The relationship between adverse childhood experiences, healthcare utilization, cost of care and medical comorbidities

Koball, Afton M.; Rasmussen, Cary; Olson-Dorff, Denyse; Klevan, Judy; Ramirez, Luis D.; Domoff, Sarah E.

doi:10.1016/j.chiabu.2019.01.021

Cited by 52 publications

(32 citation statements)

References 23 publications

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“…This is because the consequences of trauma are intensity-dependent; thus, there is a need to collect data on the number of traumatic events. Multiple traumas (2+) are an indicator of a more stressful situation and have a stronger effect on a wide range of psychosocial outcomes [ 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 ].…”

Section: Methodsmentioning

confidence: 99%

Family Socioeconomic Status and Exposure to Childhood Trauma: Racial Differences

Assari

2020

Children

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Background: Minorities’ diminished returns (MDRs) refer to weaker effects of socioeconomic status (SES) indicators such as parental educational attainment and family income in generating tangible childhood outcomes for racial and ethnic minorities compared to the majority group, a pattern prevalent in the US. Our existing knowledge is minimal, however, about diminished returns of family SES on reducing exposure to childhood trauma. Aim: To determine if there was a difference between non-Hispanic whites (NHW) and non-Hispanic blacks (NHB) in the effect of SES on exposure to childhood trauma among children ages 8–11 years old. Materials and methods: In this cross-sectional study, we analyzed data from 4696 NHW or NHB American 8–11-year-old children who were participants in the Adolescent Brain Cognitive Development (ABCD) Study. The independent variables were parental educational attainment and family income. The primary outcome was exposure to 1 or 2+ childhood traumas, measured by the Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS) semi-structured interview. Polynomial regression was used for data analysis. Results: Parental education and family income had statistically significant protective (negative) effects on childhood trauma, indicating children from high income and highly educated families were exposed to a lower level of childhood trauma. However, race/ethnicity showed statistically significant interactions with parental education and family income on exposure to childhood trauma, indicating weaker protective effects of parental education and family income on reducing exposure to trauma for NHB compared to NHW children. Race-specific models showed protective effects of parental education and family income on exposure to childhood trauma for NHW but not NHB children. Conclusion: The protective effects of parental education and family income against exposure to childhood trauma are systematically diminished for NHBs compared to NHWs. To minimize the racial/ethnic health gaps, diminished returns of parental education and family income should be addressed. There is a need for programs and interventions that equalize not only SES but also the marginal returns of SES for ethnic groups. Such efforts require addressing structural and societal barriers that hinder NHB families from translating their SES resources into tangible outcomes. There is a need for studies that can minimize MDRs for NHB families, such that SES can similarly secure tangible outcomes in the presence of SES resources.

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Section: Methodsmentioning

confidence: 99%

Family Socioeconomic Status and Exposure to Childhood Trauma: Racial Differences

Assari

2020

Children

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“…The economic burden created by child abuse and neglect includes massive productivity loss and demands on the health, education, and justice systems (Fang et al 2012;Koball et al 2019).…”

Section: Economic Burdenmentioning

confidence: 99%

Child Abuse and Neglect in Multiproblem Families

Shaw¹

2020

Mental Health and Illness Worldwide

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Our understanding of child abuse and neglect took a big step with the recognition of the "Battered-Child Syndrome," while the United Nations and World Health Organisation have played key roles in improving its recognition internationally. This chapter considers child abuse and neglect as it occurs in multiproblem families. It seems likely that at least 1 in 4 children experience abuse and/or neglect before their 18th birthday, but complex barriers to detection result in only 1 in 5 affected children being recognized by child protection services. Child abuse and neglect kill around 2 in 100,000 children per year. For those that survive, there is a dose-response relationship between exposure to abuse and neglect and big jumps in risk to developmental delay, damaging behaviors, diminished life chances, poor health, reduced life expectancy, and increased economic burden on society. However, protective factors can mitigate the harmful effects of child abuse. The author proposes an explanatory model for resilience, pathogenesis, and treatment. The availability of a "containing" parental figure, incremental and manageable doses of distress, and the development of symbolic thinking all help to build resilience. Abused and neglected children face "unbearable distress," which acts as a "pathogen" that first shuts down thinking and creates "mindlessness" and second opens the door to re-enactments or "repetitions" which potentially "infect" others with the same pathogen. Treatment involves helping children to establish emotional connections with a trustworthy adult, build a mind so that they are capable of sitting with and thinking about distress, and diverting the impulse for repetition away from action and towards thinking. Prevention is important, and more work is needed to integrate mental health services into child protection efforts.

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“… 29 In one study from the USA, patients with high ACE exposure (≥4 ACEs) made more but kept fewer GP appointments. 18 …”

Section: Introductionmentioning

confidence: 99%

“…Toxic stress can result in systemic inflammation throughout the body and increases allostatic load. This biological embedding of adversity, along with health-harming behaviours that emerge often as coping mechanisms, places individuals at greater risk of chronic disease, 17 complex multi-morbidity 18 and even early mortality. 19 Throughout the life course, those with a history of ACEs are also considerably more likely to experience mental health issues such as anxiety and depression.…”

mentioning

confidence: 99%

“…29 In one study from the USA, patients with high ACE exposure (≥4 ACEs) made more but kept fewer GP appointments. 18 There is a growing recognition among health practitioners of the impact of early life experiences on later health and the need for services to recognise and respond to historic or ongoing trauma. 30 However, evidence suggests that childhood adversity is rarely the focus of primary care consultations.…”

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confidence: 99%

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Exploring the health and service utilisation of general practice patients with a history of adverse childhood experiences (ACEs): an observational study using electronic health records

et al. 2020

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ObjectivesTo examine the relationships between adverse childhood experiences (ACEs), chronic health and health service utilisation among a sample of general practice patients.DesignCross-sectional observational study using anonymised data from electronic health records for 763 patients.SettingFour general practices in northwest England and North Wales.Outcome measuresPatient demographic data (age, gender); body mass index; self-reported smoking status; self-reported ACEs; diagnosis of chronic health conditions; current mental health problems; total number of service contacts and repeat medication use in the previous 6 months.ResultsA history of ACEs (experiencing abuse or neglect as a child, and/or growing up in a household characterised by violence, substance use, mental health problems or criminal behaviour) was strongly independently associated with current mental health problems, smoking and chronic obstructive pulmonary disease, showing a dose–response relationship with level of ACE exposure. Medication use and contact were significantly greater among patients with high ACE exposure (≥4 ACEs), compared with those with no ACEs. However, contrary to findings from population studies, health service utilisation was not significantly different for patients with increased ACE exposure (1–3 ACEs) and their ACE-free counterparts.ConclusionsFindings highlight the contribution ACEs make to unequal distributions of risk to health and well-being and patterns of health service use in the UK.

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The relationship between adverse childhood experiences, healthcare utilization, cost of care and medical comorbidities

Cited by 52 publications

References 23 publications

Family Socioeconomic Status and Exposure to Childhood Trauma: Racial Differences

Family Socioeconomic Status and Exposure to Childhood Trauma: Racial Differences

Child Abuse and Neglect in Multiproblem Families

Exploring the health and service utilisation of general practice patients with a history of adverse childhood experiences (ACEs): an observational study using electronic health records

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