Health consequences of adverse childhood experiences: A systematic review

Abstract

Purpose Adverse childhood experiences (ACEs) have been associated with negative health outcomes, but the evidence has had limited application in primary care practice. The purpose of this study was to systematically review the research on associations between ACEs and adult health outcomes to inform nurse practitioners (NPs) in primary care practice. Data sources The databases PubMed, CINAHL, PsycINFO, and Social Abstracts were searched for articles published in English between 2008 and 2013 using the search term “adverse childhood experiences.” Forty‐two research articles were included in the synthesis. The evidence was synthesized and is reported following the preferred reporting items for systematic reviews and meta‐analysis procedure (PRISMA). Conclusions ACEs have been associated with health consequences including physical and psychological conditions, risk behaviors, developmental disruption, and increased healthcare utilization. Generalization of the results is limited by a majority of studies (41/42) measuring childhood adversity using self‐report measures. Implications for practice NPs are encouraged to incorporate assessment of patients’ childhood history in routine primary care and to consider the evidence that supports a relationship between ACEs and health. Although difficult, talking about patient's childhood experiences may positively influence health outcomes.

Screening Adults With Substance Use Disorder for Adverse Childhood Experiences

“…A Level II systematic review of health consequences of ACE provided evidence for the necessity of screening for ACE in the primary care setting (Kalmakis & Chandler, 2015). Based on the work of Kalmakis and Chandler (2016), two pilot translational research studies demonstrated the impact of ACE on primary care patients, contributing additional evidence for the necessity of screening for ACE to reduce negative health consequences in the primary care setting (Aponte, 2017, Kalmakis, et al, 2018, & Shafer, 2017.…”

“…Therefore, the purpose of this translational research project is to incorporate evidence-based guidelines for Trauma-Informed Care (TIC) and screening for individuals presenting for SUD treatment (SAMHSA, 2014). The goal of this project is to translate research evidence through screening with a three part interview tool among clients receiving treatment for SUD in a IOP (Kalmakis & Chandler, 2015). This will be accomplished through utilization of the ACE screening tool used in previous studies, to facilitate patient-provider collaboration through compassion, trust, and motivation for change (Kalmakis, Schafer, Chandler, Aponte, & Roberts, 2018).…”

“…The plan for this study is to recruit individuals with a diagnosis of SUD participating in an intensive outpatient program (IOP) and/or residing in a recovery house for screening for ACE based on previous studies implemented in the primary care setting with an adult population (Kalmakis & Chandler, 2015;Kalmakis, Chandler, Roberts, & Leung, 2016;Shafer, 2017). In addition, the treatment staff received education and training on the screening protocol, to assure fidelity to the original protocol (Kalmakis et al, 2016).…”

Struggling with one’s own parenting after an upbringing with substance abusing parents

“…Substance abusing parents can frequently be neglectful, abusive, unreliable, and emotionally unavailable for their children (Chassin, Rogosch, & Barrera, 1991; Velleman, Templeton, Reuber, Klein, & Moesgen, 2008). Children who are subjected to this kind of dysfunctional family situation, summarized in the concept of “Adverse Childhood Experiences” (ACE; Felitti et al, 1998), are at risk for developing problematic behaviours that affect both their own and their future children’s lives (Ivarsson, Saavedra, Granqvist, & Broberg, 2015; Kalmakis & Chandler, 2015; Lomanowska, Boivin, Hertzman, & Fleming, 2015). This study examines how individuals raised in such conditions reflect on their childhood and the kinds of difficulties that they have in their own role as a parent.…”

Fragile, please handle with care : understanding and supporting professionals' response to suspicions of child abuse and neglect

“…Experiencing child abuse and neglect has been associated with behavioural problems, long-lasting psychological disorders, obesity, low educational employment, criminal behaviour [16], lower perceived quality of life [17], intergenerational transmission [18] and even child death [19,20]. The negative outcomes of child abuse and neglect are also reflected in substantial costs in adulthood due to health service utilisation and productivity losses [21,22]. The high burden of abuse and neglect makes clear that efforts are needed to prevent and end child abuse and neglect.…”