Childhood experiences have an enormous impact on people’s health in adulthood. This blog post is not based on any new breakthroughs or just-published research. Rather, it is a reminder to all clinicians to keep in mind the ACE Study as we see our patients who have problems with alcohol or nicotine addiction, depression, unintended and/or adolescent pregnancies, suicide attempts, liver disease, COPD, and other conditions.
In case you have not heard of the ACE Study, it was published initially in 1998 but has been updated periodically since. In the study, Robert Anda of the CDC and Vincent Felitti of Kaiser Permanente looked at 17,000 adults, and surveyed them about their exposure to 17 possible adverse situations in childhood. These adverse childhood experiences (ACEs) fell into ten categories: psychological abuse, physical abuse, sexual abuse, emotional neglect, physical neglect, living in a household where the mother was treated violently, where there was criminal activity, where there was substance abuse, mental illness, or where the parents were separated or divorced. Based on how many ACEs a person was exposed to, they were given a score of zero (no ACEs) to ten. Just over one-third of the participants had an ACE score of zero.
Anda and Felitti then looked to see whether there was a correlation between ACE scores and various adult health problems. What they found was striking. The higher one’s ACE score, the worse their health as an adult. For those with an ACE score of four or higher, the risk of COPD is almost four-fold higher than with a score of zero. Depression is almost five times as likely. Suicide is 12 times more likely. Those with an ACE score of six or higher had a 20-year drop in life expectancy.
These results are sobering indeed. Research is ongoing to find out the links between adverse childhood experiences and adult health problems, but a significant factor is likely an increased prevalence of adverse health behaviors in adulthood – especially smoking, drinking, drug abuse, irresponsible sexual activity.
So, what are practicing clinicians supposed to do with this information? There are no easy preventive measures. Reducing ACEs in the first place requires societal, cultural, and economic changes beyond the scope of practice of individual clinicians. But being aware of the lingering and pernicious influence of childhood traumas in adults is important. Referring people, as appropriate, for counseling can sometimes unearth long-standing stresses and help people find other ways of dealing with them.
More information on the ACE Study can be found at: http://www.cdc.gov/ace/index.htm.
The original article can be seen at the following link. Be aware, though, that the methods and data have been updated since the original publication, and the study is still ongoing. http://download.journals.elsevierhealth.com/pdfs/journals/0749-3797/PIIS0749379798000178.pdf
Richard Fleming, MD