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A longitudinal study in China found that adolescents who were maltreated as children are more likely to use maladaptive cognitive emotion regulation strategies. These individuals also tend to experience more severe symptoms of depression and anxiety. The research was published in Development and Psychopathology.
Childhood maltreatment refers to abuse or neglect experienced by a child. This can include physical, emotional, or sexual abuse, as well as physical or emotional neglect. Maltreatment may occur within the family or be inflicted by other caregivers, and it often has long-lasting effects on a child’s development. When it happens during critical developmental periods, maltreatment can alter brain structure and function, particularly in areas related to emotion regulation and stress response.
Children who experience maltreatment are at increased risk for mental health disorders such as depression, anxiety, post-traumatic stress, and substance use problems. It can also impair cognitive development, academic achievement, and social relationships. Early maltreatment often disrupts the formation of secure attachment and trust in others. These effects can persist into adulthood, negatively affecting self-esteem, interpersonal functioning, and physical health. Risk factors for maltreatment include poverty, parental mental illness, and domestic violence.
Study author Jianjun Huang and his colleagues set out to examine the relationship between childhood maltreatment and maladaptive cognitive emotion regulation strategies. They also explored how childhood maltreatment is linked to internalizing mental health problems—difficulties that are directed inward, such as anxiety and depression. Maladaptive cognitive emotion regulation strategies refer to unhelpful thought patterns, such as rumination, catastrophizing, or self-blame, that people use in an attempt to manage emotions, but which often worsen psychological distress instead of alleviating it.
The study participants were adolescents recruited from a high school in Chongqing, China. A total of 1,155 students agreed to participate in a longitudinal mental health survey. The initial survey was conducted in 2021, and a follow-up survey was completed by 892 students in 2023. Of those who completed the second survey, 487 were girls. The average age of the participants was 15 years.
The surveys included several standardized questionnaires to assess different aspects of mental health. Childhood maltreatment was measured using the Childhood Trauma Questionnaire. Maladaptive cognitive emotion regulation strategies were assessed with the Maladaptive Cognitive Emotion Regulation Strategies Questionnaire. Depression and anxiety symptoms were evaluated using the Self-Rating Depression Scale and the Self-Rating Anxiety Scale, respectively.
The results showed that adolescents who reported higher levels of childhood maltreatment were more likely to use maladaptive cognitive emotion regulation strategies and reported more severe symptoms of depression and anxiety.
The researchers tested a statistical model proposing that maladaptive cognitive emotion regulation strategies measured in 2021 would mediate the relationship between childhood maltreatment and internalizing problems measured in 2023. They also tested a second model suggesting that internalizing problems in 2021 could mediate the relationship between childhood maltreatment and future maladaptive emotion regulation strategies. Analyses supported both pathways.
“Taken together, childhood maltreatment was longitudinally associated with internalizing problems through MCERS [maladaptive cognitive emotion regulation strategies], and also related to subsequent MCERS through internalizing problems,” the study authors concluded.
The study contributes to the scientific understanding of the relationships between childhood maltreatment and mental health issues later in life. However, it should be noted that all the data in this study came from self-reports and that childhood maltreatment data was based on participants’ recall of experiences from their childhood. This leaves room for reporting and recall bias to have affected the results.
The paper, “The long-term effects of childhood maltreatment: Examining the indirect and cross-lagged pathways of maladaptive cognitive emotion regulation strategies and internalizing problems,” was authored by Jianjun Huang, Xi Shen, and Jin-Liang Wang.
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Cleaning between the teeth affects more than oral health and may even affect the risk of cardiovascular disease, dementia, kidney disease and more.Flossing is an essential component of oral hygiene, offering benefits that extend beyond clean teeth. Consistent flossing habits may contribute to a reduced risk of various diseases, including heart disease — the leading cause of death in Alabama.
Mia L. Geisinger, DDS, an associate professor in the University of Alabama at Birmingham School of Dentistry, explains how flossing can impact overall health.
Health beyond teeth
Interdental cleaning, including flossing, is a fundamental part of maintaining good oral health and it can improve both quality of life and life expectancy.
“Oral health is integral to overall well-being,” Geisinger said. “In fact, individuals who floss daily live on average nearly six and a half years longer than those who do not floss every day.”
Brushing removes only 40 percent to 60 percent of plaque, but cleaning between teeth helps eliminate more. When plaque builds up, the risk of tooth decay and periodontal disease can increase. Periodontal disease, also known as gum disease, is characterized by local and systemic inflammation of the tissues that support teeth.
“People who regularly floss demonstrate lower levels of gingival (gum) bleeding and inflammation,” said Geisinger, who is the acting chair of the Department of Periodontology.
Diseases linked to oral health issues include diabetes, cardiovascular disease, kidney disease, cancer and some forms of dementia. Understanding factors that can initiate or worsen cardiovascular health can help with prevention.
Cardiovascular disease
Cardiovascular disease can develop from many different factors. A lack of flossing may be a contributor to heart disease development or progression.
“Flossing regularly is associated with a reduced risk of stroke, major cardiovascular events and irregular heart rhythms,” Geisinger said.
Gum tissue that is often irritated by poor oral hygiene can increase the chance of bacteria spreading through blood vessels. The body responds by releasing chemical messengers to fight these bacteria, which can lead to inflammation throughout the body.
“Gum disease can lead to higher levels of inflammatory markers and compound damage within tissues throughout the body,” she said. “This includes the arteries and the heart.”
Brain health
Poor flossing habits are not a direct cause of dementia; but Geisinger explains that poor oral health, particularly periodontal disease, can increase the chance of developing dementias. 
As dementia develops, the protective layer around the brain, called the blood-brain barrier, becomes permeable. This could increase the chance of bacteria, bacterial byproducts and inflammatory markers entering the brain. 
“Specific bacteria found in advanced periodontal disease, for example Porphyromonas gingivalis, have been associated with worsening cognitive function and dementias,” Geisinger said.
Healthy practices
The earliest forms of gum disease can present without any symptoms. Geisinger says it is important to schedule a comprehensive periodontal examination every year to diagnose gum disease at the earliest stages. In addition, creating flossing reminder methods can help promote oral health.
“Using visual reminders, like placing your interdental cleaners on your bathroom counter with your toothbrush, or using electronic reminders can be helpful,” Geisinger said. “On average, it can take two to three months to form a new habit, and regular interdental cleaning is key to maintaining periodontal health.”
Interdental brushes are the most effective flossing tools, but some people do not have enough space between their teeth to use them.
“Patients should ask their dental health care professional about the best routine for them,” said Geisinger. “They can help identify the best tools to keep your smile and whole body as healthy as possible.”
To learn more about gum disease and treatment options, visit the UAB Periodontology Clinic.
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CHENNAI: ManipalCigna Health Insurance has deepened its commitment to Tamil Nadu by accelerating the adoption of its award-winning product, ManipalCigna Sarvah.
Focused on India’s ‘missing middle’ population, Sarvah contributed 52 per cent of the company’s new business in TN during Jan-May 2025. With 18 offices, a robust network of over 1,500 empaneled hospitals, and over 7,000 advisors, ManipalCigna has covered more than 11 lakh lives in the state in FY25.
Over the last three years, the company has settled claims worth Rs 101 crore in TN, underscoring its mission to make quality healthcare more accessible. The company plans to expand its presence in the state with 10 more branches and add over 10,000 advisors across South India in FY26.
As per the data from the General Insurance Council (GIC), ManipalCigna outpaced the sector with a 30 per cent growth in premium in Q1 FY26, the highest among SAHI players, reflecting its strong regional strategy and customer-first product design.
From a healthcare standpoint, non-communicable diseases account for 68 per cent of the total disease burden in Tamil Nadu, higher than the national average of 61.43 per cent. This underscores the need for focused interventions on chronic diseases like diabetes and cardiovascular conditions.
Sapna Desai, chief marketing officer, ManipalCigna Health Insurance, said, “Over the years, our growing network, innovative offerings, and customer-centric approach have enabled us to earn the trust of our policyholders and our partners to deliver tangible value.”

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