PSYCHOLOGICAL - SOCIAL ENVIRONMENTPsychological - Social Environment: Research Article
DeCarlo, A, and et al. (2003). Trauma and Violence in Childhood: A
U.S. Perspective. Psychiatric
Times October 2003 Vol. XX Issue 10.
ABSTRACT: Prior research on the impact of childhood abuse and trauma has been limited in scope. The Adverse Childhood Experiences (ACE) Study examined the association between multiple childhood trauma and health outcomes in adults (Felitti et al., 1998).
Questionnaires on adverse childhood experiences were mailed to 13,494 adults who completed a standardized medical evaluation in a large California HMO, with the final sample consisting of 9,508 participants.
The questionnaire assessed seven categories of adverse experiences: 1) psychological abuse; 2) physical abuse; 3) sexual abuse; 4) violence against the respondent's mother; 5) living with household members who were substance abusers; 6) living with individuals who were mentally ill or suicidal; or 7) living with individuals who had ever been imprisoned. The researchers instructed respondents to limit their responses to events that occurred during the first 18 years of life.
Additional health risk factors and disease conditions used to assess adult health status were: smoking, severe obesity, physical inactivity, depressed mood, suicide attempts, alcoholism, any drug abuse, parental drug abuse, high numbers of lifetime sexual partners, a history of having a sexually transmitted disease (STD), ischemic heart disease, cancer, stroke, chronic bronchitis, emphysema, diabetes, hepatitis or jaundice, and any skeletal fracture.
Logistic regression was used to examine the association between adverse childhood experiences (range=0 to 7) and health outcomes controlling for significant demographic factors. Of the total sample, more than half (52%) of the respondents experienced one or more types of adverse childhood exposures, and 6.2% reported four or more exposures. Significant correlations were found among all categories of adverse childhood experiences; however, no multicollinearity existed between independent variables. Those with multiple categories of childhood exposure were more likely to have multiple health risk factors later in life.
The graded relationship among the seven categories of adverse childhood exposures and each of the adult health risk factors and diseases studied was highly significant (p<0.001). These data provide evidence that adverse childhood exposure to trauma and household dysfunctions are significantly associated with negative health outcomes in adults. Clearly, these issues warrant further study utilizing longitudinal designs.
Bell CC (2002), Connecting the Dots. In: Youth in Crisis-Uniting for Action. Proceedings of the Seventeenth Annual Rosalynn Carter Symposium on Mental Health Policy. Atlanta: Mental Health Program of The Carter Center, pp44-46.
Briere J, Runtz M (1990), Differential adult symptomatology associated with three types of child abuse histories. Child Abuse Negl 14(3):357-364.
Burns BJ, Costello EJ, Angold A et al. (1995), Children's mental health service use across service sectors. Health Aff 14(3):147-159 [see comment].
Felitti VJ, Anda RF, Nordenberg D et al. (1998), Relationship of child abuse and household dysfunction to many of the leading causes of death in adults. The Adverse Childhood Experiences (ACE) Study. Am J Prev Med 14(4):245-258 [see comments].
Henggeler SW, Melton GB, Smith LA (1992), Family preservation using multisystemic therapy: an effective alternative to incarcerating serious juvenile offenders. J Consult Psychol 60(6):953-961.
Office of the Surgeon General (2000), Report of the Surgeon General's Conference on Children's Mental Health: A National Action Agenda. HSS. Available at: www.surgeongeneral.gov/topics/cmh/childreport.htm. Accessed Feb. 13, 2003.
Olds DL, Hill PL, Mihalic SF, O'Brien RA (1998), Blueprints for Violence Prevention; Book Seven: Prenatal and Infancy Home Visitation by Nurses. Boulder, Colo.: Center for the Study and Prevention of Violence. Institute of Behavioral Science, University of Colorado at Boulder.
Simpatico TA, Alaimo CJ, DeCarlo A et al. (2002), Cultural disparities in mental health service use for mentally ill offenders. Presented at the 54th Institute on Psychiatric Services. Chicago;Oct. 11.