The effect of multiple adverse childhood experiences on health: a systematic review and meta-analysis

Hughes, Karen; Bellis, Mark A; Hardcastle, Katherine A.; Sethi, Dinesh; Butchart, Alexander; Mikton, Christopher; Jones, Lisa; Dunne, Michael P.

doi:10.1016/s2468-2667(17)30118-4

Cited by 3,212 publications

(2,987 citation statements)

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“…Previous research has also documented the connection between adverse childhood experiences and substance use and suicide ( 6 ), underscoring the importance of preventing adverse childhood experiences as a strategy for addressing the opioid overdose crisis, reducing the prevalence of suicide, and preventing leading causes of death in the United States. Prevention of adverse childhood experiences is possible with state and community efforts to build resilient families and communities, provide parental support to develop positive parenting and coping skills, and increase access to, and use of, comprehensive health services ( 14 , 15 ).…”

Section: Discussionmentioning

confidence: 99%

“…Adverse childhood experiences are common and have important implications for health and well-being ( 6 , 9 ). Whereas everyone is at risk for adverse childhood experiences, numerous studies have documented inequities in such experiences attributed to the historical, social, and economic environments in which some families live ( 9 – 11 ).…”

Section: Introductionmentioning

confidence: 99%

“…Adverse childhood experiences have also been linked to reduced educational attainment, employment, and income, which directly and indirectly affect health and well-being ( 1 – 8 ). At least five of the 10 leading causes of death have been associated with exposure to adverse childhood experiences, including several contributors to declines in life expectancy ( 6 , 13 ). …”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Vital Signs: Estimated Proportion of Adult Health Problems Attributable to Adverse Childhood Experiences and Implications for Prevention — 25 States, 2015–2017

Merrick¹,

Ford²,

Ports³

et al. 2019

MMWR Morb. Mortal. Wkly. Rep.

452

375

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IntroductionAdverse childhood experiences, such as violence victimization, substance misuse in the household, or witnessing intimate partner violence, have been linked to leading causes of adult morbidity and mortality. Therefore, reducing adverse childhood experiences is critical to avoiding multiple negative health and socioeconomic outcomes in adulthood.MethodsBehavioral Risk Factor Surveillance System data were collected from 25 states that included state-added adverse childhood experience items during 2015–2017. Outcomes were self-reported status for coronary heart disease, stroke, asthma, chronic obstructive pulmonary disease, cancer (excluding skin cancer), kidney disease, diabetes, depression, overweight or obesity, current smoking, heavy drinking, less than high school completion, unemployment, and lack of health insurance. Logistic regression modeling adjusting for age group, race/ethnicity, and sex was used to calculate population attributable fractions representing the potential reduction in outcomes associated with preventing adverse childhood experiences.ResultsNearly one in six adults in the study population (15.6%) reported four or more types of adverse childhood experiences. Adverse childhood experiences were significantly associated with poorer health outcomes, health risk behaviors, and socioeconomic challenges. Potential percentage reductions in the number of observed cases as indicated by population attributable fractions ranged from 1.7% for overweight or obesity to 23.9% for heavy drinking, 27.0% for chronic obstructive pulmonary disease, and 44.1% for depression.Conclusions and implications for public health practiceEfforts that prevent adverse childhood experiences could also potentially prevent adult chronic conditions, depression, health risk behaviors, and negative socioeconomic outcomes. States can use comprehensive public health approaches derived from the best available evidence to prevent childhood adversity before it begins. By creating the conditions for healthy communities and focusing on primary prevention, it is possible to reduce risk for adverse childhood experiences while also mitigating consequences for those already affected by these experiences.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Vital Signs: Estimated Proportion of Adult Health Problems Attributable to Adverse Childhood Experiences and Implications for Prevention — 25 States, 2015–2017

Merrick¹,

Ford²,

Ports³

et al. 2019

MMWR Morb. Mortal. Wkly. Rep.

452

375

View full text Add to dashboard Cite

show abstract

“…In the United Kingdom the government definition of domestic violence and abuse is: ‘any incident or pattern of incidents of controlling, coercive, threatening behavior, violence or abuse between those aged 16 or over who are, or have been, intimate partners or family members regardless of gender or sexuality. The abuse can encompass, but is not limited to: psychological, physical, sexual, financial, emotional’ (Home Office, 2018). Although this definition applies to those aged 16 or over, children also experience the harmful effects of domestic violence, as will be examined further below.…”

Section: Introductionmentioning

confidence: 99%

Domestic Violence and Education: Examining the Impact of Domestic Violence on Young Children, Children, and Young People and the Potential Role of Schools

Lloyd

2018

Front. Psychol.

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This article examines how domestic violence impacts the lives and education of young children, children, and young people and how they can be supported within the education system. Schools are often the service in closest and longest contact with a child living with domestic violence; teachers can play a vital role in helping families access welfare services. In the wake of high profile cases of child abuse and neglect, concerns have been raised about the effectiveness of multi-agency responses to children living with abuse. In the United Kingdom, the case of 4-year-old Daniel Pelka who died in 2012 following abuse and starvation by his mother, who experienced domestic violence, and her partner, led to a serious case review. It found recording systems in Daniel’s school were not used consistently, and details held by different agencies were not collated to enable the formation of a coherent assessment. The lack of integrated working cited in the report echoes findings from previous serious case reviews. A strong correlation exists between domestic abuse and child abuse, with approximately half of all domestic violence situations involving direct child abuse. Children can also be affected indirectly by violence occurring in their home by seeing or hearing it taking place. This article examines the impact of domestic violence on the mental health of children, and the impact on their education. Violence in children’s lives often causes disruption to their schooling and harms the quality of their educational experiences and outcomes. The abuse children experience can result in emotional trauma, physical and psychological barriers to learning, and disruptive behavior in school, while the underlying causes of these problems remain hidden. Knowing when and how to seek advice from multi-agency professionals is an essential part of effective practice among school staff. Despite their vital role in identifying signs of abuse and signposting referral pathways, research indicates teachers often lack confidence and knowledge for such work. The article examines how the professional learning and professional confidence of teachers can be developed, and how recent policy and practice developments in the United Kingdom have the potential to influence work in this area.

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“…The findings of the original ACE study have been replicated many times, and a recent meta-analysis showed that individuals with four or more ACEs were at increased risk of each one of the 23 adverse health outcomes identified (Hughes et al, 2017).…”

Section: Can Aces Help Us Understand These Effects?mentioning

confidence: 93%

Capability and adversity: reframing the “causes of the causes” for mental health

Smith

2018

Palgrave Commun

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Scotland is well known for having the worst health in Western Europe, with the country's premature mortality mainly driven by suicide and substance misuse, rather than physical illness. These problems only emerged relatively recently, and a similar profile of premature mortality, sometimes called "diseases of despair", can be seen in other societies at different times. But what is "despair" in this context, and how might it exert its effects? Studies of the impact of Adverse Childhood Experiences (ACEs) on adult health consistently reveal a similar profile of morbidity, which is thought to relate to the effects of unremitting, unsupported, "toxic" stress. As models of childhood adversity expand to include a wider range of causes and powerful mitigating factors, there is a need to understand why some life events and circumstances are especially harmful. This paper argues that socioeconomic factors, childhood adversity, attachment, resilience and "toxic" stress are all consistent with a broader concept of human potential: Nussbaum's "capabilities approach" to human development. Incorporating our understanding of health and wellbeing in the broader frame of capabilities strengthens our understanding of adversity-related harm, and might also point towards new ways of repairing the social and individual damage they cause.

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The effect of multiple adverse childhood experiences on health: a systematic review and meta-analysis

Abstract: Public Health Wales.

Cited by 3,212 publications

References 60 publications

Vital Signs: Estimated Proportion of Adult Health Problems Attributable to Adverse Childhood Experiences and Implications for Prevention — 25 States, 2015–2017

Vital Signs: Estimated Proportion of Adult Health Problems Attributable to Adverse Childhood Experiences and Implications for Prevention — 25 States, 2015–2017

Domestic Violence and Education: Examining the Impact of Domestic Violence on Young Children, Children, and Young People and the Potential Role of Schools

Capability and adversity: reframing the “causes of the causes” for mental health

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