Number Of Adverse Childhood Experiences Research Articles

Predicting Uptake of the COVID Coach App Among US Military Veterans: Funnel Analysis Using a Probability-Based Panel.

BackgroundAlthough the COVID-19 pandemic has not led to a uniform increase of mental health concerns among older adults, there is evidence to suggest that some older veterans did experience an exacerbation of preexisting mental health conditions, and that mental health difficulties were associated with a lack of social support and increasing numbers of pandemic-related stressors. Mobile mental health apps are scalable, may be a helpful resource for managing stress during the pandemic and beyond, and could potentially provide services that are not accessible due to the pandemic. However, overall comfort with mobile devices and factors influencing the uptake and usage of mobile apps during the pandemic among older veterans are not well known. COVID Coach is a free, evidence-informed mobile app designed for pandemic-related stress. Public usage data have been evaluated; however, the uptake and usage of the app among older veterans have not been explored.ObjectiveThe purpose of this study was to characterize smartphone ownership rates among US veterans, identify veteran characteristics associated with downloading and use of COVID Coach, and characterize key content usage within the app.MethodsData were analyzed from the 2019-2020 National Health and Resilience in Veterans Study (NHRVS), which surveyed a nationally representative, prospective cohort of 3078 US military veterans before and 1 year into the pandemic. The NHRVS sample was drawn from KnowledgePanel, a research panel of more than 50,000 households maintained by Ipsos, Inc. The median time to complete the survey was nearly 32 minutes. The research version of COVID Coach was offered to all veterans who completed the peripandemic follow-up assessment on a mobile device (n=814; weighted 34.2% of total sample). App usage data from all respondents who downloaded the app (n=34; weighted 3.3% of the mobile completers sample) were collected between November 14, 2020, and November 7, 2021.ResultsWe found that most US veterans (81.5%) own smartphones, and that veterans with higher education, greater number of adverse childhood experiences, higher extraversion, and greater severity of pandemic-related posttraumatic stress disorder symptoms were more likely to download COVID Coach. Although uptake and usage of COVID Coach were relatively low (3.3% of eligible participants, n=34), 50% of the participants returned to the app for more than 1 day of use. The interactive tools for managing stress were used most frequently.ConclusionsThe COVID-19 pandemic has increased the need for and creation of digital mental health tools. However, these resources may require tailoring for older veteran populations. Future research is needed to better understand how to optimize digital mental health tools such as apps to ensure uptake and usage among older adults, particularly those who have experienced traumas across the lifespan.

The Impact of ACEs on BMI: An Investigation of the Genotype-Environment Effects of BMI.

Adverse Childhood Experiences are stressful and traumatic events occurring before the age of eighteen shown to cause mental and physical health problems, including increased risk of obesity. Obesity remains an ongoing national challenge with no predicted solution. We examine a subset of the Healthy Nevada Project, focusing on a multi-ethnic cohort of 15,886 sequenced participants with recalled adverse childhood events, to study how ACEs and their genotype-environment interactions affect BMI. Specifically, the Healthy Nevada Project participants sequenced by the Helix Exome+ platform were cross-referenced to their electronic medical records and social health determinants questionnaire to identify: 1) the effect of ACEs on BMI in the absence of genetics; 2) the effect of genotype-environment interactions on BMI; 3) how these gene-environment interactions differ from standard genetic associations of BMI. The study found very strong significant associations between the number of adverse childhood experiences and adult obesity. Additionally, we identified fifty-five common and rare variants that exhibited gene-interaction effects including three variants in the CAMK1D gene and four variants in LHPP; both genes are linked to schizophrenia. Surprisingly, none of the variants identified with interactive effects were in canonical obesity-related genes. Here we show the delicate balance between genes and environment, and how the two strongly influence each other.

Association between adverse childhood experiences and premenstrual disorders: a cross-sectional analysis of 11,973 women

BackgroundChildhood abuse and neglect have been associated with premenstrual disorders (PMDs), including premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD). However, the associations of other adverse childhood experiences (ACEs) and the cumulative number of ACEs with PMDs remain to be explored.MethodsTo evaluate the associations of the cumulative number and types of ACEs with PMDs, we conducted a cross-sectional analysis with a subsample of menstruating women within the Stress-And-Gene-Analysis (SAGA) cohort, assessed for PMDs and ACEs (N=11,973). The cumulative and individual exposure of 13 types of ACEs was evaluated by a modified ACE-International Questionnaire. A modified version of the Premenstrual Symptom Screening Tool was used to identify probable cases of PMDs, further sub-grouped into PMS and PMDD. Prevalence ratios (PRs) of PMDs in relation to varying ACEs were estimated using Poisson regression.ResultsAt a mean age of 34.0 years (standard deviation (SD) 9.1), 3235 (27%) met the criteria of probable PMDs, including 2501 (21%) for PMS and 734 (6%) for PMDD. The number of ACEs was linearly associated with PMDs (fully-adjusted PR 1.12 per ACE, 95% CI 1.11–1.13). Specifically, the PR for PMDs was 2.46 (95% CI 2.21–2.74) for women with 4 or more ACEs compared with women with no ACEs. A stronger association was observed for probable PMDD compared to PMS (p for difference <0.001). The associations between ACEs and PMDs were stronger among women without PTSD, anxiety, or depression, and without childhood deprivation and were stronger among women a lower level of social support (p for interaction<0.001). All types of ACEs were positively associated with PMDs (PRs ranged from 1.11 to 1.51); the associations of sexual abuse, emotional neglect, family violence, mental illness of a household member, and peer and collective violence were independent of other ACEs.ConclusionsOur findings suggest that childhood adverse experiences are associated with PMDs in a dose-dependent manner. If confirmed by prospective data, our findings support the importance of early intervention for girls exposed to ACEs to minimize risks of PMDs and other morbidities in adulthood.

Adverse childhood experiences and handgrip strength among middle-aged and older adults: a cross-sectional study in China

BackgroundEvidence on the association between adverse childhood experiences (ACEs) and handgrip strength (HGS) in later life was limited and inconclusive. We aimed to explore the impact of ACEs on HGS among middle-aged and older Chinese adults.MethodsWe conducted a cross-sectional study with data extracted from the China Health and Retirement Longitudinal Study (CHARLS), a nationally representative survey with respondents recruited from 450 villages/urban communities of 28 provinces. Participants aged 45 years or older were drawn from the CHARLS 2014 life history survey and the 2015 health survey. Twelve ACE indicators before the age of 17 years were collected. HGS was measured with a dynamometer and the maximum value of HGS obtained from both hands was used in the analyses. Low muscle strength (LMS) was defined according to the recommendation of European Working Group on Sarcopenia in Older People (EWGSOP). Multivariate linear and logistic regression models were constructed to evaluate the association of ACEs with continuous HGS and LMS, with adjustment for age, sex, marital status, ethnicity, area of residence, smoking and drinking status, body mass index, hypertension, dyslipidaemia, diabetes mellitus, cardiovascular disease, arthritis, hip fracture, and memory-related disease.ResultsOf the 7209 eligible participants, 2258 (31.3%) had experienced three or more ACEs. Compared to individuals without ACEs, exposure to ≥ 3 ACEs was negatively associated with continuous HGS in kilogram (β = -0.93, 95% CI: -1.37, -0.49) and positively associated with the risk of LMS (OR = 1.34, 95% CI: 1.12, 1.61). Such associations were consistently found both in men and women who had experienced three or more ACEs. Significant dose–response relationship between the number of ACEs and outcomes was also observed in the overall population and different sex groups.ConclusionExposure to ACEs was associated with lower HGS and increased risk of LMS among middle-aged and older Chinese adults, indicating the importance of intervention in individuals with experience of ACEs in order to mitigate its detrimental impact on HGS and promote healthy ageing.

Long-term effects of childhood adversity on the subjective well-being of older adults in urban China: the mediating effect of elder abuse

Objectives Adverse childhood experiences (ACEs) have negative impacts on individuals’ subjective well-being (SWB) in later life. This article investigates the relationships between the ACEs and SWB of Chinese older adults and examines how elder abuse victimization mediates the pathways in these relationships. Method We used retrospective cross-sectional survey data collected in Beijing, China, in 2019. The study sample consists of 1002 older adults aged 65 years and over. The survey measured individual types, number, and various categories of ACEs of older adults and their elder abuse victimization experiences, along with their SWB (i.e. depression and life satisfaction). We tested the potential mediating role of elder abuse victimization in the relationships between ACEs and SWB. Results After controlling for socio-demographic factors and self-rated health, the results suggest a full mediating effect of elder abuse on the relationship between both several individual types and multiple categories of ACEs (i.e. childhood victimization, the family’s economic difficulties, and a family member’s episodes of illness) and depression, in addition to a partial mediating effect of elder abuse between number of ACEs and depression. A full mediating effect of elder abuse was found in regard to the relationship between a family’s economic difficulties and life satisfaction. Conclusion This study provides evidence for a long-term impact of ACEs on the SWB of older adults in China. In analyzing and understanding elder abuse victimization as a pathway linking ACEs and SWB, we stress the importance of the prevention of interpersonal violence across the life course. Supplemental data for this article is available online at https://doi.org/10.1080/13607863.2022.2040427 .

Prevalence, distribution and attributable risks of adverse childhood experiences in different family types: A survey of young adults in Botswana

BackgroundAlthough adverse childhood experiences (ACEs) are often associated with poor outcomes in adulthood, little is known about its distribution in various family types, especially in low- and middle-income countries. ObjectiveWe assessed the prevalence, distribution, and attributable risks of ACEs in different family types in early adults. MethodsUsing data from 483 young adults (18–25 years of age), we assessed the prevalence and distribution of ACEs and employed binary logistic regressions to quantify the attributable risk of ACEs in different family types: nuclear (reference), single-mother, separated/divorced, and extended family types. We compared respondents without reports of ACEs (reference) to those reporting different numbers of ACEs (1 or more, 2 or more, 3 or more, 4 or more and 5 or more) to assess attributable risks of ACEs in different family types. ResultsOut of the 483 participants, (female = 262 [53.3%]), 26.7% reported no ACEs, 21.1% reported 1 ACE, 13.3% reported 2 ACEs, and 38.9% reported 3 or more ACEs. Two hundred thirty-two (48%) and 153 (31.7%) students reported that they were from a nuclear and single-mother family types, respectively. Overall, there were higher densities of ACEs in single-mother and separated/divorced compared to nuclear family type. Compared to nuclear family type, the attributable risks of ACEs for single-mother family type ranged from 2.85 (95% Confidence Intervals (CI) 1.65) to 4.13 (95% CI: 1.92–8.91) and for separate/divorced family type ranging from 3.69 (95% CI: 1.72) to 6.32 (95% CI: 2.40–16.64). ConclusionsThe odds of ACEs differ with family types and were markedly pronounced in single-mother and separated/divorced compared to nuclear family types. Interventions to mitigate the effects of ACEs should be targeted at family types with a high density of ACEs. Professionals should design programmes targeting single-mother, separated/divorced and extended family types to alleviate the negative effects of childhood adversity.

Adverse childhood experiences and resilience among adult women: A population-based study.

Adverse childhood experiences (ACEs) have consistently been associated with elevated risk of multiple adverse health outcomes, yet their contribution to coping ability and psychiatric resilience in adulthood is unclear. Cross-sectional data were derived from the ongoing Stress-And-Gene-Analysis cohort, representing 30% of the Icelandic nationwide female population, 18-69 years. Participants in the current study were 26,198 women with data on 13 ACEs measured with the ACE-International Questionnaire. Self-reported coping ability was measured with the Connor-Davidson Resilience Scale and psychiatric resilience was operationalized as absence of psychiatric morbidity. Generalized linear regression assuming normal or Poisson distribution were used to assess the associations of ACEs with coping ability and psychiatric resilience controlling for multiple confounders. Number of ACEs was inversely associated with adult resilience in a dose-dependent manner; every 1SD unit increase in ACE scores was associated with both lower levels of coping ability (β = -0.14; 95% CI-0.15,-0.13) and lower psychiatric resilience (β = -0.28; 95% CI-0.29,-0.27) in adulthood. Compared to women with 0 ACEs, women with ≥5 ACEs had 36% lower prevalence of high coping ability (PR = 0.64, 95% CI 0.59,0.70) and 58% lower prevalence of high psychiatric resilience (PR = 0.42; 95% CI 0.39,0.45). Specific ACEs including emotional neglect, bullying, sexual abuse and mental illness of household member were consistently associated with reduced adult resilience. We observed only slightly attenuated associations after controlling for adult socioeconomic factors and social support in adulthood. Cumulative ACE exposure is associated with lower adult resilience among women, independent of adult socioeconomic factors and social support, indicating that adult resilience may be largely determined in childhood. This work was supported by the European Research Council (Consolidator grant; UAV, grant number 726413), and the Icelandic Center for Research (Grant of excellence; UAV, grant number 163362-051). HBD was supported by a doctoral grant from the University of Iceland Research Fund.

Adverse Childhood Experiences (ACEs) and Homelessness: A Critical Examination of the Association between Specific ACEs and Sex Trafficking among Homeless Youth in Kentuckiana

ABSTRACT Youth experiencing homelessness have often also been exposed to childhood trauma or adverse childhood experiences (ACEs). Aims: More information is needed to determine the prevalence and impact of ACEs in youth experiencing homelessness who have also been trafficked for sex with the goal of developing services informed by this knowledge. The present study examines ACEs and sex trafficking in a convenience sample of 119 youths experiencing homelessness aged 12 to 25 years old in Kentuckiana—a region of counties within metropolitan Louisville, Kentucky, and Southern Indiana. Participants were asked questions regarding the 10 categories of ACEs as part of an enhanced version of the 60-item Youth Experiences Survey (YES). One hundred percent of the sample reported experiencing at least one ACE. Over two-thirds (69%) reported experiencing four or more ACEs. Approximately 52% of youth who had not been trafficked had experienced five or more ACEs, compared with 70% of trafficked youth. The ACEs most significantly related to sex trafficking were physical neglect, emotional neglect, emotional abuse, domestic abuse, and sexual abuse. Reports of sex trafficking and a higher number of ACEs from this sample of youth were found to be importantly correlated. Programs serving youth experiencing homelessness should require additional training and resources regarding the identification, screening, and assessment of youth who are at risk of or who have experienced sex trafficking in order to more accurately connect youth with trauma-informed services.

Exploring Primary Care Non-Attendance: A Study of Low-Income Patients.

Introduction:While evidence has been established on the impact of medical appointment non-attendance on the healthcare system and patient health, previous research has not focused on how poverty and rurality may influence patient experiences with non-attendance. This paper explores patient perceptions of non-attendance among those experiencing poverty in a rural U.S county to better inform providers to the context in which their patients make attendance-related decisions.Methods:Using a grounded theory approach, we conducted semi-structured interviews with 32 U.S. low-income adults in the rural Western U.S. who recurrently missed primary care appointments. We also used a questionnaire to assess individual characteristics related to health, resiliency, personal mastery, medical mistrust, life chaos, and adverse childhood experiences.Results:Participants identified 3 barriers to attending appointments: appointment disinterest, competing demands, and insufficient systems. Appointment disinterest stemmed from physical and mental health issues, misalignment between needs and treatment, and comfort with the provider. Competing demands included family responsibilities, employment, and relationships. Finally, participants reported that current scheduling and transportation systems were helpful but insufficient. To provide further context, participants also reported low overall health, moderate levels of medical mistrust, life chaos, and mastery, moderate to low resilience, and very a high number of adverse childhood experiences.Conclusions:Results point to the need for modified structures that allow low-income patients more control over their personal health and highlight opportunities for clinics to address patients’ lack of interest and fear in the medical encounter.

Sex Differences in the Associations of Specific Adverse Childhood Experiences (ACEs) with Comorbid Psychiatric Disorders

Using nationally representative data from the National Longitudinal Study of Adolescent to Adult Health (Add Health), we examined associations of specific Adverse Childhood Experiences (ACEs) on the comorbid combinations of Depression (DEP), Anxiety (ANX) and Post-Traumatic Stress Disorder (PTSD). The measures of ACEs were derived from the CDC-Kaiser ACE Study. Unlike prior research focusing on the number of ACEs, we hypothesize that there are specific types of ACEs strongly associated with psychiatric comorbidity (i.e., high-risk ACEs) and that these associations differ by sex. The results demonstrated that emotional, physical, and sexual abuse was strongly associated with all combinations of these three disorders. Mental illness in household was also strongly associated with DEP+ANX as well as DEP+PTSD but not DEP+ANX+PTSD. Among females, the odds ratios for the combination of DEP+ANX given 1 or 2 or more high-risk ACEs were 2.07 (95% CI: 1.50-2.85, p&lt;0.0001) and 4.17 (95% CI: 2.90-6.01, p&lt;0.0001); the odds ratios for the combination of DEP+PTSD given 1 or 2 or two or more high-risk ACEs were 2.53 (95% CI: 0.84-7.64, p=0.10) and 16.01 (95% CI: 5.41-47.39, p&lt;0.0001); the odds ratios for the combination of DEP+ANX+PTSD given 1 or 2or more high-risk ACEs were 6.53 (95% CI: 3.22-13.22, p&lt;0.0001) and 18.91 (9.20-38.88, p&lt;0.0001). Similar graded relationships were not found among males. The results reveal that exposure to two or more of the specific high-risk ACEs in females increased their odds of DEP+PTSD by 16 and the odds of DEP+ANX+PTSD by 19 when compared to females with zero high-risk ACE exposure. These findings were not observed in males.

Examining Recovery Status and Supports before and after Substance Abuse Disorder Treatment Among Clients Who Experienced Lifetime and Recent Firearm-Related Threats

Firearm-related risks have often been overlooked in the sequela of substance use and substance use disorders. This study compares adult substance abuse disorder treatment (SADT) clients who experienced recent ( n = 274) and lifetime ( n = 889) firearm threats to adults who were not threatened with a firearm ( n = 2029) before and 12 months after program entry. More men experienced firearm threats (38.8%) than women (34.2%). However, among those with any firearm threats, more women (27.2%) experienced firearm threats in the year before program entry than men (20.2%). Being threatened with a firearm was associated with increased economic vulnerability, criminal justice system involvement, mental health problems, and victimization both before and after SADT program entry. A higher number of adverse childhood experiences were associated with firearm threats and particularly recent firearm threats. Results of this study underscore the importance of screening for firearm-related risks in substance abuse disorder treatment programs.

Configurations of Adult Attachment, Indicators of Mental Health and Adverse Childhood Experiences in Women: A Cross-Sectional Study.

The relationship between adverse childhood experiences, attachment and adult mental health has been pointed out in a large amount of studies. In a sample of 339 women receiving support from mental health and social services, this research analyzed the association between three adult attachment variables (fear of rejection or abandonment—FRA; desire for closeness—DC; preference for independence—PI) and four mental health indicators. After dichotomizing these variables, we constructed eight configurations of attachment and examined their association with mental health indicators. BAB people (those below the median in FRA, above in DC and below in PI) obtained the most favorable scores in mental health, whereas the ABA configuration (above the median in FRA, below in DC and above in PI) was the least favorable. The association between attachment configurations and mental health indicators was different to what might be expected, aggregating the effects of individual attachment variables. When analyzing the relationship between configurations and adverse childhood experiences (ACEs), women with an ABA configuration reported the highest number of ACEs and eight ACE types had a higher-than-expected contingency coefficient. In conclusion, these findings suggest that certain adult attachment configurations are associated with a greater number of ACEs and poorer mental health indicators in adult women.

Adverse childhood experiences and marijuana use during pregnancy: Findings from the North Dakota and South Dakota PRAMS, 2017–2019

BackgroundEmerging research suggests that adverse childhood experiences (ACEs) may be a risk factor for prenatal marijuana use. This study is the first to use a representative sample from state surveillance systems to assess the connection between accumulating ACEs and marijuana use during pregnancy. MethodsData are from the North Dakota and South Dakota Pregnancy Risk Assessment Monitoring System (PRAMS) from years 2017–2019 (N = 5399). The bivariate association between number of ACEs and marijuana use during pregnancy is assessed using a chi-square test. The multivariable association is assessed using linear probability modeling. ResultsOnly 0.9% of women with zero ACEs reported marijuana use during pregnancy, compared to 11.7% of women with four or more ACEs. Findings from linear probability models showed that mothers reporting two ACEs (b =0.023, 95% CI =0.003,.043), three ACEs (b =0.042, 95% CI =0.014,.069), and four or more ACEs (b =0.053, 95% CI =0.035,.071) are more likely to report marijuana use during pregnancy relative to those with zero ACEs, net of demographic and socioeconomic control variables. ConclusionsAccumulating maternal ACEs —especially four or more— is associated with increased likelihood of using marijuana during pregnancy. These findings demonstrate the early life trauma is a key social determinant of health over the life course and highlights how ACEs can contribute to intergenerational harm via the worsening of health behaviors during pregnancy.

Correlates of mental health problems among students in Texas alternative high schools and school-level efforts to address mental health.

Students in alternative high schools (AHSs) are an understudied population who experience disproportionate levels of risk factors that contribute to mental health problems. Using logistic regression, we explored associations between mental health problems and risk and protective factors among students in Texas AHSs (n = 515; mean age 17.1 years; 51% female, 78% youth of color, 64% eligible for free/reduced lunch). Principals (n = 14) and lead health educators (n = 14) reported on school-level efforts to address mental health. Students reported, on average, 1.55 of 4 mental health problems in the past year. Logistic regression indicated that greater number of adverse childhood experiences, lower self-esteem, female gender, and sleep disruption (getting <8 h of sleep per night) were common contributors to symptoms of depression, anxiety, suicidal ideation, and PTSD with models showing medium-to-large effects (AUC: 0.73-0.81). We assessed school-level efforts to address mental health using descriptive statistics. At the school level, most (>50%) principals reported having policies and services to support student mental health, with the exception of having mental health/social services staff represented on school health councils (36%) and having Gay-Straight Alliances (21%). Most lead health educators (86%) reported educating AHS students about mental health, and many (57%) reported receiving professional development in mental health. Future research with a larger number of schools is needed to analyze whether school policies are statistically associated with student-level mental health outcomes. Such multi-level research can inform policies and practices for AHS student mental health.

Is Adversity in Childhood Linked to Marijuana Use in Adulthood?: Findings from the Behavioral Risk Factor Surveillance System

Background: Adverse childhood experiences (ACEs) are potentially traumatic events, which can have long-term, negative consequences. Few studies have examined ACEs’ relationship to marijuana use. Objectives: We examined the association between ACEs and past-month marijuana use among adults and the pathways between childhood adversity and marijuana use. Methods: Adults from five states (n = 22,991) who responded to the 2019 Behavioral Risk Factors Surveillance System were included. We examined the prevalence of ACEs and marijuana use. We employed generalized structural equation modeling to assess the relationship between ACEs and marijuana use and the role of depression and poor mental and physical health as possible mediators. Results: Overall, 65.0% of the population reported 1+ ACE. Heavy marijuana use and past-month marijuana use prevalence rates were 10.3% and 5.0%, respectively. We found mediation effects for depression and poor mental health but not poor physical health. The number of ACEs was associated with a statistically significant increase in any past-month marijuana use—indirect effects ranged from 1.0 (95% CI, 1.0–1.0) to 1.4 (95% CI, 1.2–1.7), direct effects ranged from 1.1 (95% CI, 07–1.7) to 5.3 (95% CI 3.2–8.8), and total effects ranged from 1.1 (95% CI, 0.7–1.7) to 5.9 (95% CI, 3.6–9.8). Women, married persons, and middle aged and older adults had a lower odds of marijuana use. Reporting at least one HIV risk behavior was associated with an increased odds of marijuana use. Conclusion: ACE exposure was positively associated with marijuana use. Depression and poor mental health separately mediated this relationship.

The Psychiatric Comorbidities of Migraine in Children and Adolescents.

Understanding comorbidities in migraine is important because it can help us understand disease pathophysiology while also aiding the development of more effective treatment strategies. Additionally, it can provide greater awareness about appropriate diagnosis, the need for additional disease screening, and the natural history of migraine. Psychiatric comorbidities have been independently studied in both adults and children with migraine because their presentations can be distinct, and the physiology in these two groups can be different. While symptoms of anxiety and depression seem to be comorbid with migraine in children, clinically significant disease does not appear to be, though the clarity of these data is limited by overlap between migraine symptomatology and that assessed by many screening tools. Functional neurologic disorders like psychogenic non-epileptic episodes (PNEE) and other functional movement disorders are not common but can be comorbid with migraine in this population and tend to improve with migraine treatment. The number of adverse childhood experiences (ACEs) a child is exposed to seems to be near-linearly associated with risk of migraine, but not with tension-type headache (TTH). The findings from these studies underscore the importance of utilizing appropriate screening methodologies for identifying psychiatric disorders in children with migraine. Additionally, the role of the insula, the hypothalamic-pituitary-adrenal axis, the serotonergic system, and the instability of hyperactivated neural networks may underlie the pathophysiology of both migraine and its psychiatric comorbidities.

Adverse Childhood Experiences and Subsequent Chronic Diseases Among Middle-aged or Older Adults in China and Associations With Demographic and Socioeconomic Characteristics

Associations between adverse childhood experiences (ACEs) and chronic diseases among middle-aged or older Chinese individuals have not been well documented. In addition, whether demographic and socioeconomic characteristics modify any such associations has been underexplored. To examine associations between ACEs and subsequent chronic diseases and to assess whether age, sex, educational level, annual per capita household expenditure level, and childhood economic hardship modify these associations. This population-based cross-sectional study used data from the China Health and Retirement Longitudinal Study (CHARLS), a survey of residents aged 45 years or older in 28 provinces across China; specifically, the study used data from the CHARLS life history survey conducted from June 1 to December 31, 2014, and a CHARLS follow-up health survey conducted from July 1 to September 30, 2015. The study population included 11 972 respondents aged 45 years or older who had data on at least 1 of 14 specified chronic diseases and information on all 12 of the ACE indicators included in this study. Data analysis was performed from December 1 to 30, 2020. Any of 12 ACEs (physical abuse, emotional neglect, household substance abuse, household mental illness, domestic violence, incarcerated household member, parental separation or divorce, unsafe neighborhood, bullying, parental death, sibling death, and parental disability), measured by indicators on a questionnaire. The number of ACEs per participant was summed and categorized into 1 of 5 cumulative-score groups: 0, 1, 2, 3, and 4 or more. Hypertension, dyslipidemia, diabetes, heart disease, stroke, chronic lung disease, asthma, liver disease, cancer, digestive disease, kidney disease, arthritis, psychiatric disease, and memory-related disease were defined by self-reported physician diagnoses or in combination with health assessment and medication data. Multimorbidity was defined as the presence of 2 or more of these 14 chronic diseases. Logistic regression models were used to assess associations of the 12 ACEs with the 14 chronic diseases and with multimorbidity. Modification of the associations by demographic and socioeconomic characteristics was assessed by stratified analyses and tests for interaction. Of the 11 972 individuals included (mean [SD] age, 59.85 [9.56] years; 6181 [51.6%] were females), 80.9% had been exposed to at least 1 ACE and 18.0% reported exposure to 4 or more ACEs. Compared with those without ACE exposure, participants who experienced 4 or more ACEs had increased risks of dyslipidemia, chronic lung disease, asthma, liver disease, digestive disease, kidney disease, arthritis, psychiatric disease, memory-related disease, and multimorbidity. The estimated odds ratios (ORs) ranged from 1.27 (95% CI, 1.02-1.59) for dyslipidemia to 2.59 (95% CI, 2.16-3.11) for digestive disease. A dose-response association was also observed between the number of ACEs and the risk of most of the chronic diseases (excluding hypertension, diabetes, and cancer) (eg, chronic lung disease for ≥4 ACEs vs none: OR, 2.01; 95% CI, 1.59-2.55; P < .001 for trend) and of multimorbidity (for individuals among the overall study population with ≥4 ACEs vs none: OR, 2.03; 95% CI, 1.70-2.41; P < .001 for trend). The demographic or socioeconomic characteristics of age, sex, educational level, annual per capita household expenditure level, or childhood economic hardship were not shown to significantly modify the associations between ACEs and multimorbidity. In this population-based, cross-sectional study of adults in China, exposure to ACEs was associated with higher risks of chronic diseases regardless of demographic and socioeconomic characteristics during childhood or adulthood. These findings suggest a need to prevent ACEs and a need for a universal life-course public health strategy to reduce potential adverse health outcomes later in life among individuals who experience them.

A mixed methods study of lived experiences of homelessness in Wales and childhood adversity

Abstract Background Homelessness is a serious and complex societal and public health issue with multiple causes and solutions. Dealing with homelessness involves both supporting people at risk of homelessness and addressing personal and structural causes occurring through the life-course, including Adverse Childhood Experiences (ACEs). We examine the relationship between ACEs and homelessness in Wales, and consider priority areas for early intervention and prevention. Methods Data was retrospectively analysed from a 2017 cross-sectional national 2017 (n = 2452) of adults aged 16-69 years living in Wales using a stratified random probability sampling methodology. Outcome measures included number of ACEs, lifetime homelessness, and childhood resilience assets and were analysed using bivariate statistics. Pathways interviews with people experiencing homelessness (n = 27) and services (n = 16) explored experiences and views, and were analysed thematically. Results Homelessness affects 1 in 14 (7%) of the Welsh population in their lifetime. 87% of those with lived experience of homelessness had experienced at least one ACE compared with a Welsh average of 46%; and 50% of those with lived experience of homelessness had experienced 4+ ACEs, compared to 11% in the wider population. Compared with those with no ACEs, individuals with 4+ ACEs were 16 times more likely to report experiencing homelessness (95% CI 9.73,26.43), but Childhood Resilience Assets were protective reducing this by half (adjusted odds ratio 8.073, 95% CI 4.68,13.93). From interviews, early years/schools are critical in supporting children with ACEs, and services through the life-course need to be ACE-aware and better able to cope with impacts of ACEs. Conclusions A clear association is seen between ACEs and homelessness. Early intervention that prevents ACEs is needed, as well as better addressing support needs of both child and adult vulnerable populations to prevent homelessness and intervene earlier. Key messages In a national Welsh study, 87% of those reporting lived experience of homelessness had experienced at least one adverse childhood experience (ACE), and 50% reported four or more ACEs. Early intervention that prevents ACEs, combined with a trauma-informed approach that builds resilience in at-risk children and adults, is likely to contribute to reducing and preventing homelessness.

Health Care Access and Quality Among Children Exposed to Adversity: Implications for Universal Screening of Adverse Childhood Experiences.

Given recent advances toward universal screening for Adverse Childhood Experiences (ACEs), our objective was to investigate whether children with higher ACEs experience poorer quality of provider care and greater challenges accessing needed mental health treatment. This study uses a nationally representative sample of US children aged 0-17years drawn from the National Survey on Children's Health for 2016-2019. Caregivers and parents completed surveys between June 2016 and February 2020 (N = 131,774). Logistic regression models adjusting for identified covariates were used to test associations between a child's number of ACEs, their quality of provider care, and their access to mental health treatment. All analyses used appropriate survey weighting commands. High ACEs (4 or more) were associated with lower quality of provider care, including effective care coordination [OR 0.45, 95% CI (0.38, 0.52)], family-centered care [OR 0.49, 95% CI (0.41, 0.58)], shared decision making [OR 0.50, 95% CI (0.39, 0.85)], and referrals for care [OR 0.58, 95% CI (0.43, 0.80)]; children with high ACEs were also less likely to have a medical home [OR 0.66, 95% CI (0.57, 0.76)]. High ACEs were also significantly associated with greater difficulty accessing mental health treatment [OR 0.55, 95% CI (0.43, 0.70)]. Similar results were found for children in the moderate ACE (2-3) and low ACE (1) groups. Findings indicate that greater ACEs were associated with poorer quality medical care and greater difficulty accessing needed mental health treatment. Because findings indicate that children with high ACEs may be the least likely to receive quality care or necessary mental health treatment to address this adversity, universal screening for ACEs should be considered with caution.

Adverse Childhood Experiences & mental health - the urgent need for public health intervention in India.

SummaryGlobal evidence has demonstrated that Adverse Childhood Experiences (ACEs) up to age 18 significantly increases the risk of mental and physical health for an adult. The research linking ACE with health and well-being has confirmed a dose-response relationship between the number of ACEs experienced and the extent of the impact on wellbeing. The source of ACE is the family, community, and the immediate environment, and it causes long-term risk for mental health with the potential to carry it over beyond the present generation. The findings are consistent across the developed and developing countries, and the evidence highlights the need for new elements beyond the 10 ACE elements in the pathbreaking original study. India needs urgent intervention on ACE prevention and management with 0.4 billion children and adolescents, with one out of seven Indians with mental health issues. Firstly, this commentary reviews global research and summarizes the limited evidence available in India on ACE elements’ impact on mental health. And, secondly, it proposes a multi-pronged approach to identify, manage and prevent the mental health implications of ACE in India to preempt a significant public health challenge.