Impact Of Adverse Childhood Experiences Research Articles

The Association between Adverse Childhood Experiences and Alcohol Use during Pregnancy in a Representative Sample of Adult Women

BackgroundThe impact of adverse childhood experiences (ACEs) on adult alcohol consumption is well-established, but little is known about the association with alcohol use during pregnancy. MethodsUsing data from the 2010 Nevada Behavioral Risk Factor Surveillance System, we assessed the relationship between ACEs and alcohol use during pregnancy in a representative sample of 1,987 adult women. An established ACEs scale was used to assess a range of childhood physical, emotional, and sexual abuse and household dysfunction (range, 0–8). Weighted logistic regression was used to assess the relationship between ACE scores and alcohol use during pregnancy after controlling for drinking before pregnancy and other covariates. ResultsSix percent of participants reported drinking alcohol during pregnancy. After controlling for race/ethnicity, age, employment status, smoking status, and prepregnancy alcohol use, increasing ACEs were positively associated with higher odds of alcohol use during pregnancy (1 ACE: adjusted odds ratio [AOR], 2.92; 95% CI, 1.08–7.87), (2–3 ACEs: AOR, 3.52; 95% CI, 1.46–8.48), and (≥4 ACEs: AOR, 4.79; 95% CI, 2.14–10.72). Prepregnancy drinking was also strongly associated with alcohol use during pregnancy (AOR, 11.95; 95% CI, 5.02–28.43). ConclusionsWe found evidence of a dose–response relationship between ACEs and alcohol use during pregnancy that remained even after controlling for prepregnancy drinking and other covariates. Screening women of childbearing age as well as pregnant women for ACEs may be an effective way to identify and address many of the emotional, behavioral, and physical sequelae of childhood adversity.

Self Reported Childhood Difficulties, Adult Multimorbidity and Allostatic Load. A Cross-Sectional Analysis of the Norwegian HUNT Study.

BackgroundMultimorbidity receives increasing scientific attention. So does the detrimental health impact of adverse childhood experiences (ACE). Aetiological pathways from ACE to complex disease burdens are under investigation. In this context, the concept of allostatic overload is relevant, denoting the link between chronic detrimental stress, widespread biological perturbations and disease development. This study aimed to explore associations between self-reported childhood quality, biological perturbations and multimorbidity in adulthood.Materials and MethodsWe included 37 612 participants, 30–69 years, from the Nord-Trøndelag Health Study, HUNT3 (2006–8). Twenty one chronic diseases, twelve biological parameters associated with allostatic load and four behavioural factors were analysed. Participants were categorised according to the self-reported quality of their childhood, as reflected in one question, alternatives ranging from ‘very good’ to ‘very difficult’. The association between childhood quality, behavioural patterns, allostatic load and multimorbidity was compared between groups.ResultsOverall, 85.4% of participants reported a ‘good’ or ‘very good’ childhood; 10.6% average, 3.3% ‘difficult’ and 0.8% ‘very difficult’. Childhood difficulties were reported more often among women, smokers, individuals with sleep problems, less physical activity and lower education. In total, 44.8% of participants with a very good childhood had multimorbidity compared to 77.1% of those with a very difficult childhood (Odds ratio: 5.08; 95% CI: 3.63–7.11). Prevalences of individual diseases also differed significantly according to childhood quality; all but two (cancer and hypertension) showed a significantly higher prevalence (p<0.05) as childhood was categorised as more difficult. Eight of the 12 allostatic parameters differed significantly between childhood groups.ConclusionsWe found a general, graded association between self-reported childhood difficulties on the one hand and multimorbidity, individual disease burden and biological perturbations on the other. The finding is in accordance with previous research which conceptualises allostatic overload as an important route by which childhood adversities become biologically embodied.

176. Adverse Childhood Events Among Youths in Custodial Facilities: Their Impact and the Additional Impact of Monoparental Families

Over the last two decades, studies in adults have shown a correlation between adverse childhood experiences (ACE) and unfavorable health outcomes (mental health, substance abuse, suicide attempts, high-risk sexual behaviour, chronic diseases, etc.). However, there are few data on the impact of ACEs on the health status of teenagers, especially youths living in custodial facilities who represent an at-risk group. We undertook this analysis with the objective of evaluating if there is an association between the number of adverse childhood experiences and the health status of teenagers in custodial facilities.

Adverse childhood experiences: assessing the impact on health and school engagement and the mitigating role of resilience.

The ongoing longitudinal Adverse Childhood Experiences Study of adults has found significant associations between chronic conditions; quality of life and life expectancy in adulthood; and the trauma and stress associated with adverse childhood experiences, including physical or emotional abuse or neglect, deprivation, or exposure to violence. Less is known about the population-based epidemiology of adverse childhood experiences among US children. Using the 2011-12 National Survey of Children's Health, we assessed the prevalence of adverse childhood experiences and associations between them and factors affecting children's development and lifelong health. After we adjusted for confounding factors, we found lower rates of school engagement and higher rates of chronic disease among children with adverse childhood experiences. Our findings suggest that building resilience-defined in the survey as "staying calm and in control when faced with a challenge," for children ages 6-17-can ameliorate the negative impact of adverse childhood experiences. We found higher rates of school engagement among children with adverse childhood experiences who demonstrated resilience, as well as higher rates of resilience among children with such experiences who received care in a family-centered medical home. We recommend a coordinated effort to fill knowledge gaps and translate existing knowledge about adverse childhood experiences and resilience into national, state, and local policies, with a focus on addressing childhood trauma in health systems as they evolve during ongoing reform.

Setting the stage for chronic health problems: cumulative childhood adversity among homeless adults with mental illness in Vancouver, British Columbia.

BackgroundIt is well documented that childhood abuse, neglect and household dysfunction are disproportionately present in the backgrounds of homeless adults, and that these experiences adversely impact child development and a wide range of adult outcomes. However, few studies have examined the cumulative impact of adverse childhood experiences on homeless adults with mental illness. This study examines adverse events in childhood as predictors of duration of homelessness, psychiatric and substance use disorders, and physical health in a sample of homeless adults with mental illness.MethodsThis study was conducted using baseline data from a randomized controlled trial in Vancouver, British Columbia for participants who completed the Adverse Childhood Experiences (ACE) scale at 18 months follow-up (n = 364). Primary outcomes included current mental disorders; substance use including type, frequency and severity; physical health; duration of homelessness; and vocational functioning.ResultsIn multivariable regression models, ACE total score independently predicted a range of mental health, physical health, and substance use problems, and marginally predicted duration of homelessness.ConclusionsAdverse childhood experiences are overrepresented among homeless adults with complex comorbidities and chronic homelessness. Our findings are consistent with a growing body of literature indicating that childhood traumas are potent risk factors for a number of adult health and psychiatric problems, particularly substance use problems. Results are discussed in the context of cumulative adversity and self-trauma theory.Trials registrationThis trial has been registered with the International Standard Randomized Control Trial Number Register and assigned ISRCTN42520374.

Generating Hypotheses About Care Needs of High Utilizers: Lessons from Patient Interviews

Informed by a largely secondary and quantitative literature, efforts to improve care and outcomes for complex patients with high levels of emergency and hospital-based health care utilization have offered mixed results. This qualitative study identifies psychosocial factors and life experiences described by these patients that may be important to their care needs. Semi-structured interviews were conducted with 19 patients of the Camden Coalition of Healthcare Providers' Care Management Team. Investigators coded transcripts using a priori and inductively-derived codes, then identified 3 key themes: (1) Early-life instability and traumas, including parental loss, unstable or violent relationships, and transiency, informed many participants' health and health care experiences; (2) Many "high utilizers" described a history of difficult interactions with health care providers during adulthood; (3) Over half of the participants described the importance to their well-being of positive and "caring" relationships with primary health care providers and the outreach team. Additionally, the transient and vulnerable nature of this complex population posed challenges to follow-up, both for research and care delivery. These themes illuminate potentially important hypotheses to be explored in more generalizable samples using robust and longitudinal methods. Future work should explore the prevalence and impact of adverse childhood experiences among "high utilizers," and the different types of relationships they have with providers. Investigators should test new modes of care delivery that attend to patients' trauma histories. This qualitative study was well suited to provide insight into the life stories of these complex, vulnerable patients, informing research questions for further investigation.

Childhood adversities in relation to psychiatric disorders

Substantial evidence has documented that adverse childhood experiences exert deleterious effects on mental health. It is less clear to what extent specific maltreatment during specific developmental periods may vary between disorders rather than increasing vulnerability for any particular disorder. The present comparison of characteristics of childhood adversity (type and frequency of adversity, developmental period) between major depressive disorder (MDD), borderline personality disorder (BPD), schizophrenia, and psychiatrically healthy subjects examined how effects of adverse childhood experiences vary between disorders. Patients generally reported more adverse events than healthy subjects. Irrespective of diagnosis, emotional maltreatment was substantial in all patients. BPD was characterized by marked increase of adversities across age relative to MDD and schizophrenia. Fifty-six percent of BPD, 40% of MDD and 18% of schizophrenia cases experienced a significant degree of early childhood adversity. Stress pattern (type and time) varied between diagnoses, but not for patients with significant early adversities. Regression analyses confirmed early experiences as a predictor of BPD, but not of MDD and schizophrenia. Prepubescent experiences predicted affective and traumatic symptoms in BPD, and moderated the association with symptoms in MDD. Results indicate a dose-effect with differential impact of adverse childhood experiences in BPD, MDD, and schizophrenia, while early maltreatment beyond a certain degree affects mental health independent of diagnosis.

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.

A Typology of Childhood Problems among Chronically Homeless Adults and Its Association with Housing and Clinical Outcomes

Studies of chronically homeless adults have not adequately investigated the impact of adverse childhood experiences. The current retrospective, longitudinal study profiles the childhood experiences reported by 738 participants in an 11-site supported housing initiative and examines how their childhood profile is related to their homeless history, their psychosocial status before entry into supported housing, and their outcomes once enrolled in supported housing. A two-step cluster analysis revealed three childhood profiles: Relatively Numerous Childhood Problems, Disrupted Family, and Relatively Few Childhood Problems. Results found that participants with Relatively Numerous Childhood Problems were significantly younger when they were first homeless and had worse drug use before entry into supported housing than other participants. There were no differences in housing, substance use, or mental and physical health outcomes once participants were enrolled in supported housing. Prevention of homelessness should focus, to the extent possible, on individuals with extensive childhood problems.

The impact of adverse childhood experiences on an urban pediatric population

Objective The goal of this study was to investigate the adverse childhood experiences (ACEs) in youth in a low-income, urban community. Study design Data from a retrospective chart review of 701 subjects from the Bayview Child Health Center in San Francisco are presented. Medical chart documentation of ACEs as defined in previous studies were coded and each ACE criterion endorsed by a traumatic event received a score of 1 (range = 0–9). This study reports on the prevalence of various ACE categories in this population, as well as the association between ACE score and two pediatric problems: learning/behavior problems and body mass index (BMI) ≥ 85% (i.e., overweight or obese). Results The majority of subjects (67.2%, N = 471) had experienced 1 or more categories of adverse childhood experiences (ACE ≥ 1) and 12.0% ( N = 84) had experienced 4 or more ACEs (ACE ≥ 4). Increased ACE scores correlated with increased risk of learning/behavior problems and obesity. Conclusions There was a significant prevalence of endorsed ACE categories in this urban population. Exposure to 4 or greater ACE categories was associated with increased risk for learning/behavior problems, as well as obesity. Practice implications Results from this study demonstrate the need both for screening of ACEs among youth in urban areas and for developing effective primary prevention and intervention models.

The Impact of Adversity in Childhood on Outcomes in Adulthood

• Summary: Current UK Government policy is concerned with the possible connections between childhood adversity, social exclusion and negative outcomes in adulthood. Understanding the impact of adverse childhood experiences on outcomes in adulthood is therefore key to informing effective policy and practice. In this article, the research on the impact of childhood adversity on outcomes in adulthood is reviewed in the broad categories of: mental health and social functioning; physical health; offending; service use; and economic impact. The literature on resilience that focuses on those who experience adversity, but do not have associated negative outcomes is also briefly considered. The strengths and limitations of the range of research methods used are then examined. • Findings: Previous studies have tended to focus on specific forms of adversity, predominantly abuse and neglect, and either: specific populations and specific outcomes; specific populations and general outcomes; or general populations and specific outcomes. This means there may be incomplete understanding of the inputs (the range of adverse experiences in childhood), the processes (how these may affect people) and the outcomes (across domains in adulthood). • Applications : It is concluded that it is important for social work researchers to engage in the current debate about how to prevent harmful childhood adversity and there is an important gap in the research for more interdisciplinary large-scale general population studies that consider the full range of childhood adversity and associated impacts across time and the possible processes involved.

Risky Health Behaviors Among Mothers-to-Be: The Impact of Adverse Childhood Experiences

Adverse childhood experiences (ACEs) are risk factors for health problems later in life. This study aims to assess the influence of ACEs on risky health behaviors among mothers-to-be and determine whether a dose response occurs between ACEs and risky behaviors. A prospective survey of women attending health centers was conducted at the first prenatal care visit, and at 3 and 11 months postpartum. Surveys obtained information on maternal sociodemographic and health characteristics, and 7 ACEs prior to age 16. Risky behaviors included smoking, alcohol use, marijuana use, and other illicit drug use during pregnancy. Our sample (N = 1476) consisted of low-income (mean annual personal income, $8272), young (mean age, 24 years), African American (71%), single (75%) women. Twenty-three percent of women reported smoking even after finding out they were pregnant, 7% reported alcohol use, and 7% reported illicit drug use during pregnancy. Nearly three fourths (72%) had one or more ACEs. There was a higher prevalence of each risky behavior among those exposed to each ACE than among those unexposed. The exception was alcohol use during pregnancy, where there was not an increased risk among those exposed when compared with those unexposed to witnessing a shooting or having a guardian in trouble with the law or in jail. The adjusted odds ratio for each risky behavior was >2.5 for those with >3 ACEs when compared with those without. ACEs were associated with risky health behaviors reported by mothers-to-be. Greater efforts should target the prevention of ACEs to lower the risk for adverse health behaviors that have serious consequences for adults and their children.

Depressive psychopathology and adverse childhood experiences in eating disorders

Purpose. – The aim of this paper was to investigate the diagnostic specificity of the self-critical and dependent depressive experiences in a clinical sample of eating disorder patients and to explore the impact of adverse childhood experiences on these dimensions of personality. Method. – A sample of 94 anorexic and 61 bulimic patients meeting DSM-IV criteria and 236 matched controls were assessed with the Depressive Experience Questionnaire (DEQ), the abridged version of the Beck Depression Inventory (BDI) and the AMDP Life Events Inventory. Subjects presenting a major depression or a comorbid addictive disorder were excluded from the sample using the Mini International Neuropsychiatric Interview (MINI). Results. – Anorexic and bulimic patients showed higher scores than controls on both self-criticism and dependency sub-scales of the DEQ. Bulimic patients scored significantly higher than anorexic patients on self-criticism and reported more adverse childhood experiences. Finally, negative life events correlated only with self-criticism in the whole sample. Discussion. – Differences in the DEQ Self-Criticism between anorexics and bulimics could not be accounted for by depression since bulimic patients did not show higher BDI levels compared to anorexic patients and depressive symptoms measured with the BDI were not found to be significant predictors of diagnostic grouping in a logistic multiple regression. Conclusion. – This study supports the diagnostic specificity of the dependent and self-critical depressive dimensions in eating disorders and strengthens previous research on the role of early experiences in the development of these disorders.

The impact of adverse childhood experiences on health problems: evidence from four birth cohorts dating back to 1900

Background We examined the relationship of the number of adverse childhood experiences (ACE score) to six health problems among four successive birth cohorts dating back to 1900 to assess the strength and consistency of these relationships in face of secular influences the 20th century brought in changing health behaviors and conditions. We hypothesized that the ACE score/health problem relationship would be relatively “immune” to secular influences, in support of recent studies documenting the negative neurobiologic effects of childhood stressors on the developing brain. Methods A retrospective cohort study of 17,337 adult health maintenance organization (HMO) members who completed a survey about childhood abuse and household dysfunction, as well as their health. We used logistic regression to examine the relationships between ACE score and six health problems (depressed affect, suicide attempts, multiple sexual partners, sexually transmitted diseases, smoking, and alcoholism) across four successive birth cohorts: 1900–1931, 1932–1946, 1947–1961, and 1962–1978. Results The ACE score increased the risk for each health problem in a consistent, strong, and graded manner across four birth cohorts ( P < 0.05). For each unit increase in the ACE score (range: 0–8), the adjusted odds ratios (ORs) for depressed affect, STDs, and multiple sexual partners were increased within a narrow range (ORs: 1.2–1.3 per unit increase) for each of the birth cohorts; the increase in risk for suicide attempts was stronger but also in a narrow range (ORs: 1.5–1.7). Conclusions Growing up with ACEs increased the risk of numerous health behaviors and outcomes for 20th century birth cohorts, suggesting that the effects of ACEs on the risk of various health problems are unaffected by social or secular changes. Research showing detrimental and lasting neurobiologic effects of child abuse on the developing brain provides a plausible explanation for the consistency and dose–response relationships found for each health problem across birth cohorts, despite changing secular influences.

Adult outcome of children reared for long-term periods in foster families

Objective: To study the long term impact of adverse childhood experiences resulting from family breakdowns combined with a stable care environment. Another aim was to determine predictive factors for maladjusted psycho-social integration in adulthood. Method: Sixty-three children from severely psychosocially dysfunctioning families selected from among those having been in care in an institutional setting: All had been reared for at least 5 years by foster families, had been out of care for more than 5 years and were at least 23 years old at the time of the survey. Semi-structured interviews were used in a follow-up study to assess adult outcome, essentially in terms of professional status, social, and family relationships. Results: Data was obtained for 94% of the study population ( n = 59), 71% via direct interviews ( n = 45). The majority had managed to overcome their childhood adversities: 56% were well-integrated socially, 12% had average integration results, 20% were partially integrated and 10% were in situations of failure. These difficulties were linked to multiple family disturbances and repeated traumatic experiences during childhood ( p < .05). Multiple regression analyses indicated that these risk factors accounted for 28% of the variance in the social integration score ( p < .0001). Severe emotional deprivation over a prolonged period was a contributing factor to clinical disorders. Conclusion: At the study period, intergenerational repetition of “child placement” behaviors, significant in the previous generation, had practically disappeared. The results also highlighted the substantial psychotherapeutic and child-rearing assistance provided by the staff of the foster care agency.

Eating-disordered behavior in males: the impact of adverse childhood experiences.

The authors examined the possible relationship of childhood sexual abuse, physical abuse, and dysfunctional family background and the risk for developing an eating disorder in adult males. Several anonymous questionnaires were distributed to male university students. Of the 301 men, 12 (4.0%) had experienced childhood sexual abuse, 11 (3.6%) had been victims of physical abuse, 79 (26.2%) reported an adverse family background, and 14 (4.6%) had an increased risk for developing an eating disorder. There were no significant differences in the risk for developing an eating disorder and in total EDI between victims and nonvictims, but a significantly increased risk for eating disorders in men with an adverse family background. The findings suggest that long-lasting negative familial relationships, particularly in connection with physically abusive experiences, may increase the risk for eating disorders.

O-7-5 - On the possible role of testosterone in serotonin-related psychiatric disorders in Women

Purpose. – The aim of this paper was to investigate the diagnostic specificity of the self-critical and dependent depressive experiences in a clinical sample of eating disorder patients and to explore the impact of adverse childhood experiences on these dimensions of personality.Method. – A sample of 94 anorexic and 61 bulimic patients meeting DSM-IV criteria and 236 matched controls were assessed with the Depressive Experience Questionnaire (DEQ), the abridged version of the Beck Depression Inventory (BDI) and the AMDP Life Events Inventory. Subjects presenting a major depression or a comorbid addictive disorder were excluded from the sample using the Mini International Neuropsychiatric Interview (MINI).Results. – Anorexic and bulimic patients showed higher scores than controls on both self-criticism and dependency sub-scales of the DEQ. Bulimic patients scored significantly higher than anorexic patients on self-criticism and reported more adverse childhood experiences. Finally, negative life events correlated only with self-criticism in the whole sample.Discussion. – Differences in the DEQ Self-Criticism between anorexics and bulimics could not be accounted for by depression since bulimic patients did not show higher BDI levels compared to anorexic patients and depressive symptoms measured with the BDI were not found to be significant predictors of diagnostic grouping in a logistic multiple regression.Conclusion. – This study supports the diagnostic specificity of the dependent and self-critical depressive dimensions in eating disorders and strengthens previous research on the role of early experiences in the development of these disorders.