Pathways from childhood abuse and other adversities to adult health risks: The role of adult socioeconomic conditions

doi:10.1016/j.chiabu.2015.05.013

Child Abuse & Neglect

Volume 51, January 2016, Pages 390-399

https://doi.org/10.1016/j.chiabu.2015.05.013 Get rights and content

Abstract

Adverse childhood experiences (ACEs), including child abuse, have been linked with poor health outcomes in adulthood. The mechanisms that explain these relations are less understood. This study assesses whether associations of ACEs and health risks are mediated by adult socioeconomic conditions, and whether these pathways are different for maltreatment than for other types of adversities. Using the Behavioral Risk Factor Surveillance System 2012 survey (N = 29,229), we employ structural equation modeling to (1) estimate associations of the number and type of ACEs with five health risks—depression, obesity, tobacco use, binge drinking, and self-reported sub-optimal health; and (2) assess whether adult socioeconomic conditions—marriage, divorce and separation, educational attainment, income and insurance status—mediate those associations. Findings suggest both direct and indirect associations between ACEs and health risks. At high numbers of ACEs, 15–20% of the association between number of ACEs and adult health risks was attributable to socioeconomic conditions. Associations of three ACEs (exposure to domestic violence, parental divorce, and residing with a person who was incarcerated) with health risks were nearly entirely explained by socioeconomic conditions in adulthood. However, child physical, emotional, and sexual abuse were significantly associated with several adult health risks, beyond the effects of other adversities, and socioeconomic conditions explained only a small portion of these associations. These findings suggest that the pathways to poor adult health differ by types of ACEs, and that childhood abuse is more likely than other adversities to have a direct impact.

Section snippets

ACEs and Health

Experiences during childhood have a profound effect on health and well-being later in life. Much of our knowledge about this issue stems from studies of ACEs. Generally speaking, studies of ACEs include the following types of adversities: physical, sexual and emotional abuse, as well as exposure to domestic violence, parental divorce or separation, or having resided with someone who abused drugs or alcohol, was incarcerated, or had a mental illness. In the initial ACEs study, which involved

Data and Sample

This study uses the Behavioral Risk Factor Surveillance System (BRFSS) data from the year 2012 (U.S. Center for Disease Control and Prevention, 2012). Although each state contributes data to this survey, only 5 states included the ACEs module in their 2012 interviews (Iowa, North Carolina, Wisconsin, Tennessee, and Oklahoma). Hence, only observations from these 5 states were used, amounting to 39,434 observations. Twenty-six percent of observations were excluded (N = 10,205) due to not completing

Sample Description

Descriptive statistics are presented in Table 2. We estimate the lifetime prevalence of a depressive disorder and recent binge drinking to affect about 18% of the respondents, whereas tobacco use and obesity are present for 25% and 31% of respondents, respectively. About 17% of respondents self-reported sub-optimal health. Over half of the sample experienced at least 1 ACE and 17% experienced 4 or more ACEs. Turning to socioeconomic characteristics, 62% of the sample is married or widowed and

Limitations

We note several limitations to our study, most of which are common to studies using the ACEs module. First, retrospective reporting of childhood experiences may be biased due to inaccurate recall, although prior work suggests that reports of ACEs are reliable (Dube et al., 2004). Second, we cannot determine whether these associations are causal in nature. There are possible confounding factors for which we are unable to account. For example, we cannot account for childhood poverty, which is

Discussion

This study examined three main research questions: (1) What are the direct effects of ACEs (ACE scores and ACE types) on three adult socioeconomic factors—education level, marital status, and income level?; (2) What are the direct effects of ACEs (ACE scores and ACE types) on five health risks—depression, tobacco use, binge drinking, obesity, and self-reported health status?; and (3) Are associations between ACEs (ACE scores and ACE types) and the five health risks partially or fully mediated

References (34)

R.F. Anda et al.
Adverse childhood experiences and risk of paternity in teen pregnancy
Obstetrics and Gynecology
(2002)
M. Chartier et al.
Separate and cumulate effects of adverse childhood experiences in predicting adult health and health care utilization
Child Abuse & Neglect
(2010)
M. Dong et al.
The relationship of exposure to childhood sexual abuse to other forms of abuse, neglect, and household dysfunction during childhood
Child Abuse & Neglect
(2003)
M. Dong et al.
The interrelatedness of multiple forms of childhood abuse, neglect, and household dysfunction
Child Abuse & Neglect
(2004)
S.R. Dube et al.
Growing up with parental alcohol abuse: Exposure to childhood abuse, neglect and household dysfunction
Child Abuse & Neglect
(2001)
S.R. Dube et al.
Long-term consequences of childhood sexual abuse by gender of victim
American Journal of Preventive Medicine
(2005)
S. Dube et al.
Assessing the reliability of retrospective reports of adverse childhood experiences among adult HMO members attending a primary care clinic
Child Abuse & Neglect
(2004)
V.J. Felitti et al.
Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) Study
American Journal of Preventive Medicine
(1998)
J.P. Mersky et al.
Comparing early adult outcomes of maltreated and non maltreated children: A prospective longitudinal investigation
Children and Youth Services Review
(2010)
L. Ramiro et al.
Adverse childhood experiences (ACE) and health-risk behaviors among adults in a developing country setting
Child Abuse & Neglect
(2010)

K.W. Springer et al.

Long-term physical and mental health consequences of childhood physical abuse: Results from a large population-based sample of men and women

Child Abuse & Neglect

(2007)

P.D. Allison

Handling missing data by maximum likelihood

(2012)

R.F. Andra et al.

Adverse childhood experiences and smoking during adolescence and adulthood

Journal of the American Medical Association

(1999)

R.F. Anda et al.

Abused boys, battered mothers, and male involvement in teen pregnancy: New insights for pediatricians

Pediatrics

(2001)

R. Anda et al.

Childhood abuse, household dysfunction, and indicators of impaired adult worker performance

The Permanente Journal

(2004)

L.M. Berger et al.

The role of families in children's health

Future of Children

(2015)

Child Welfare Information Gateway

Child witnesses to domestic violence

(2012)

Cited by (159)

Pathways explaining the intergenerational effects of ACEs: The mediating roles of mothers' mental health and the quality of their relationships with their children
2024, Journal of Applied Developmental Psychology
The effects on children of their parents' accumulated adverse childhood experiences (ACEs), or the mechanisms through which the intergenerational transmission of trauma operates, is still poorly understood.
The present study explored whether mothers' experiences of childhood adversity predicted the presence of social, emotional, or behavioural difficulties in their children, and if the association of maternal ACEs with these child outcomes was mediated by maternal mental health and the quality of the parent-child relationship. Participants and Setting: Three hundred and fourteen mothers attending an Irish community-based therapeutic family service.
Surveys assessed mothers' exposure to ACEs, their mental health, their perception of the quality of the relationship they have with their children, and their children's social, emotional, and behavioural difficulties.
Serial mediation analysis supported the view that mothers' own experiences of adversities experienced in childhood predict the presence of social, emotional, or behavioural difficulties in their children both directly and indirectly via their negative impact upon maternal mental health and the quality of parent-child interactions. These relationships were noted while controlling for child gender and age, and a range of socio economic status (SES) factors.
Understanding how ACEs negatively impact upon mothers' mental health and the quality of their relationship with their children, which in turn negatively impacts upon a range of child development domains, can inform early intervention strategies designed to improve life course outcomes for mothers and their children and contribute towards breaking the transmission of intergenerational risk.
Behavioural health problems among Keralite youth: Relationship with family risk factors and adverse childhood experiences
2023, Children and Youth Services Review
Preventing adverse childhood experiences (ACEs) is very critical for assuring the healthy development of children. Substantial research shows a robust, dose–response relationship between ACEs and subsequent adverse outcomes. The current study examines the prevalence of ACEs, family risk factors, and Behavioural Health Problems (BHPs) and, the risk of BHPs in relation to family risk factors while considering the influential role of ACEs. A Demographic proforma and Childhood Experiences of Care and Abuse Questionnaire-2 were used to gather data from 613 youth, selected through multi-stage stratified sampling from selected educational institutions in Kerala, South India. Descriptive and inferential statistics (Chi-square test and Binary Logistic regression) were used for analysis. Keralite youth have exposure to multiple ACEs and family risk factors. Various ACEs were highly prevalent (14%-69%) and a quarter of youth had four or more ACEs, with more exposure in males. Neglect, antipathy, and psychological abuse were the common types. Family risk factors, domestic violence (8%), and parental substance abuse (10%) were significant predictors for loss, antipathy and sexual abuse, and the ACEs score. Youth with family risk factors were more likely to have ACEs and those with ACEs exposure were more likely to have BHPs. Parental substance abuse increased the likelihood of depression irrespective of ACEs exposure. This evidence suggests that the exposure to family risk factors and ACEs increases the likelihood of the risk of BHPs in youth and their interrelatedness needs to be addressed in preventing the negative outcomes in later life.
Association between adverse childhood experiences and marital status among Japanese older adults
2023, Child Abuse and Neglect
Marital status is a well-known social determinant of health. Adverse childhood experiences (ACEs) affect attachment, critical to establishing and maintaining intimate relationships, such as marital status.
This study examined the association between ACEs and marital status among older Japanese adults.
This research used data from a nationwide population-based study among functionally independent people aged 65 and above in Japan.
ACEs were assessed by self-reported questionnaires on the following experiences before 18 years old: parental death, parental divorce, parental mental disease, exposure to intimate partner violence, physical abuse, psychological neglect, psychological abuse, and poverty. Marital status was asked as currently having a spouse (including common-law marriage), widowed, divorced, or unmarried. Associations between the total number of ACEs and marital status were analyzed by multinomial logistic regression.
Three or more ACEs showed higher risks of being widowed, divorced, or unmarried. Psychological neglect led to higher divorce risks among males (RRR, 95%CI = 1.41, 1.13–1.76) and females (RRR, 95%CI = 1.56, 1.28–1.89). Childhood poverty showed higher risks of unmarried among males (RRR, 95%CI = 1.25, 1.02–1.53) and females (RRR, 95%CI = 1.41, 1.18–1.69). Association between ACEs and divorce risks showed gender differences (RRR, 95%CI of having three or more ACEs in males: 2.19, 1.66–2.90; in females: 3.45, 2.71–4.38; p for interaction = 0.034).
ACEs showed higher risks of being widowed, divorced, and unmarried among older Japanese people. Policy to tackle ACEs and research investigating how ACEs, attachment, and relationship quality influence marital status are required to promote well-being in later life.
Pathways to recovery among survivors of childhood physical abuse: What is important to promote complete mental health
2023, Children and Youth Services Review
Despite the numerous adverse health and social consequences of childhood physical abuse (CPA), some of those with a history of CPA manage to thrive in adulthood and achieve complete mental health (CMH). CMH is defined as the absence of mental illness in combination with happiness and/or life satisfaction, as well as high levels of social and psychological well-being.
(1) To identify pathways linking CPA to CMH in adulthood; and (2) To estimate the magnitude of risk and protective factors associated with CMH among those exposed to CPA.
A sample of 17,216 respondents from the 2012 Canadian Community Health Survey-Mental Health was selected, including 853 with a history of CPA.
Path analysis was used to estimate indirect and direct pathways between CPA, risk and protective factors, and CMH. Multivariable logistic regression was used to investigate the magnitude of effects of the same risk and protective factors on CMH among CPA survivors.
After controlling for sociodemographic factors, the association between CPA and CMH was mediated by lifetime depression, anxiety, substance misuse, chronic pain, and presence of a confidant. The strongest predictors of past year CMH among those with a history of CPA was lifetime depression (OR = 0.19; 95 % CI 0.12–0.30) and presence of a confidant (OR = 3.77; 95 % CI = 1.67–8.55).
It is important to consider external factors, such as social support, in addition to mental health factors, such as depression and anxiety, to promote resiliency among those with a history of CPA.
The impacts of adverse childhood experiences on socioeconomic disadvantage by sexual and gender identity in the U.S.
2023, Child Abuse and Neglect
Adverse childhood experiences (ACEs) predict low education and low income, but this has scarcely been examined by sexual orientation and gender identity.
We investigated prevalence and associations between ACEs, low income, and low education in sexual and gender diverse (SGD) and cisgender heterosexual (CGH) sub-groups.
Data came from 14 states in the 2019 Behavioral Risk Factor Surveillance System survey (n = 79,303).
Chi-square, logistic regression, and moderation analyses were implemented to examine the prevalence and associations between ACEs, low income, and low education. Sample stratification was used to examine differences between SGD and CGH sub-groups.
SGD participants reported higher prevalence of ACEs, low income, and low education compared to CGH participants (p < 0.0001) with the highest proportions in transgender and queer/something else groups. ACEs were associated with low income (AOR 1.084, CI 1.067–1.102) and low education (AOR 1.056, CI 1.041–1.071) in the entire sample. Transgender and queer/something else groups had higher odds of low income (AOR 3.345, CI 1.975–5.665; AOR 1.702, CI 1.096–2.643) and low education (AOR 1.702, CI 1.096–2.643; AOR 3.552, CI 2.842–4.440) and gay/lesbian identity had reduced odds of low education (AOR 0.586, CI 0.457–0.751) compared to CGH males. The strength of associations between ACEs and low income and low education were weaker among SGD compared to CGH sub-groups.
These findings highlight the importance of including categories of sexual identity cross-classified by gender identity in population-based analyses in order to facilitate a comprehensive characterization of the life course outcomes of SGD populations.
Family, Neighborhood and Parent Resilience Are Inversely Associated With Reported Depression in Adolescents Exposed to ACEs
2023, Academic Pediatrics
To examine the association of 1) extrinsic resilience factors and 2) adverse childhood experiences (ACEs) with a caregiver reported diagnosis of depression in a nationally representative sample of adolescents.
A cross sectional analysis of the 2016–2017 National Survey of Children's Health, restricted to adolescents 12 to 17 years old was conducted. The dependent variable was caregiver reported depression: no current diagnosis vs. current diagnosis of depression. Independent variables were reported ACEs dichotomized as lower (0–3) or higher (4 or more), and specific resilience factors: family resilience, neighborhood cohesion and caregiver emotional support. Resilience factors were analyzed as a composite score dichotomized as lower (0–3) or higher (4 or more) and individually. Purposeful selection multivariable logistic regression model building was used to estimate the associations between reported diagnosis of depression, ACEs and resilience factors adjusting for demographic covariates.
Study sample consisted of 29,617 (weighted N = 24,834,232) adolescents, 6% with current reported diagnosis of depression, 8% with higher ACEs and 91% with higher resilience. Family resilience, neighborhood cohesion and caregiver emotional supports were each independently associated with lower odds of reported diagnosis of depression. However, with all resilience factors in the model, only family resilience and neighborhood cohesion (specifically school safety) remained significantly associated with lower odds of reported diagnosis of depression.
In this nationally representative sample, family resilience and neighborhood cohesion were associated with lower odds of a reported diagnosis of depression even with confounding ACEs exposure. These factors may be important targets for future intervention.

View all citing articles on Scopus

^☆: This research has received support from the grant, 5 T32 HD007081, Training Program in Population Studies, awarded to the Population Research Center at The University of Texas at Austin by the Eunice Kennedy Shriver National Institute of Child Health and Human Development.

View full text

Research articlePathways from childhood abuse and other adversities to adult health risks: The role of adult socioeconomic conditions☆

Abstract

Section snippets

ACEs and Health

Data and Sample

Sample Description

Limitations

Discussion

Obstetrics and Gynecology

Child Abuse & Neglect

Child Abuse & Neglect

Child Abuse & Neglect

Child Abuse & Neglect

American Journal of Preventive Medicine

Child Abuse & Neglect

American Journal of Preventive Medicine

Children and Youth Services Review

Child Abuse & Neglect

Child Abuse & Neglect

Handling missing data by maximum likelihood

Adverse childhood experiences and smoking during adolescence and adulthood

Journal of the American Medical Association

Abused boys, battered mothers, and male involvement in teen pregnancy: New insights for pediatricians

Pediatrics

Childhood abuse, household dysfunction, and indicators of impaired adult worker performance

The Permanente Journal

The role of families in children's health

Future of Children

Child witnesses to domestic violence

Research article
Pathways from childhood abuse and other adversities to adult health risks: The role of adult socioeconomic conditions☆