From Hard Knocks to Headache

Abstract

The relationship of adverse childhood experiences (ACEs) with chronic health conditions in adulthood has been a growing topic of research over the past 4 decades. Initial studies focused predominantly on the influence of childhood sexual and physical abuse on health risk behaviors and mental health conditions. Subsequent studies have investigated the relationship of ACEs and physical health conditions and added additional ACE types. The Adverse Childhood Experiences International Questionnaire (ACE-IQ), for example, asks about physical, sexual, and emotional abuse; physical and emotional neglect; household dysfunction (substance abuse in household; incarcerated household member; household member who has is chronically depressed, mentally ill, or suicidal; household member treated violently; one or no parents, parental separation, or divorce); bullying; community violence; and collective violence.1 Although causality should not be inferred from observational studies, reports of graded dose-response relationships of ACEs with more than 40 different health-related outcomes lend credence to this possibility.2 In concert with accounts that nearly 60% of adults report ≥1 ACEs, 35% report ≥2 ACEs, and that those reporting ≥6 ACEs have a 20-year reduction in life expectancy, these studies highlight that childhood adversity is a major public health concern2-4 and one with a large price tag (e.g., estimated annual cost $748 billion in North America).4