The Intersection and Dynamics between COVID-19, Health Disparities, and Adverse Childhood Experiences

Abstract

The coronavirus disease 2019 pandemic is shining a spotlight on health disparities that have long been overlooked in our society. The intersection between Adverse Childhood Experiences (ACEs), longstanding health disparities, and COVID-19 cannot be ignored. The accumulation of traumatic events throughout the childhood and adolescent years can cause toxic stress in the absence of supportive adults. This repetitive activation of the stress response system can be a catalyst to long-term, negative effects on both the body and brain. A major factor to appreciate is that ACEs do not affect all populations equally. ACEs disproportionately affect groups that have been historically oppressed. The current COVID-19 pandemic highlights this point when observing both case rates and fatality rates of the virus and has the potential to create a new series of long-term health conditions that will disproportionately affect marginalized communities. A foundational first and critical step of adopting a trauma-informed approach will help lead to system change, advance equity, and create a setting of mutuality and empowerment for our patients.

Psychological Flexibility Mediates Wellbeing for People with Adverse Childhood Experiences during COVID-19

“…Recent findings related to COVID-19 and historical research show that the mental health fallout from COVID-19 will disproportionately impact those already vulnerable in society [65][66][67][68]. This study supports previous research showing that those who have experienced ACE report greater psychological distress over time during the current COVID-19 pandemic [25,26,32,36].…”

“…The Effects of COVID-19 Questionnaire is a 34-item tool designed to measure individuals' perception of COVID-19 related stresses and associated gratitude. This measure contains four subscales: Personal Stress (items 1-13), Parenting Stress (items 14-21), Older Aging Parent Stress (22)(23)(24)(25), and Gratitude (26)(27)(28)(29)(30)(31)(32)(33)(34), in which respondents must choose from five response options. Within the ECQ subscales, the ranges for Personal Distress are: Normal 0-12; Mild 13-19; Moderate 20-26; Severe 27-33; Extremely Severe ≥34.…”

“…The stress sensitization hypothesis [24] posits that adversities in early childhood sensitize individuals to subsequent proximal stress and increases the risk for psychopathology in the face of future stressful life events. As such, one such population that is likely to be vulnerable to the stressors associated with COVID-19 are individuals who have experienced Adverse Childhood Experiences (ACEs) [25][26][27].…”

“…Early research has indicated that those who experienced ACEs are more vulnerable to both the direct and indirect effects of COVID-19, than those without [26,27,[32][33][34][35][36][37][38][39]. In addition, those with several ACEs (i.e., ≥4) are more likely than individuals without ACEs to have existing mental health difficulties, chronic physical ill-health, and are disproportionately from lower socioeconomic backgrounds [21,25,28,[40][41][42][43]. Based on the stress sensitization hypothesis, COVID-19 is an additional major stressor to individuals with an already heightened liability to physical and psychological difficulties [26,44], with comorbid medical conditions shown to relate to elevated psychological distress, notwithstanding ACEs [14,21,23,45].…”

COVID-19: Evidenced Health Disparity

“…Table 2 presents ten studies examining different forms of violence (e.g., police brutality, riots, shooting), mostly during COVID-19. In addition to the institutional violence, environmental injustice, and segregationist and discriminatory laws that faced, majorly, the minorities and immigrants in most countries is the COVID-19 pandemic which stretches structural racism in many countries [30,37,[60][61][62][63][64][65]. It has become common knowledge that "pandemics always follow the fault line of society" [33]-structural or institutional racism.…”