The lifelong toll of adverse events in childhood

A new study shows that poor mental health is almost three times more prevalent among people in New Zealand who experienced four or more “adverse childhood events” compared with people who experienced none. This is a correlation, of course, but of a probable causal nature…

From the press release:

The study covered eight types of childhood adversity: Emotional, physical or sexual abuse, and growing up in a household where there was violence, substance abuse, mental illness, divorce, or a household member behind bars. “Toxic stressors in childhood can take a lifelong toll on many aspects of our health,” says Associate Professor Janet Fanslow, of the School of Population Health in the Faculty of Medical and Health Sciences. “The effects ripple across society to create a huge burden on family and wh?nau, our health service and the economy.”

Experiencing even just one type of childhood adversity — such as having a household member in jail or witnessing interpersonal violence in the home — is associated with an increased risk of poor mental health, the study suggests. Experiencing two or more is associated with higher odds of disability, and four or more with chronic physical health problems.

Increased risks of health problems such as heart disease or asthma can be linked to specific types of adverse events, according to researchers led by Dr Ladan Hashemi, also of the School of Population Health. The scientists analysed 2,888 responses to the 2019 New Zealand Family Violence Survey, which was carried out in Waikato, Northland, and Auckland.

The odds of heart disease rose for people who had experienced emotional or sexual abuse, witnessed interpersonal violence, or lived in a household where there was substance abuse. The odds of asthma increased for those from a household with substance abuse, mental illness or divorce.

International research shows how adversity in childhood can affect neurological and hormonal development, inflammation pathways, cognitive, social, and emotional competencies, and propensity for risky behaviours such as smoking or substance abuse. Socio-economic factors didn’t fully explain the associations in the New Zealand study. “Policy and programmes to address child poverty are important in their own right, but will not fully mitigate the effect of adverse childhood experiences,” write Dr Fanslow, Dr Hashemi, Dr Pauline Gulliver, and Professor Tracey McIntosh in the research paper.

About 45 percent of the people in the study reported no adverse childhood events. A majority experienced at least one, and one-in-three reported more than one. In the study, a person’s mental health was described as poor if they had been diagnosed with a long-term condition or had recently taken anti-depressants or sleeping medication. The paper, “Exploring the health burden of cumulative and specific adverse childhood experiences in New Zealand: Results from a population-based study,” was published in the journal Child Abuse & Neglect. The findings “should provide impetus to establish widespread prevention and intervention initiatives,” the academics write. “Strategies that address socioeconomic inequities are needed, but will not, of themselves, fully mitigate the consequences of adverse childhood experiences.”

Abstract of the paper:

Background
Adverse childhood experiences (ACEs) can influence later health, but there are gaps in understanding how ACEs may interact with Positive Childhood Experiences (PCEs). Additionally, there are gaps in understanding how ACEs impact on positive markers of health.

Objectives
To explore associations of ACEs with both negative and positive markers of physical and mental health in adulthood and to examine whether positive childhood experiences (PCEs) can mitigate the negative effects of ACEs on health.

Participants and setting
2887 participants (1464 female, 1423 male) from the 2019 New Zealand Family Violence Survey, a population-based study conducted in New Zealand between March 2017–March 2019.

Methods
Multivariable logistic regressions were conducted to ascertain how both ACE score and ACE subtypes influenced the odds of experiencing adverse and positive mental and physical health after adjusting for socio-demographic predictors. A combined ACE-PCE variable was created and included in the multivariable logistic regression models to examine whether PCEs can mitigate the negative effects of ACEs.

Results
Findings indicated that respondents with higher ACE scores had an increased likelihood of reporting each adverse outcome. Higher ACE scores had the strongest association with poor mental health followed by disability and chronic physical health conditions. Respondents with higher ACE scores had a decreased likelihood of reporting each positive health outcome. Exposure to ACEs was detrimental to health even in the presence of PCEs, with minimal effects observed from PCEs given the limited variance observed from its assessment.

Conclusion
This study documents the deleterious impacts of ACEs on a wide range of health outcomes and demonstrates that these effects are persistent. Findings should provide the impetus for widespread prevention and intervention initiatives that seek to address ACEs. Further exploration of PCEs with a more complete assessment is needed to determine if they can mitigate the detrimental consequences of ACEs.

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