Research paperAnxiety among adults with a history of childhood adversity: Psychological resilience moderates the indirect effect of emotion dysregulation
Introduction
Anxiety disorders are common in the general population, with 12-month and lifetime rates of 18.1% and 28.8%, respectively (Kessler et al., 2005b, Kessler et al., 2005a). Anxiety disorders are characterized by excessive fear/worry and subsequent avoidance (American Psychiatric Association, 2013) and are often chronic and re-occurring (Moffitt et al., 2007). Elevated symptoms of anxiety represent a significant public health concern, as they are associated with substantial functional impairment (Löwe et al., 2008), high rates of comorbidity (Roy-Byrne et al., 2008), reduced work productivity, and increased health care costs and utilization (Wittchen et al., 2002, Wittchen, 2002). In the United States alone, anxiety disorders are estimated to cost $44 billion dollars per year in indirect and direct costs (Greenberg et al., 1999).
Although the consequences associated with anxiety disorders have received increased recognition in recent years, further research is needed to clarify the etiology of anxiety. Results of twin and family studies suggest that the magnitude of heritable influences on anxiety disorders is relatively moderate (see Hettema et al., 2001 for a review), indicating that psychosocial factors may be especially relevant in the etiology of anxiety disorders. One factor that theorists and researchers have emphasized to be relevant to the development of anxiety disorders throughout the lifespan is childhood exposure to adversity.
Section snippets
Adverse childhood experiences
Adverse childhood experiences (ACEs) are defined as exposure to emotional, physical, and sexual abuse, emotional and physical neglect, and household dysfunction (i.e., household substance abuse, mental illness, and criminal behavior; intraparental violence; parental separation or divorce) prior to the age of 18 years. Approximately two in every three American adults report a history of at least one ACE, and 12% report at least four types of ACEs (Dube et al., 2001). ACEs have consistently been
Participants
Data were collected from a total of 4,0064006 primary care patients aged 18 years and older. Participants were recruited from 11 primary care clinics in the greater Calgary, AB, Canada area, as part of the EmbrACE study. Recruitment took place from October 2014 to July 2015. The EmbrACE study was approved by the University of Calgary's Human Research Ethics Board.
Procedure
Physicians at primary care clinics in Calgary, AB, Canada and surrounding areas were invited to participate in the EmbrACE study. On
Demographic information
All participants were asked to provide information on their age, gender, ethnicity, education, annual household income, marital status, and employment status. All nominal and ordinal variables (i.e. ethnicity, education, income, marital status, employment) were dummy coded.
Adverse childhood experiences (ACEs)
The Adverse Childhood Experiences (ACE) Questionnaire is a 29-item scale adapted from a variety of published questionnaires including the Conflict Tactics Scale (Straus, 1979), The Child Trauma Questionnaire (Bernstein et
Statistical analyses
Results indicated that the data met assumptions related to multicollinearity, linearity, homoscedasticity, and normally distributed errors. Missing values analyses (e.g, Little's MCAR test, t-tests) revealed that missing data were missing at random and thus did not reflect selection bias. Thus, list-wise deletion was utilized to handle all missing data. Finally, one-way ANOVAs were utilized to evaluate differences in responses to self-reported data as a function of survey modality (i.e. online
Results
Table 1 summarizes the descriptive data for the sample. Approximately 68% of the respondents were women. Participants ranged in age from 18 to 92 years (M=44.13 years, SD=16.98). Eighty-three percent of respondents were White, 9.9% were Asian, 1% were Black, .8% were Native American, and 5.2% were of other ethnicities. In general, the sample had relatively high socioeconomic status and was highly educated (e.g., approximately 57% of the sample had obtained post-secondary or graduate degrees).
Discussion
The current study revealed important insights regarding the psychosocial processes that underlie elevated symptoms of anxiety in adulthood. First, results provided support for the hypothesis that increased cumulative ACEs were associated with elevated symptoms of anxiety in adulthood. Further, each type of ACE (emotional abuse, physical abuse, sexual abuse, emotional neglect, physical neglect, and household dysfunction) was significantly associated with increased symptoms of anxiety. Second,
Conclusions
Despite the substantial personal and economic costs associated with anxiety disorders, only a minority of patients are effectively recognized and treated within primary care settings (Kessler et al., 2009; Goorden et al., 2014). Adverse childhood experiences have been repeatedly identified as an antecedent to anxiety disorders and thus appear to be highly relevant to the conceptualization and treatment of anxiety disorders. Prior to the current study, little was known about the mechanisms by
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