Adverse Childhood Experiences Screening Research Articles

Screening for Adverse Childhood Experiences: A Critical Appraisal.

Adverse childhood experiences (ACEs) are common and can impact health across the life course. Thus, it is essential for professionals in child- and family-serving roles, including pediatric and adult primary care clinicians, to understand the health implications of childhood adversity and trauma and respond appropriately. Screening for ACEs in health care settings has received attention as a potential approach to ACEs identification and response. Careful examination of the existing evidence on ACEs screening and consideration, from a clinical and ethical perspective, of the potential benefits, challenges, and harms is critical to ensuring evidence-informed practice. In this critical appraisal, we synthesize existing systematic and scoping reviews on ACEs screening, summarize recent studies on the ability of ACEs to predict health outcomes at the individual level, and provide a comprehensive overview of potential benefits, challenges, and harms of ACEs screening. We identify gaps in the existing evidence base and specify directions for future research. We also describe trauma-informed, relational care as an orientation and perspective that can help pediatric and primary care clinicians to sensitively assess for and respond to ACEs and other potentially traumatic experiences. Overall, we do not yet have sufficient evidence regarding the potential benefits, challenges, and harms of ACEs screening in health care and other settings. In the absence of this evidence, we cannot assume that screening will not cause harm and that potential benefits outweigh potential harms.

Prevalent Adverse Childhood Experiences Among Young Adults Returning Home From Jail: The Need for Trauma-Informed Reentry Services.

Prevalence of adverse childhood experiences (ACEs) and the extent to which they relate to health among young adults (ages 18-25) returning home from jail is underexamined. To build on the growing literature examining associations between ACE exposure among young people involved with carceral systems and health, we (1) measured ACE prevalence and (2) explored associations between ACEs and health/well-being indicators among young adults experiencing reentry. Using a telephone survey on reentry experiences, participants completed an ACE screening, single-item responses on health and social indicators, and five-item responses on substance misuse. Fisher's exact tests and t tests compared sociodemographic and health-related factors by the levels of ACEs. Among the 85 participants, 66 (78%) reported four or more ACEs and 48 (56%) reported six or more ACEs, including divorced parents (n = 69, 81%), witnessing violence (n = 63, 74%), and household member incarceration (n = 60, 71%). Higher exposure to ACEs was associated with mental health diagnoses, psychiatric medication prescriptions, psychiatric hospitalizations, drug dependence, binge drinking, and cannabis misuse. High ACE exposure among young adults experiencing reentry portends worse mental health and high rates of substance use. Findings signify an opportunity to apply a trauma-focused developmental framework to support emerging adults during the crucial reentry period.

Adverse Childhood Experiences in Parental History and how they Relate to Subsequent Observed Parent–Child Interaction: A Systematic Review

Abstract Background Adverse childhood experiences (ACEs) in parental history have been associated with higher self-reported rates of negative parenting behaviors and lower self-reported rates of positive parenting behaviors. Further research is needed to explore the association between parental ACEs and the observed parent–child interaction quality. Parent–child interactions are a potential pathway behind the continuity of ACEs across generations. Objective This review aimed to expand on existing literature by synthesizing evidence on the associations between parental ACEs and parent–child interactions, assessed through videotaped observations, the gold standard for interaction assessment. Methods A systematic literature search conducted in October 2022 in Medline, EMBASE, and PsycInfo identified twenty-four articles. The studies assessed parental childhood adversity and the quality of parent–child interaction across high- and low-risk samples. Results In 79% of studies, higher rates of childhood adversity were related to lower quality of observed parent–child interaction. Childhood abuse and neglect were linked to fewer positive and more negative parenting behaviors. Among household challenges, only witnessing family violence negatively impacted interaction quality. In 58% of studies, ACEs directly influenced interaction, while in 21% this effect was mediated by other factors. This pattern held across different sample types. Conclusions The evidence suggesting a relationship between parental ACEs and lower quality of parent–child interaction is robust, given the reliability and validity of observational measures. Considering the influence of the quality of parent–child interaction on a child’s development, interventions and prevention programs focusing on parent–child interaction should consider screening for parental ACEs.

Age, Adverse Childhood Experiences, and Health Care Utilization.

To assess whether the association of adverse childhood experiences (ACEs) with pediatric health care utilization differs by age. In this retrospective cohort study, we included patients completing primary care ACEs screening between January 2020 and September 2021. Pediatric ACEs and Related Life Events Screener Part 1 scores were categorized 0, 1 to 3, or ≥4 (none, low, and high, respectively). Two multivariable logistic regression models assessed emergency department (ED) and inpatient utilization across all ages 6 months after screening. Among 37 315 patients, 15.7% visited the ED and 2.5% were hospitalized within 6 months of ACEs screening. Using no ACEs as the reference, infants and toddlers with any ACEs had lower odds of ED and inpatient utilization, whereas older children with any ACEs had higher odds of ED (age-low ACEs: 0.04, P value < .001; age-high ACEs: 0.08, P value < .001) and inpatient (age-low ACEs: 0.06, P value < .001; age-high ACEs: 0.15, P value < .001) utilization and increased each successive year of age. The association of ACEs with health care utilization is dependent on age and is more complex than previously described. These trends may inform specific therapeutic strategies for pediatric patients by age.

Examining the Association Between Adverse Childhood Experiences and ADHD in School-Aged Children Following the COVID-19 Pandemic.

Adverse childhood experiences (ACEs) have long been associated with attention-deficit/hyperactive disorder (ADHD) diagnoses in children; but the data used is now over 6 years old (from 2017 to 2018). Understanding the current landscape of their prevalence and association is needed to capture evolving social, environmental, and economic conditions, and ensure interventions remain relevant to addressing current childhood trauma. This study provides an updated analysis of the association between ACEs and ADHD using post-acute-COVID-19 pandemic data. This cross-sectional study of 10,518 children aged 5 to 17 years old derived data from the 2021 to 2022 National Health Interview Survey (NHIS). Differences in the prevalence of number (0, 1-3, or 4+) and type of ACEs by ADHD diagnosis were evaluated using Rao-Scott chi-square tests and multivariable logistic regression. All analyses incorporate complex survey weights. In 2021 to 2022, 2,457 (23.3%) of children experienced ACEs and 1,115 (9.9%) had an ADHD diagnosis. Children with ADHD were more likely to experience every type of ACE and were more likely to have 1 to 3 or 4+ ACEs than children without ADHD. Children with 4+ ACEs had higher odds of having an ADHD diagnosis (aOR: 3.44, 95% CI [2.64, 4.49]) than children without ACEs. Male children, children with fair or poor health, and children living in rural counties were more likely to have an ADHD diagnosis, while children of color and uninsured children were less likely. We found the odds ratio of ADHD diagnosis for children with four or more ACEs, compared to those without ACEs, slightly lower than found in Brown et al., 2017's estimate of 3.97 (CI [3.29, 4.80]). These results suggest a consistent association between ACEs and ADHD when comparing pre-COVID data to our post-acute-COVID results. These findings highlight the need for clinicians to consider traumatic stress in ADHD screening. Policymakers and early childhood organizations should encourage early screening and intervention for ACEs to reduce the impacts of ADHD diagnoses.

Differences in Exposures to Adverse Childhood Experiences by Primary Source of Health Care, Behavioral Risk Factor Surveillance System 2019-2020.

To estimate the prevalence of adverse childhood experiences (ACEs) among a population-based sample of adults in the United States by their primary source of health care. Debate continues around the effectiveness and implementation of health care-based screening of ACEs. However, it is unclear how the burden of ACEs would be distributed across different sources of health care (ie, what a health system might expect should it implement ACEs screening). Data are from 8 U.S. states that include optional modules for ACEs and health care utilization in their 2019 or 2020 Behavioral Risk Factor Surveillance System survey. The analytic sample includes respondents with completed interviews (n = 45,820). ACEs were categorized into ordinal categories of 0, 1, 2, 3, or ≥4, and the prevalence of ACEs was summarized across 5 sources of health care: (1) employer-based or purchased plan, (2) Medicare, Medicaid, or other state programs, (3) TRICARE, Veterans Affairs, or military (ie, military-related health care), (4) Indian Health Service, or (5) some other source. All estimates were weighted to account for the complex sampling design. Across all health insurance types, at least 60% of individuals reported at least one ACE. The greatest prevalence of patients reporting ≥4 ACEs occurred for military-related health care (21.6%, 95% CI = 18.2-25.5) and Indian Health Service (45.4%, 95% CI = 22.6-70.3). ACEs are extremely common across sources of health care, but some health systems have greater proportions of patients with high ACE exposures. The unique strengths and challenges of specific health care systems need to be integrated into the debate about clinical ACEs screening.

Investigating the Impact of Caregiver Adverse Childhood Experiences Screening and Pediatrician-Led Discussions on Posttraumatic Stress Disorder Symptoms in a Majority-Hispanic Pediatric Primary Care Clinic Setting

Background: Evidence suggests that screening and provider-led discussions of parental adverse childhood experiences (ACEs) may help identify at-risk families and be linked to positive health outcomes in caregivers and their children. However, the direct effect of ACEs screening and discussions on posttraumatic stress disorder (PTSD) has yet to be studied. Objectives: To determine if screening or provider-led discussions of parental ACEs are associated with inadvertent worsening of PTSD symptoms 1 week after screening. Research Design: Data was obtained as part of a cluster randomized controlled trial to examine the effects of ACEs screening and provider-led discussions on child health care utilization outcomes. Baseline surveys were completed before scheduled infant well child checks (WCCs). Providers were randomized into the standard of care or intervention (discussion) conditions. Intervention providers were trained in delivering brief trauma-informed discussions about the impact of ACEs on parenting during WCCs. Subjects: Caregivers in a pediatric primary care clinic serving predominantly Hispanic and low socioeconomically resourced families (N=179, 93% female, 87% Hispanic). Measures: The Primary Care PTSD Screen for DSM-5 (PC-PTSD-5), Brief Resilience Scale (BRS), and ACEs screening were completed at baseline. PC-PTSD-5 was repeated 1-week after screening. Results: Mixed-effects ordinal logistic regression analysis of PTSD scores from baseline to 1-week postscreening with the full sample showed no significant effect of time [odds ratio (OR)=1.21, P=0.68], group (OR=1.68, P=0.33), or their interaction (OR=0.48, P=0.21). Conclusions: Screening or brief discussion of ACEs with providers trained in trauma-informed care were not associated with worsening PTSD symptoms.

Implementing an Adverse Childhood Experiences Screening Tool With Migrant Children: A Quality Improvement Project Using the PEARLS Screening Tool

BackgroundImmigrants, asylum seekers, and refugees live with extreme stress, consistent vulnerability, and life-long health consequences. Children in these populations face increased risk of poor mental health due to adverse childhood experiences (ACEs) and related healthcare barriers, such as lack of screening, that limit their ability to receive appropriate mental health care. AimTo implement an ACEs screening questionnaire for all migrant children 19 and under in a community shelter. MethodsThe Model for Improvement. InterventionThe Pediatric ACES and Related Life Events Screener (PEARLS) was implemented over a 10-week period in a community shelter. ResultsAll children screened had at least 1 ACE. Initiation of PEARLS screening led to recognition of adverse experiences thus allowing for mental health support and referrals to mental health specialists. ConclusionsThis QI project supports implementation of screening for adverse childhood experiences within populations of migrant children in order to uncover potential mental health concerns and provide targeted support, recognizing the long-term effects of trauma on their wellbeing.

Assessment of adverse childhood experiences in adolescents from a rural agricultural community: Associations with depressive symptoms and psychosocial problems

The main goal of this study was to determine the prevalence of adverse childhood experiences (ACEs) among Latino adolescents from an agricultural community and to examine how it may impact their neuropsychiatric functioning. This research particularly assessed the association between ACEs and depression, as well as ACEs and psychosocial problems. The study sample consisted of 852 adolescents treated at a rural primary care clinic with a comprehensive ACE screening protocol that assesses for ACEs, depressed mood, and psychosocial functioning during every annual Well-Child Visit. Study results showed that ACEs were relatively common among participants with 64 % endorsing having experienced at least one ACE. Approximately 23 % of participants screened positive for depressed mood and 11 % for psychosocial problems. ACEs were found to have significant associations with both depression symptoms and with psychosocial problems. Males were found to have less depression symptoms than females among subjects with exposure to most ACE types, and older age was associated with lower psychosocial impairment. Study participants live in an agricultural community and are likely exposed to both chemical and non-chemical stressors. The exposure to ACEs and chemical environmental stressors may interact with pathological synergy to alter their biobehavioral development. Further research is needed to understand the “rules” for which stressors at what dose and at what stage of development place youth at greatest risk.

Cumulative Adverse Childhood Experiences (ACEs) and Recidivism: A Meta-Analysis

This meta-analysis quantitatively synthesizes existing literature to investigate the relationship between aggregations of adverse childhood experiences (ACEs) and recidivism among court-involved youth and adults. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed, and moderation analyses were conducted. Sixteen studies (published n = 12), encompassing 101,778 unique participants (girls/women = 21.1%; adults n = 1,204), met the inclusion criteria. A small overall effect size revealed that an accumulation of ACEs increased the odds of reoffending. The relationship between ACEs and recidivism was only statistically significant for the subgroup of studies using youth samples. In addition, ACEs only predicted recidivism in the subgroup of published studies (compared to dissertations). Other moderators (gender, study location, recidivism time frame) were not significant. Our results suggest that courts, particularly youth courts, would benefit from screening for cumulative ACEs to help identify those most at risk for reoffending and in need of intervention.

Applying Adverse Childhood Experience (ACE) Screening in Adolescent Inpatient Mental Health

ABSTRACT This quality improvement project aimed to implement screening for adverse childhood experiences (ACEs) and other related life stressors in inpatient adolescent psychiatry and to assess their relationship with mental health clinical and quality indicators. The project was conducted in a 25-bed adolescent inpatient unit in Los Angeles County from 2022 to 2023. The Pediatric ACEs and Related Life Events Screener (PEARLS) was used for systematic ACE screening. ACE screening results, demographic and clinical data, youth perceptions of trauma-informed care, new PTSD diagnoses, and length of hospitalization were collected throughout the project period. Linear and logistic regression models were used to examine the relationship between ACE scores, stressful life events, and outcome measures. The sample included 103 adolescents admitted for a psychiatric emergency. Most patients were girls (75.7%), and 94% had at least one ACE. The average length of stay was 6.4 days, and 30% of youth received a new diagnosis of PTSD during hospitalization. Higher ACE scores were associated with increased odds of a new PTSD diagnosis. Sexual abuse and death of a parent/caregiver were the only individual items associated with new PTSD diagnosis. This quality improvement project implementing ACE screening in inpatient adolescent psychiatry demonstrated a high prevalence of ACEs among the target population and the need for trauma-informed care. Our findings contribute to the growing efforts to address ACEs and improve the quality of trauma-informed care in child-serving systems.

Parent Perspectives on Social Risk Screening in the PICU.

Health inequities are widespread and associated with avoidable poor health outcomes. In the PICU, we are increasingly understanding how health inequities relate to critical illness and health outcomes. Experts recommend assessing for health inequities by screening for social determinants of health (SDOH) and adverse childhood experiences (ACEs); however, guidance on screening is limited and screening has not been universally implemented. Our study aimed to understand parent perspectives on screening for SDOH/ACEs in the PICU, with the primary objective of determining whether screening would be acceptable in this setting. We conducted a qualitative study using semistructured interviews with a convenience sample of eleven PICU parents between November 2021 and January 2022. Urban, quaternary free-standing children's hospital. Parents of children with a PICU hospitalization between November 2020 and October 2021. None. Domains of interest included experience with and attitudes toward SDOH/ACEs screening, perspectives on addressing needs with/without resources and their relationship to health, and recommendations for screening. Interviews were transcribed verbatim and coded with an inductive approach using thematic analysis and constant comparative methods. Ann & Robert H. Lurie Children's Institutional Review Board approved this study (2021- 4781, Approved September 13, 2021). Ten participants found SDOH/ACEs screening to be acceptable and valuable in the PICU, even for topics without a readily available resource. Participants did not have broad experience with ACEs screening, though all believed this provided the medical team with valuable context regarding their child. Ten participants recommended screening occur after their child has been stabilized and that they are notified that screening is universal. Participants found screening for SDOH/ACES to be acceptable and valuable in the PICU. Families have important insight that should be leveraged to improve the support of unmet needs through the development of strengths-based, parent-informed screening initiatives.

Constructing Adolescent-Friendly Settings to Facilitate Screening for Adverse Childhood Experiences

This study was conducted to elicit clinicians’ and adolescents’ perspectives regarding adverse childhood experiences (ACEs) screening. Fourteen clinician interviews and 3 adolescent focus groups (n = 12 youth) were conducted, transcribed, coded, and analyzed using grounded theory. Participants noted scarcity of time and private space, adolescents’ disclosure concerns, importance of confidentiality, and benefits of opening adversity conversations. Engaging trust may facilitate teen disclosure and conversations about ACEs. Policies to protect confidentiality of screening and records, provide time for discussions about results, destigmatize trauma, and foster continuity and acceptance in provider-adolescent relationships are critical to successful implementation and adolescent acceptance of ACEs screening.

Patient‐Provider Trust as a Key Component of Prenatal Screening for Adverse Childhood Experiences (ACES): A Concept Analysis

IntroductionThe concept of patient‐provider trust in prenatal adverse childhood experiences (ACEs) screening remains unexplored. This concept analysis illuminates the role of trust in prenatal ACE screening to improve patient‐provider relationships, increase patient uptake of ACE screening, and ensure that ACE screening is implemented in a strengths‐based, trauma‐informed way.MethodsA concept analysis was conducted using the Rodgers’ evolutionary method to define the antecedents, attributes, and consequences of this construct. The databases searched were PubMed, PsychInfo, and Scopus between 2010 and 2021. A total of 389 articles were retrieved using the search terms prenatal, adverse childhood experiences screening, adverse childhood experiences, and adverse childhood experiences questionnaire. Included articles for detailed review contained prenatal screening, trauma screening (ACE or other), trust or building trust between patient and health care provider, patient engagement, and shared decision making. Excluded articles were those not in the context of prenatal care and that were exclusively about screening with no discussion about the patient‐provider relationship or patient perspectives. A total of 32 articles were reviewed for this concept analysis.ResultsWe define trust in prenatal ACE screening as a network of evidence‐based attributes that include the timing of the screening, patient familiarity with the health care provider, cultural competence, demystifying trauma, open dialogue between the patient and health care provider, and patient comfort and respect.DiscussionThis concept analysis elucidates the importance of ACE screening and provides suggestions for establishing trust in the context of prenatal ACE screening. Results give insight and general guidance for health care providers looking to implement ACE screening in a trauma‐informed way. Further research is needed to evaluate pregnant patients' attitudes toward ACE screening and how a health care provider's trauma history might influence their care. More inquiry is needed to understand the racial, ethnic, and cultural barriers to ACE screening.

Caregiver report of adverse childhood events: comparison of self-administered and telephone questionnaires

Adverse childhood experiences (ACEs) are traumatic experiences that increase people’s susceptibility to adverse physical health, mental health, and social consequences in adulthood. Screening for ACEs in primary care settings is complicated by a lack of consensus on appropriate methods for identifying exposure to ACEs. It is unclear whether self-report methods could increase disclosure of ACEs as compared to interview-based methods. This study compares data on the prevalence of ACEs from two publicly available surveys conducted on the same population of children’s caregivers: the 2019 Ohio subsample of the web/mail-based National Survey of Children’s Health and the telephone-based 2019 Ohio Medicaid Assessment Survey. We find higher disclosure of caregiver-reported child exposure to ACEs in the telephone interview survey, highlighting the importance of the role of verbal communication in developing a safe and trusting relationship in the disclosure of trauma.

Evaluation of an Embedded Health Psychologist Intervention for Obstetric Patients With Adverse Childhood Experiences.

Screening for adverse childhood experiences (ACEs) and resilience in pregnancy is a promising practice for mitigating ACEs-related health complications. Yet, the best follow-up for pregnant patients with high ACEs and/or low resilience has not been established. This study evaluates referrals to and participation in an embedded health psychologist (EHP) intervention for pregnant patients with ACEs and/or low resilience. Patients in 3 Kaiser Permanente Northern California medical centers with ACEs who had also received resilience screening during standard prenatal care and who were participating in an EHP intervention were included (N = 910). The authors used multivariable logistic regression to examine whether ACEs (0, 1-2, 3+) and resilience (high vs low) were associated with referrals to and participation in EHP intervention. They also evaluated the impact of EHP intervention through clinician (N = 53) and patient (N = 51) surveys. Patients with 3+ vs 0 ACEs were more likely to receive an EHP referral (adjusted odds ratio [aOR] = 2.89, 95% confidence interval [CI]: 1.93-4.33) and were more likely to participate in EHP intervention (aOR = 2.85, 95% CI: 1.87-4.36). Those with low vs high resilience were also more likely to receive an EHP referral (aOR = 1.86, 95% CI: 1.32-2.62) and participate in EHP (aOR = 1.71, 95% CI: 1.19-2.44). When ACEs and resilience were combined, those with high ACEs and low resilience had the greatest odds of referrals and participation. Patients and clinicians reported positive experiences with EHP intervention. Patients with higher ACEs and lower resilience scores were more likely to be referred to and participate in EHP intervention, suggesting that at-risk patients can be successfully linked with a health psychologist when accessible within obstetric care.

Maternal History of Adverse Childhood Experiences and Subsequent Infant Paternal Involvement

Background and Objective Adverse childhood experiences (ACEs) are associated with unfavorable pregnancy outcomes. Fathers’ involvement during pregnancy positively impacts maternal behaviors and birth outcomes. Lack of voluntary paternity acknowledgment (PA) at birth implies potential limited paternal involvement. This study explores the association between mothers with a history of ACEs and PA status for their infants. Methods Using secondary data from the Monroe County Mothers and Babies Health Survey and logistic regression modeling, we assessed the odds of court-mandated paternity affidavit (CM-PA) associated with maternal ACEs. Univariate analyses were conducted first, with additional variables included subsequently. Results Of the 1,556 mothers with legal paternity established for their infants, 279 (18%) had a CM-PA for their infants, and 1,277 (82%) had a PA established voluntarily (vPA). Mothers of infants with CM-PA were more likely to be Black or Hispanic, had lower income and education, had higher substance use and traumatic stress, and had lower social support. A one-point increase in maternal ACE total score was associated with 14% higher odds of CM-PA (OR = 1.14; 95% CI, 1.03–1.27). Maternal experience of household dysfunction was linked to 83% higher odds of CM-PA (OR = 1.83; 95% CI, 1.23–2.71) while living with a problem drinker or drug user during childhood was associated with 70% higher odds of CM-PA (OR = 1.70; 95% CI, 1.09–2.65). Conclusion and Implications for Translation This study suggests a potential link between maternal ACEs and CM-PA, implying possible lower father involvement for the infants whose mothers experienced adverse events in childhood. To address this, future research is warranted to confirm this association and explore interventions like prenatal ACE screening in pregnancy, providing psychological support and resources for mothers to promote infant paternal involvement.

Associations between Adverse Childhood Experiences and Gambling Severity in Youth Online Gamblers: The Mediating Roles of Internalizing, Attention and Externalizing Problems.

This study examined the association between Adverse Childhood Experiences (ACEs) and Gambling Severity (gambling severity), considering the mediating roles of internalizing, externalizing, and attention among youth online gamblers. 762 youth (agemean±SD= 15.03 ± 2.40; agerange = 10-18 years; 75.3% boys) completed the Persian Gambling Disorder Screening Questionnaire (GDSQ-P), Pediatric Symptom Checklist - Youth Report (Y-PSC), and Behavioral Risk Factor Surveillance System Questionnaire (ACE's section, modified by authors). The analysis was done using the SMART PLS software. The reliability and discriminant validity of the provided model were assessed using Partial Least Squares-Structural Equation Modeling (PLS-SEM). According to the results of the PLS-SEM analysis, the present model demonstrated suitable levels of reliability and validity. Adverse Childhood Experiences (ACEs) significantly affected attention, internalizing, externalizing problems, and gambling severity. Additionally, the level of gambling was directly correlated with ACEs. Moreover, the indirect influence of the independent variable on the dependent variable via the mediators was found to be statistically significant (P < .001).These findings suggest that externalizing behaviors, attention problems, and internalizing symptoms mediate the effect of ACEs on gambling severity. Lastly, fitness indices indicated that our proposed model fit the data well (SRMR = 0.06, d_ULS = 1.15, Chi-square = 1291.461, and NFI = 0.71). Our study found that ACEs significantly influence gambling severity among youth online gamblers, with internalizing, externalizing, and attention problems mediating this relationship. Practical implications include integrating ACE screening and targeted interventions for associated mental health issues into youth gambling prevention programs to mitigate the risk of problematic gambling behavior.

Adverse childhood experiences among people with schizophrenia at comprehensive specialized hospitals in Bahir Dar, Ethiopia: a comparative study.

People who have encountered adverse childhood experiences (ACEs) are predisposed to developing schizophrenia, experiencing exacerbated symptoms, and facing an elevated risk of disease relapse. It is imperative to evaluate the prevalence of ACEs to comprehend the specific attributes of this condition and enable the implementation of suitable interventions. The aim of this study was to assess the prevalence of ACEs and its determinants among people with schizophrenia and the patient attendants in Bahir Dar, Ethiopia. A comparative cross-sectional study was carried out at the Comprehensive Specialized Hospitals in Bahir Dar, Ethiopia, from April 26 to June 10, 2023. A total of 291 individuals with schizophrenia and 293 individuals from the patient attendants were selected using a systematic random sampling method. A proportional odds model ordinal logistic regression analysis was used to identify the factors associated with ACEs. The occurrence of at least one ACE among individuals diagnosed with schizophrenia was 69.4%, while patient attendants had a 46.8%, as indicated by the Chi-square test, which showed a significant difference at p <0.05. The study findings indicated that individuals with schizophrenia who have encountered four or more ACEs are more inclined to have lower educational attainment (AOR: 4.69 [1.94 - 11.61]), low resilient coping mechanisms (AOR: 2.07 [1.11 - 3.90]), and poor social support (AOR: 3.93 [2.13 - 7.32]). Conversely, factors such as rural residency, illiteracy, and heightened attachment-related anxiety were found to be notably associated with the patient attendants. In this study, the substantial prevalence of ACEs emphasized the necessity for ACE screening and the implementation of evidence-based interventions to address and alleviate the overall burden of ACEs.

Association between adverse childhood experiences and health related quality of life in adult cancer survivors in the United States.

The impact of adverse childhood experiences (ACEs) on health-related quality of life (HRQOL) is increasingly recognized, however, this has not been studied in cancer survivors in the United States. This study investigates if ACEs are associated with HRQOL in cancer survivors. We conducted a cross-sectional analysis of the 2020 Behavioral Risk Factor Surveillance System from states that administered ACEs and Cancer Survivorship modules. Eligibility criteria included being a cancer survivor and not currently receiving cancer treatment. Primary exposure was number of ACEs (categorized as 0, 1-2, 3, or ≥ 4). Primary outcomes were self-reported measures of HRQOL including worse overall health and ≥ 14 unhealthy days (mentally or physically) per month. Mantel-Haenszel stratified analyses were performed and prevalence ratios were adjusted for age. Of 5,780 participants, 62.0% were female and 67.8% were ≥ 65 years. Prevalence of worse overall health was 22.5% for individuals with no ACEs compared to 30.2% for 2-3 ACEs (aPR = 1.4, 95% CI 1.2, 1.5) and 38.5% for ≥ 4 ACEs (aPR = 1.7, 95% CI 1.5, 2.0). Prevalence of ≥ 14 unhealthy days was 18.1% with no ACEs compared to 21.0% for 1 ACE (aPR = 1.3, 95% CI 1, 1.3), 29.0% for 2-3 ACEs (aPR = 1.6, 95% CI 1.4, 1.8), and 44.8% for ≥ 4 ACEs (aPR = 2.2, 95% CI 2.0, 2.5). Our study provides novel evidence of the association of multiple ACEs with higher prevalence of poor HRQOL in cancer survivors. Screening for ACEs is warranted in all patients to guide targeted interventions to improve HRQOL and mitigate the impact of ACEs on HRQoL in cancer survivors.