Paula S. Nurius

Life course pathways of adverse childhood experiences toward adult psychological well-being: A stress process analysis.

Growing evidence suggests that toxic stressors early in life not only convey developmental impacts but also augment risk of proliferating chains of additional stressors that can overwhelm individual coping and undermine recovery and health. Examining trauma within a life course stress process perspective, we posit that early childhood adversity carries a unique capacity to impair adult psychological well-being both independent of and cumulative with other contributors, including social disadvantage and stressful adult experiences. This study uses data from a representative population-based health survey (N=13,593) to provide one of the first multivariate assessments of unique, cumulative, and moderated effects of adverse childhood experiences (ACEs) toward explaining 3 related yet distinct measures of adult mental health: perceived well-being, psychological distress, and impaired daily activities. Results demonstrate support for each set of hypothesized associations, including exacerbation and amelioration of ACEs effects by adult stress and resilience resources, respectively. Implications for services and future research are discussed.

Heterogeneity Among Violence-Exposed Women Applying Person-Oriented Research Methods

Variability of experience and outcomes among violence-exposed people pose considerable challenges toward developing effective prevention and treatment protocols. To address these needs, the authors present an approach to research and a class of methodologies referred to as person oriented. Person-oriented tools support assessment of meaningful patterns among people that distinguish one group from another, subgroups for whom different interventions are indicated. The authors review the conceptual base of person-oriented methods, outline their distinction from more familiar variable-oriented methods, present descriptions of selected methods as well as empirical applications of person-oriented methods germane to violence exposure, and conclude with discussion of implications for future research and translation between research and practice. The authors focus on violence against women as a population, drawing on stress and coping theory as a theoretical framework. However, person-oriented methods hold utility for investigating diversity among violence-exposed peoples experiences and needs across populations and theoretical foundations.

Intimate Partner Survivors’ Help-Seeking and Protection Efforts: A Person-Oriented Analysis

Domestic violence advocates and researchers advocate for a survivor-centered approach for assisting women experiencing intimate partner violence (IPV), with individualized safety plans and services; yet little empirical work has been done to determine IPV survivors’ specific combinations of vulnerabilities and assets that might inform such an approach. Using latent profile analysis of a cohort of 448 survivors, five distinct subgroups were previously identified in terms of biopsychosocial asset and vulnerability profiles. The purpose of the current study was to apply person-oriented methodology for survivor-centered investigation of differences in help-seeking and protective actions according to subgroup membership within this cohort. Though not differing demographically, the subgroups were found to differ significantly and meaningfully in their patterns of IPV help-seeking and protective actions. Thus, reliance on population-aggregate linear relationships between IPV exposure and safety efforts may risk overlooking important variation by vulnerability and asset profile, and knowledge of distinct clusters among functioning profiles may help with understanding of survivors’ coping strategies.The authors outline service-need considerations across the subgroups and provide guidance for targeted outreach, locating IPV survivors and matching services to their needs.

Distinct Contributions of Adverse Childhood Experiences and Resilience Resources: A Cohort Analysis of Adult Physical and Mental Health

Although evidence is rapidly amassing as to the damaging potential of early life adversities on physical and mental health, as yet few investigations provide comparative snapshots of these patterns across adulthood. This population-based study addresses this gap, examining the relationship of adverse childhood experiences (ACEs) to physical and mental health within a representative sample (n = 19,333) of adults, comparing the prevalence and explanatory strength of ACEs among four birth cohorts spanning ages 18–79. This assessment accounts for demographic and socioeconomic factors, as well as both direct and moderating effects of resilience resources (social/emotional support, life satisfaction, and sleep quality). Findings demonstrate (1) increasing trends of reported ACEs across younger cohorts, including time period shifts such as more prevalent family incarceration, substance abuse, and divorce, (2) significant bivariate as well as independent associations of ACEs with poor health within every cohort, controlling for multiple covariates (increasing trends in older age for physical health), and (3) robust patterns wherein resilience resources moderated ACEs, indicating buffering pathways that sustained into old age. Theoretical and practice implications for health professionals are discussed.

Adverse Childhood Experiences (ACE) Within a Social Disadvantage Framework: Distinguishing Unique, Cumulative, and Moderated Contributions to Adult Mental Health

The deleterious impact of adverse childhood experiences (ACE) may be confounded with frequently co-occurring social disadvantage. In this analysis we test the effects of ACE on adult mental health within a social disadvantage framework, using a population-based survey (n = 7,444; mean age = 55.2 years) from Washington State. We also examined the protective effects of socioemotional support, and the distinct and combined contribution of the measured ACE factors. Results demonstrated sustained impact of ACE on mental health many decades later, even net of social disadvantage and demographic contributors. Protective factors provided both direct and moderating influences, potentially masking the elevated effects of ACE for those with few resources. Toxicity examination of ACE items evinced differential effects of ACE experiences on mental health. These results demonstrate that interventions ameliorating the effects of ACE and bolstering protective resources such as socioemotional support may be effective toward augmenting mental health even late in life.

Multi-domain risk and protective factor predictors of violent behavior among at-risk youth

This study extends prior examination of adolescent violence etiology, drawing on an ethnically diverse, community accessed, yet emotionally vulnerable sample (N=849) of adolescents at-risk for school dropout. A balanced risk and protective factor framework captured theorized dimensions of strain, coping, and support resources. We tested the combined and unique contribution of risk and protective components spanning individual, peer/school, and family predictor domains, including victimization histories. Hierarchical regressions yielded significant overall explanation of violent behaviors as well as unique predictors within each of the three domains. Tests for sex differences and moderating effects suggested that levels of risk and protective factors differed for males and females, although the functional relationships to violence were the same for both sexes. Results are discussed relative to prevention and early intervention programs; particularly the importance of understanding adolescent violent behaviors within a context that addresses stress and distress.

Spouse Psychological Well-Being: A Keystone to Military Family Health

Understanding predictors of military spouse psychosocial vulnerability informs efforts to assess, identify, and support at-risk spouses and families. In this analysis, we test the effects of family stress and strain on military spouse psychological health, using a sample of female civilian spouses (n = 161). Regression findings confirm expectations of the significant contribution of family stressors, strain, and resources in explaining variation in spouses psychological health, controlling for deployment and socioeconomic factors. Identifying the effects of family stress on military spouse psychological health supports the need for family-centered interventions and prevention programs.

Person-Oriented Methods in Partner Violence Research: Distinct Biopsychosocial Profiles Among Battered Women

Violence researchers have called for the use of person-oriented methods to understand differences that have been found in biopsychosocial consequences among those who experience intimate partner violence (IPV). To address this issue, we apply a person-oriented statistical method, latent profile analysis (LPA), to test for meaningful subgroups of a sample of 448 battered women based on participants’ appraisals of their vulnerability relative to their violent partner, depressive symptoms, physical injuries, overall physical health functioning, and their positive and negative social relationships with friends and family. The LPA established five significantly distinct subgroups. Using MANOVA, we examined these subgroups and their respective IPV exposure, both concomitant and separate incidents within the past year. Those with the most intensive violence exposure show the greatest level of challenge and impairment. However, the groups with comparable levels of IPV exposure manifest distinctly different configurations of biopsychosocial profiles, indicating a need for adaptive interventions commensurate with these profiles. We discuss the implications these findings have for developing adaptive interventions for battered women, as well as the potential utility of person-oriented tools for violence researchers.

Intersection of Stress, Social Disadvantage, and Life Course Processes: Reframing Trauma and Mental Health.

This paper describes the intersection of converging lines of research on the social structural, psychosocial, and physiological factors involved in the production of stress and implications for the field of mental health. Of particular interest are the stress sensitization consequences stemming from exposure to adversity over the life course. Contemporary stress sensitization theory provides important clinical utility in articulating mechanisms through which these multiple levels exert influence on mental health. Stress sensitization models (a) extend understanding of neurobiological and functional contexts within which extreme stressors operate and (b) make clear how these can influence psychologically traumatic outcomes. The value of interventions that are sensitive to current contexts as well as life course profiles of cumulative stress are illustrated through recent treatment innovations.

Preparing Emerging Doctoral Scholars for Transdisciplinary Research: A Developmental Approach

Research models that bridge disciplinary, theoretical, and methodological boundaries are increasingly common as funders and the public push for effective responses to pressing social problems. Although social work is inherently an integrative discipline, there is growing recognition of the need to better prepare emerging scholars for sophisticated transdisciplinary and translational research environments. This article outlines a developmental, competency-oriented approach to enhancing the readiness of doctoral students and emerging scholars in social work and allied disciplines for transdisciplinary research, describes an array of pedagogical tools applicable in doctoral course work, and urges coordinated attention to enhancing the field’s transdisciplinary training capacity.