Identifying and characterising adverse childhood experiences (ACE) in a Northern Irish military veteran population

Abstract

ABSTRACT Background: The experience of childhood adversities, particularly those related to maltreatment and household dysfunction, has been consistently documented in the extant literature as having a detrimental impact on psychological wellbeing across the life course, including adverse outcomes such as mood disorders, anxiety disorders and PTSD. Previous research has uncovered a higher proportion of childhood adversity experiences amongst military populations (Katon et al., 20152015) and that those who experienced trauma during their childhood, and during their military career, were at the greatest risk of a range of psychological concerns. A wealth of research has been conducted to identify what social and psychological constructs may mediate the relationship between adversity and psychopathological outcomes. It has been suggested that one such construct may be resilience; given that resilience can help build immunity to psychopathology following adverse experiences (Denckla et al., 2020). In the context of Northern Ireland, no study to date has examined childhood adversities and psychopathological outcomes or any mediating or moderating factors of this association in UK Armed Forces veterans residing in Northern Ireland. There has however been research on childhood adversities, polyvictimisation profiles, and associated outcomes as reported in the general Northern Irish population. The rates of adversity were high comparative to reports from other countries and one potential explanation for this is the prolonged period of civil conflict experienced by residents, including children, of Northern Ireland. Individuals in polyvictimisation classes were more likely to report a range of psychopathologies compared to those in a class reporting little to no adversity (McLafferty et al., 2015). Objectives: The current study examined, for the first time, the rates of childhood adversity experiences in a sample of UK Armed Forces veterans residing in Northern Ireland. Further, we examined the co-occurrence of reported adverse childhood experiences and subsequently assessed the mediating role of resilience as it pertains to membership in an adversity class and psychopathological outcomes including depression, anxiety, and PTSD. Methods: This study used data collected during the Northern Ireland Veterans’ Health and Wellbeing Study (NIVHWS). This was a large-scale, cross-sectional, self-report survey conducted between December 2017 and June 2019. Overall, 1,329 veterans completed the survey but due to the nature of the survey and the use of skip functions in addition to data reduction due to missingness, the sample for the current analysis was 656 respondents. Respondents completed the Adverse Childhood Experiences Questionnaire, the Connor-Davidson Resilience Scale (CDRS), The Patient health Questionnaire – 9 (PHQ-9), the Generalised Anxiety Disorder −7 (GAD-7) and the PTSD checklist for DSM-5 (PCL-5). Using SPSS version 25 and Mplus version 7.31 we conducted a series of analyses including frequencies, latent class analyses, and mediation analyses. Results: Reported rates of adversities and depression, anxiety, and PTSD were high. Utilising data across 10 childhood adversities (psychological abuse, physical abuse, sexual abuse, felt unloved, neglect, parent separation, witnessed domestic abuse, substance abuse at home, mental health problem at home, household member in prison) we uncovered four classes (1. Baseline/Low Risk, 2. Chaotic Home, 3. Physical and Psychological Abuse and 4. Multi-adversity). Individuals in the Multi- adversity and Abuse classes were much more likely to report depression and anxiety, and those in the Multi-adversity class were more than 2.5 times more likely to have PTSD when compared to the low risk class. Concerning mediation analyses, when resilience was included in the mediation model the impact of childhood adversities on psychological health reduced. Conclusions: Reports of childhood adversities and polyvictimisation is found in a UK Armed Forces veteran population resident in Northern Ireland. Those reporting a greater degree of adversity are at increased risk of a range of adverse psychological outcomes. The association between the experience of adversity in childhood and psychopathological outcomes can however be mediated by a greater degree of resilience.