Abuse, Child

We used a modified version of the Life Events Checklist for DSM-5 to measure exposure to twelve specific, contextually relevant lifetime PTEs. Events of interest included: seeing people hitting or harming one another in your family as a child, physical assault or abuse as a child, sexual assault or rape as a child, physical assault or abuse as an adult from an intimate partner, physical assault or abuse in adulthood from someone other than an intimate partner, sexual assault or rape in adulthood, seeing someone physically assaulted or abused, seeing someone seriously injured or killed, experiencing a natural disaster, experiencing a serious accident or fire, exposure to war, and losing a child through death. One additional question asked individuals to identify any other traumatizing event experienced during childhood or adulthood. We explored the free response text describing any “other” type of experienced lifetime traumatic events and recategorized these events if they fit more appropriately in a pre-defined category (e.g., one individual who reported death of a child through childbirth had not reported loss of a child to death. This event was recoded to loss of a child to death).
For analytic purposes, similar events were further combined such that seven distinct event types were considered: trauma during childhood, experiencing violence in adulthood, witnessing violence in adulthood, accidents, death of a child, war, and any other PTE. We also created a dichotomous variable to represent individuals who were and were not in the top quarter of number of PTEs reported. Individuals in the top quarter reported 6 or more PTEs.

This retrospective cohort study was performed at a tertiary academic medical center in a Midwestern US state that legalized recreational cannabis on December 6, 2018. Throughout the study period, the institution had no formal policy regarding prenatal urine drug testing or newborn drug testing, leaving testing decisions to the discretion of clinicians. The state mandates that clinicians place a CPS report of suspected child abuse if a newborn has known or suspected exposure to alcohol and/or a controlled substance as evidenced by a positive newborn drug test or withdrawal symptoms.¹⁸ The University of Michigan institutional review board approved this study and waived the requirement for patient consent, per the Common Rule. This study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guideline for cohort studies.^{19 (link)}