It is not surprising that traumatic events from childhood can have lasting effects, and perhaps few people know that better than mental health professionals.
“Adverse childhood events are prevalent – even in the general population, they are not rare events,” Joshua P. Mersky, PhD, a professor at the Jane Addams College of Social Work at the University of Illinois at Chicago, who has co-authored numerous studies on the topic, told Psychiatry Advisor. Not surprisingly, “clients who present for mental health services are even more likely to have been exposed to significant adversity.”
Until recent years, however, there has not been a focused effort to track the long-term impact of childhood adversity on subsequent health and functioning in adulthood. The original Adverse Childhood Experiences (ACE) study,1 published in the American Journal of Preventive Medicine in 1998, was the first such endeavor.
In the collaborative effort between the Centers for Disease Control and the Health Maintenance Organization Kaiser Permanente, nearly 10,000 patients completed standard medical exams and questionnaires regarding seven categories of ACEs, including various forms of abuse and family dysfunction. According to results, over half of patients reported an ACE in at least one category, and a fourth of patients had experienced an ACE in two or more categories.
After adjusting for the effects of demographic factors, the researchers found a graded relationship between the number of ACE categories and the various health issues studied: Patients who reported multiple categories of ACEs had multiple health risk factors as adults.
Compared to those who had experienced none of the ACE categories, patients who reported four or more such categories had between four and 12 times the risk for drug and alcohol abuse, depression and suicide attempts, as well as increased risk for many leading causes of death, such as heart disease and cancer.
“Many different forms of trauma can lead to dysfunction, and there is a dose-response relationship between trauma and dysfunction,” said Mersky. “That is, all else equal, the more types of adversity you experience and the longer you are exposed to adversity, the worse your outcomes tend to be.”
Since the original ACE paper was published, subsequent studies have linked ACEs with higher risk of premature death, 2, 3 and others have investigated different dimensions of ACE-adult health relationship. Although participants in the original study had an average age of 56 years and were predominantly white, a 2013 study4 by Mersky and colleagues investigated the long-term effects of ACEs in a minority sample of young adults.
They found that higher levels of childhood adversity were linked with “poorer self-rated health and life satisfaction, as well as more frequent depressive symptoms, anxiety, tobacco use, alcohol use, and marijuana use.” Again, there was a cumulative effect: Participants who had experienced multiple ACEs, for instance, were more likely than non-ACE participants to have three or more negative outcomes.