Adverse Childhood Experiences (ACEs) refer to stressful or traumatic events that children face before reaching 18. These include various forms of abuse (physical, emotional, sexual), neglect (emotional, physical), and household challenges such as witnessing domestic violence, living with substance abusers, having an incarcerated relative, or experiencing family separation.
Studies have shown that individuals with a high number of ACEs are at an increased risk for negative outcomes in adulthood, including chronic diseases, mental illness, substance misuse, and reduced life potential. The more ACEs one has, the greater the risk for these outcomes.
Key Points
Rationale
Child abuse, neglect, and other adverse childhood experiences have been associated with poorer health outcomes in adulthood (Springs & Friedrich, 1992; Felitti, 1991, 1993).
However, prior studies focused on single forms of adversity and did not assess the cumulative impact of multiple experiences (Briere & Runtz, 1988; Moeller et al., 1993).
This study aimed to examine the relationship between the breadth of exposure to abuse, violence, and family dysfunction in childhood and health risk behaviors, health status, and diseases in adulthood. Understanding these associations can inform more effective prevention and treatment strategies.
Method
Thisretrospective cohortstudy surveyed 13,494 adult health maintenance organization (HMO) members who had a standardized medical evaluation at a clinic.
The mailed survey asked about adverse childhood experiences like psychological, physical, or sexual abuse; violence against mother; or living with household members who were substance abusers, mentally ill, suicidal, or imprisoned.
The number of exposure categories (0-7) was compared to the presence of risk factors for leading causes of death and disease conditions using logistic regression models.
Sample:
After exclusions, the final sample was 8,056 people aged 19-92 years, predominantly white (79%) and college-educated (43%). 53% were women.
Statistical Analysis
Results
Implications
Future Research
Strengths & Limitations
The study had many methodological strengths, including:
However, this study was limited in a few ways:
Conclusion
This study reveals powerful relationships between the breadth of exposure to childhood adversity and health risk behaviors and diseases in adulthood.
It underscores the profound, long-term impact of adverse developmental experiences.
More research is needed, but these findings suggest that prevention and intervention around childhood adversity could improve public health.
Healthcare providers should be alert for patients whose health problems may have developmental origins.
Further progress relies on compassionately understanding how high-risk health behaviors may represent coping responses in the face of trauma and cumulative stress.
References
Primary Paper
Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., & Marks, J. S. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) Study.American Journal of Preventive Medicine, 14(4), 245-258.
Other References
Briere, J., & Runtz, M. (1988). Multivariate correlates of childhood psychological and physical maltreatment among university women.Child Abuse & Neglect, 12(3), 331-341.
Felitti, V. J. (1991). Long-term medical consequences of incest, rape, and molestation.Southern Medical Journal, 84(3), 328-331.
Felitti, V. J. (1993). Childhood sexual abuse, depression, and family dysfunction in adult obese patients: a case control study.Southern Medical Journal, 86(7), 732-736.
Moeller, T. P., Bachman, G. A., & Moeller, J. R. (1993). The combined effects of physical, sexual, and emotional abuse during childhood: Long-term health consequences for women.Child Abuse & Neglect, 17(5), 623-640.
Springs, F., & Friedrich, W. N. (1992). Health risk behaviors and medical sequelae of childhood sexual abuse.Mayo Clinic Proceedings, 67(6), 527-532.
Further Reading
Learning Check
How might experiences of childhood adversity sensitize people biologically and psychologically to engage in high-risk behaviors?If adverse childhood experiences tend to co-occur and have cumulative effects, how should prevention/intervention strategies be designed differently than just targeting single types of adversity?What biases or limitations might affect participants’ retrospective self-reports of childhood experiences and current health status? How could the study design be improved?How might a healthcare provider compassionately uncover whether a patient’s health issues may have origins in adverse developmental experiences? What challenges does this present?How might knowledge of the prevalence and impacts of childhood adversity reduce stigma and lead to improved public health policies and outcomes? What barriers stand in the way?
Olivia Guy-Evans, MSc
BSc (Hons) Psychology, MSc Psychology of Education
Olivia Guy-Evans is a writer and associate editor for Simply Psychology. She has previously worked in healthcare and educational sectors.
Saul McLeod, PhD
BSc (Hons) Psychology, MRes, PhD, University of Manchester
Saul McLeod, PhD., is a qualified psychology teacher with over 18 years of experience in further and higher education. He has been published in peer-reviewed journals, including the Journal of Clinical Psychology.
