., Anderson, C.M. and Ohashi, K., (2016). The effects of childhood maltreatment on brain structure, function and connectivity. Nature Reviews Neuroscience, 17(10), p.652.
32. Wiersma, J.E., Hovens, J.G., van Oppen, P., Giltay, E.J., van Schaik, D.J., Beekman, A.T. and Penninx, B.W., (2009) The importance of childhood trauma and childhood life events for chronicity of depression in adults. Journal of clinical Psychiatry, 70(7), p.983.
33. Wingo, A.P., Wrenn, G., Pelletier, T., Gutman, A.R., Bradley, B. and Ressler, K.J., (2010) Moderating effects of resilience on depression in individuals with a history of childhood abuse or trauma exposure. Journal of affective disorders, 126(3), pp.411-414.
34. Lefever, S., Dal, M. and Matthiasdottir, A., (2007) Online data collection in academic research: advantages and limitations. British Journal of Educational Technology, 38(4), pp.574-582.
35. Campbell-Sills, L., Forde, D.R. and Stein, M.B., (2009) Demographic and childhood environmental predictors of resilience in a community sample. Journal of psychiatric research, 43(12), pp.1007-1012.
36. Center for Substance Abuse Treatment, (2014) Building a trauma-informed workforce. In Trauma-Informed Care in Behavioral Health Services. Substance Abuse and Mental Health Services Administration (US).
37. Šuc, J., Prokosch, H.U. and Ganslandt, T., (2009) Applicability of Lewin s change management model in a hospital setting. Methods of information in medicine, 48(05), pp.419-428.

Continue your exploration of Exploring the Significance of Nursing Care with our related content.