Health and financial costs of adverse childhood experiences in 28 European countries: a systematic review and meta-analysis

Adverse childhood experiences: a meta-analysis of prevalence and moderators among half a million adults in 206 studies

Exposure to adverse childhood experiences (ACEs), including maltreatment and family dysfunction, is a major contributor to the global burden of disease and disability. With a large body of international literature on ACEs having emerged over the past 25 years, it is timely to now synthetize the available evidence to estimate the global prevalence of ACEs and, through a series of moderator analyses, determine which populations are at higher risk. We searched studies published between January 1, 1998 and August 5, 2021 in Medline, PsycINFO and Embase. Study inclusion criteria were using the 8- or 10-item ACE Questionnaire (±2 items), reporting the prevalence of ACEs in population samples of adults, and being published in English. The review protocol was registered with PROSPERO (CRD42022348429). In total, 206 studies (208 sample estimates) from 22 countries, with 546,458 adult participants, were included. The pooled prevalence of the five levels of ACEs was: 39.9% (95% CI: 29.8-49.2) for no ACE; 22.4% (95% CI: 14.1-30.6) for one ACE; 13.0% (95% CI: 6.5-19.8) for two ACEs; 8.7% (95% CI: 3.4-14.5) for three ACEs, and 16.1% (95% CI: 8.9-23.5) for four or more ACEs. In subsequent moderation analyses, there was strong evidence that the prevalence of 4+ ACEs was higher in populations with a history of a mental health condition (47.5%; 95% CI: 34.4-60.7) and with substance abuse or addiction (55.2%; 95% CI: 45.5-64.8), as well as in individuals from low-income households (40.5%; 95% CI: 32.9-48.4) and unhoused individuals (59.7%; 95% CI: 56.8-62.4). There was also good evidence that the prevalence of 4+ ACEs was larger in minoritized racial/ethnic groups, particularly when comparing study estimates in populations identifying as Indigenous/Native American (40.8%; 95% CI: 23.1-59.8) to those identifying as White (12.1%; 95% CI: 10.2-14.2) and Asian (5.6%; 95% CI: 2.4-10.2). Thus, ACEs are common in the general population, but there are disparities in their prevalence. They are among the principal antecedent threats to individual well-being and, as such, constitute a pressing social issue globally. Both prevention strategies and downstream interventions are needed to reduce the prevalence and mitigate the severity of the effects of ACEs and thereby reduce their deleterious health consequences on future generations.

Early-Life Factors and Multimorbidity Risk Later in Older Age: Evidence Based on CHARLS

INTRODUCTION

Early-life factors were reported to exert influence on the health condition of individuals in the long-term. However, limited research explored the connection between early-life factors and multimorbidity in later years.

METHODS

We utilized the data from the China Health and Retirement Longitudinal Study to assess this possible association in the present cross-sectional study. Multimorbidity was determined based on 14 common chronic diseases included in the study. Logistic regression was employed to examine the link between early-life factors and subsequent multimorbidity.

RESULTS

Out of 7,578 participants who met the inclusion criteria for analysis, 3,765 (49.68%) were females. The mean age was 68.25 ± 6.70 years. Participants who rated their health during childhood as average (odds ratio [OR] 0.78, 95% confidence interval [CI] 0.63-0.96) or better [OR 0.72, 95% CI 0.57-0.91] were significantly less likely to experience multimorbidity in older life. By contrast, experiencing violence from two of the family members was significantly associated with future multimorbidity (OR [95% CI], 1.29 [1.04-1.60]). A superior family financial situation was also negatively associated with multimorbidity, with average (OR [95% CI], 0.72 [0.63-0.83]) and better off than average (OR [95% CI], 0.76 [0.62-0.93]).

DISCUSSION

Individuals with poor health status, inferior family socioeconomic status, or experienced violence from family members in childhood were more likely to suffer from multimorbidity in later life. Enhanced social monitoring of potentially adverse conditions in youngsters and targeted interventions could help mitigate the progression of multimorbidity in later life.

Killing pain? A prospective population-based study on trauma exposure in childhood as predictor for frequent use of over-the-counter analgesics in young adulthood. The HUNT study

Frequent and increasing use of over-the-counter analgesics (OTCA) is a public health concern. Pain conditions and psychological distress are related to frequent OTCA use, and as exposure to potentially traumatic events (PTE) in childhood appears to increase risk of experiencing such symptoms, we aimed to assess childhood PTEs and related symptoms in adolescence as predictors for frequent OTCA use in young adulthood. Prospective population survey data were used (n = 2947, 59.1% female, 10-13 years follow-up). Exposure to PTEs, symptoms of post-traumatic stress, anxiety and depression, musculoskeletal pain and headache were assessed in adolescence (13-19 years). Use of OTCA was assessed in young adulthood (22-32 years) and use of OTCA to treat musculoskeletal pain and headache served as separate outcomes in ordinal logistic regression analyses. Overall, exposure to childhood PTEs, particularly direct interpersonal violence, was significantly and consistently related to more frequent use of OTCA to treat musculoskeletal pain and headaches in young adulthood. Adjusting for psychological symptoms and pain attenuated associations, indicating that these symptoms are of importance for the relationship between traumatic events and OTCA use. These findings emphasize the need to address symptomatology and underlying causes at an early age.

Adversity profiles of children receiving care and support from social services: A latent-class analysis of school-aged children in Wales

BACKGROUND

Children receive care and support from social services due to the risk of harm or impeded development or because of disability. This study aimed to identify typologies of adversity experienced by children receiving care and support from social services and to explore how typologies differ by sociodemographic characteristics.

METHODS

This is a cross-sectional study of 'Children Receiving Care and Support' (N = 12 792) during 2017/2018 in Wales, UK. We sought to (1) examine the prevalence of household adversities experienced by children in receipt of care and support from social services; (2) identify typologies of household adversities; and (3) explore how typologies of household adversities differ by family characteristics (demographics, measures of social disadvantage, perinatal and care factors).

RESULTS

We found evidence for multiple risk factor constellations. The four-class solution suggested four distinct classes of adversities: child disability (50.0%), low adversities (20.3%), family poor health (6.7%) and multiple risks (23.0%). Children in the 'multiple risk' class were significantly more likely to be younger, more deprived and 'looked after' by the local authority compared with those in the 'low adversities' class.

CONCLUSIONS

Given the presence of different constellations of household adversities, policies and interventions that address multiple risk factors simultaneously may be more effective and have longer-lasting benefits.

Depression among Patients with an Implanted Left Ventricular Assist Device: Uncovering Pathophysiological Mechanisms and Implications for Patient Care

Depression is a common and devastating mental illness associated with increased morbidity and mortality, partially due to elevated rates of suicidal attempts and death. Select patients with end-stage heart failure on a waiting-list for a donor heart undergo left ventricular assist device (LVAD) implantation. The LVAD provides a circulatory flow of oxygenated blood to the body, mimicking heart functionality by operating on a mechanical technique. LVAD improves functional capacity and survivability among patients with end-stage heart failure. However, accumulating data suggests that LVAD recipients suffer from an increased incidence of depression and suicide attempts. There is scarce knowledge regarding the pathological mechanism and appropriate treatment approach for depressed LVAD patients. This article summarizes the current evidence on the association between LVAD implantation and occurrence of depression, suggesting possible pathological mechanisms underlying the device-associated depression and reviewing the current treatment strategies. The summarized data underscores the need for a rigorous pre-(LVAD)-implantation psychiatric evaluation, continued post-implantation mental health assessment, and administration of antidepressant treatment as necessary.

Comparison of Person-Centered and Cumulative Risk Approaches in Explaining the Relationship Between Adverse Childhood Experiences and Behavioral and Emotional Problems

Adverse childhood experiences (ACEs) commonly co-occur, and researchers often estimate their impact using a cumulative risk approach. The person-centered approach offers another approach to operationalize the co-occurrence of ACEs. This study aims to estimate latent classes of ACEs in a sample of U.K. children, examine their relationship with emotional and behavioral problems, and compare the explanatory value of the latent classes to cumulative risk scores. Data were collected among a general population sample of British 10-year-old children extracted from the U.K. Household Longitudinal Study (N = 601). Seven items characterized ACEs, comprising parent-report physical discipline, emotional abuse, supervisory neglect, maternal psychological distress, child-report parental educational disinterest, bullying victimization, and adverse neighborhood. Outcome measures were derived from the self-report Strengths and Difficulties Questionnaire including total difficulties, emotional symptoms, conduct problems, hyperactivity, peer problems, and prosocial behavior. Latent class analysis resulted in a three-class solution: low ACEs, household challenges, and community challenges. Compared to the other classes, the community challenges class scored substantially worse on total difficulties, emotional symptoms, and peer subscales. The cumulative risk score was associated with all outcomes except prosocial behavior. Cumulative risk models accounted for a larger proportion of variance compared with the latent class models, except for peer problems which the person-centered model explained better. This study confirms that ACEs are associated with impairment in child functioning, and that both person-centered and cumulative risk approaches can capture this relationship well. Specifically, the person-centered approach demonstrated how co-occurring risk factors in the community challenges class produced particularly poor internalizing outcomes.

[Family stressors on young children's emotional development]

BACKGROUND

Adverse childhood experiences (ACE) have been pointed out as risk factors for physical and mental health, with consequences extending from childhood into adulthood. Based on research regarding the effects of selected ACE as well as the accumulation of ACE, this article investigates how different types of family stressors are linked to children's negative emotionality in infancy and early childhood.

METHODS

Data are from the KiD 0-3 study (N = 5583) and the follow-up of a subsample after 2 years (n = 681). Based on 14 stress factors, we distinguish families with no/little stressors, socioeconomic stressors, parenting stressors, and multiple stressors.

RESULTS

Children in multiply stressed families have the highest risk of high negative emotionality (compared to unstressed families: Odds Ratios [OR] ranging from 13.00 to 6.81), controlling for demographic characteristics, child-related stress factors (e.g., excessive crying), and caregiver childhood stress. Children in families primarily characterized by parenting stress also showed a significantly increased risk of high negative emotionality (OR ranging from 8.31 to 6.95), whereas this did not hold for children from socioeconomically stressed families (without parenting stress) compared to those from unstressed families. Longitudinal analyses of the follow-up subsample showed that changes in the number of stressors were also associated with parallel changes in children's negative emotionality.

DISCUSSION

These results confirm findings from international research on ACE in Germany and for early childhood. They underline the importance of a well-developed early intervention system.

Spousal concordance in adverse childhood experiences and the association with depressive symptoms in middle-aged and older adults: findings across China, the US, and Europe

Background

Adverse childhood experiences (ACEs) are associated with higher depressive risks in adulthood. Whether respondents' ACEs are associated with their own depressive symptoms in adulthood and whether this association extends to their spouses' depressive symptoms remain unexplored.

Methods

Data were from China Health and Retirement Longitudinal Study (CHARLS), the Health and Retirement Study (HRS), and the Survey of Health, Ageing and Retirement in Europe (SHARE). ACEs were categorized into overall, intra-familial, and extra-familial ACEs. Correlations of couples' ACEs were calculated using Cramer's V and partial Spearman's correlation. Associations of respondents' ACEs with spousal depressive symptoms were assessed using logistic regression, and mediation analyses were conducted to explore the mediating role of respondents' depressive symptoms.

Results

Significant associations between husbands' ACEs and wives' depressive symptoms, with odds ratios (ORs) and 95% confidence intervals (CIs) of 2.09 (1.36-3.22) for 4 or more ACEs in CHARLS, and 1.25 (1.06-1.48) and 1.38 (1.06-1.79) for 2 or more ACEs in HRS and SHARE. However, wives' ACEs were associated with husbands' depressive symptoms only in CHARLS and SHARE. Findings in intra-familial and extra-familial ACEs were consistent with our main results. Additionally, respondents' depressive symptoms mediated more than 20% of the effect of respondents' ACEs on spousal depressive symptoms.

Conclusion

We found that ACEs were significantly correlated between couples. Respondents' ACEs were associated with spousal depressive symptoms, with respondents' depressive symptoms mediating the association. The bidirectional implications of ACEs on depressive symptoms should be considered within household and effective interventions are warranted.

Childhood adversity is associated with hospitalisations and survival following external causes and non-communicable diseases: a 46-year follow-up of a Stockholm birth cohort

BACKGROUND

Childhood adversity indicated by involvement with child welfare services (ICWS) is associated with increased risks of disease and injuries in young adulthood. It is yet unknown whether such risks are limited to external causes and mental and behavioural disorders or whether they extend beyond early adulthood and to non-communicable diseases (NCDs) with later onset. Moreover, it has not been explored whether ICWS associates with decreased survival prospects following hospitalisation.

METHODS

Based on prospective data for a 1953 Stockholm birth cohort (n=14 134), ICWS was operationalised distinguishing two levels in administrative child welfare records (ages 0-19; 'investigated' and 'placed' in out-of-home care (OHC)). Hospitalisations and all-cause mortality (ages 20-66) were derived from national registers. Hospitalisation records were categorised into external causes and NCDs, and nine subcategories. Negative binomial regression models were used to estimate differences in hospitalisation risks between those with and without experiences of ICWS and Cox survival models to estimate mortality after hospitalisation.

RESULTS

Placement in OHC was associated with higher risks of hospitalisation due to external causes and NCDs and all investigated subcategories except cancers. Risks were generally also elevated among those investigated but not placed. ICWS was further linked to higher mortality risks following hospitalisation.

CONCLUSION

Differential risk of morbidity and differential survival may explain inequalities in mortality following childhood adversity. We conclude that the healthcare sector might play an important role in preventing and mitigating the elevated risks of externally caused morbidity, disease and premature mortality observed among those with a history of ICWS.

Air Purifier Intervention to Remove Indoor PM2.5 in Urban China: A Cost-Effectiveness and Health Inequality Impact Study

Using air purifiers is an intervention to reduce exposure to fine particulate matter (PM_2.5) for health benefits. We performed a comprehensive simulation in urban China to estimate the cost-effectiveness of long-term use of air purifiers to remove indoor PM_2.5 from indoor and ambient air pollution in five intervention scenarios (S1-S5), where the indoor PM_2.5 targets were 35, 25, 15, 10, and 5 μg/m³, respectively. In scenarios S1 to S5, 5221 (95% uncertainty interval: 3886-6091), 6178 (4554-7242), 8599 (6255-10,109), 11,006 (7962-13,013), and 14,990 (10,888-17,610) thousand disability-adjusted-life-years (DALYs) can be avoided at the cost of 201 (199-204), 240 (238-243), 364 (360-369), 522 (515-530), and 921 (905-939) billion Chinese Yuan (CNY), respectively. A high disparity in per capita health benefits and costs was observed by city, which expanded with the decrease of the indoor PM_2.5 target. The net benefits of using purifiers in cities varied across scenarios. Cities with a lower ratio of annual average outdoor PM_2.5 concentration to gross domestic product (GDP) per capita tended to achieve higher net benefits in the scenario with a lower indoor PM_2.5 target. Controlling ambient PM_2.5 pollution and developing the economy can reduce the inequality in air purifier use across China.

Childhood Traumatic Experiences and Negative Alcohol-Related Consequences in Adulthood: A Cross-Cultural Examination of Distress Tolerance and Drinking to Cope

Background: Prior research has established that Adverse Childhood Experiences (ACEs) predict harmful alcohol use outcomes. However, underlying mechanisms that could explain these associations are less clear. The present study examined if ACEs are indirectly related to alcohol negative consequences through their associations with distress tolerance and drinking to cope. Method: A sample of 3,763 (71.9% female) college students who drink alcohol from seven countries (U.S., Argentina, Canada, Uruguay, Spain, South Africa, and England) completed online surveys. Path analysis was performed within the whole sample testing the serial unique associations between ACEs→distress tolerance→drinking to cope→negative alcohol-related consequences. Multi-group analysis was performed to determine if the proposed pathways were invariant across gender and countries. Results: Both distress tolerance and drinking to cope uniquely accounted for the relationship between ACEs and negative alcohol-related consequences. Additionally, a significant double-mediation effect was found illustrating that a higher endorsement of ACEs was associated with lower distress tolerance, which in turn was associated with higher drinking to cope, which in turn was associated with more negative alcohol-related consequences. These effects were invariant across countries and gender groups. Conclusions: These findings provide support for the relevance of distress tolerance and coping motives as potential factors in linking ACEs to problematic alcohol use across nations. Our data are consistent with the idea that intervening on distress tolerance and drinking motives could mitigate downstream alcohol-related consequences related to ACEs in college student populations around the world.

The association between adverse childhood experiences and oral health: A systematic review

OBJECTIVE

It is well established that adverse childhood experiences (ACEs) negatively affect health and are associated with health-risk behaviors. This study aimed to provide a systematic review of the studies that examine the relationship between ACE exposure and oral health among adults aged 18 years and older.

METHODS

The following electronic databases were searched in January 2022: MEDLINE, Cochrane, Web of Science, CINAHL via EBSCOhost, ProQuest, ScienceDirect, and Google Scholar. Data were extracted independently by two reviewers. The quality of the studies was assessed using the Newcastle-Ottawa Scale.

RESULTS

Among the 292 articles identified, four met the eligibility criteria. All included studies were cross-sectional and of satisfactory quality. The dental outcomes included: last dental visit, last dental cleaning, number of filled teeth, number of extracted teeth, and number of remaining teeth. The studies showed that exposure to ACE was negatively associated with oral health. The relationship between ACE score and oral health outcome measures was found to be directly proportional.

CONCLUSION

There is an association between ACE and poor oral health. Moreover, the association was proven to have a dose-response relationship. Given that the studies in the literature were cross-sectional, causality cannot be determined with certainty, therefore interpretation of the results should be cautious. Longitudinal follow-up studies are needed to understand how ACEs contribute to oral diseases later in life.

Intergenerational transmission of the effects of maternal exposure to childhood maltreatment in the USA: a retrospective cohort study

BACKGROUND

Childhood maltreatment is associated with adverse health outcomes and this risk can be transmitted to the next generation. We aimed to investigate the association between exposure to maternal childhood maltreatment and common childhood physical and mental health problems, neurodevelopmental disorders, and related comorbidity patterns in offspring.

METHODS

We conducted a retrospective cohort study using data from the Environmental influences on Child Health Outcomes (ECHO) Program, which was launched to investigate the influence of early life exposures on child health and development in 69 cohorts across the USA. Eligible mother-child dyads were those with available data on maternal childhood maltreatment exposure and at least one child health outcome measure (autism spectrum disorder, attention-deficit hyperactivity disorder [ADHD], internalising problems, obesity, allergy, and asthma diagnoses). Maternal history of childhood maltreatment was obtained retrospectively from the Adverse Childhood Experiences or Life Stressor Checklist questionnaires. We derived the prevalence of the specified child health outcome measures in offspring across childhood and adolescence by harmonising caregiver reports and other relevant sources (such as medical records) across cohorts. Child internalising symptoms were assessed using the Child Behavior Checklist. Associations between maternal childhood maltreatment and childhood health outcomes were measured using a series of mixed-effects logistic regression models. Covariates included child sex (male or female), race, and ethnicity; maternal and paternal age; maternal education; combined annual household income; maternal diagnosis of depression, asthma, ADHD, allergy, or autism spectrum disorder; and maternal obesity. Two latent class analyses were conducted: to characterise patterns of comorbidity of child health outcomes; and to characterise patterns of co-occurrence of childhood maltreatment subtypes. We then investigated the association between latent class membership and maternal childhood maltreatment and child health outcomes, respectively.

FINDINGS

Our sample included 4337 mother-child dyads from 21 longitudinal cohorts (with data collection initiated between 1999 and 2016). Of 3954 mothers in the study, 1742 (44%) had experienced exposure to abuse or neglect during their childhood. After adjustment for confounding, mothers who experienced childhood maltreatment were more likely to have children with internalising problems in the clinical range (odds ratio [OR] 2·70 [95% CI 1·95-3·72], p<0·0001), autism spectrum disorder (1·70 [1·13-2·55], p=0·01), ADHD (2·09 [1·63-2·67], p<0·0001), and asthma (1·54 [1·34-1·77], p<0·0001). In female offspring, maternal childhood maltreatment was associated with a higher prevalence of obesity (1·69 [1·17-2·44], p=0·005). Children of mothers exposed to childhood maltreatment were more likely to exhibit a diagnostic pattern characterised by higher risk for multimorbidity. Exposure to multiple forms of maltreatment across all subtypes of maternal childhood maltreatment was associated with the highest risk increases for most offspring health outcomes, suggesting a dose-response relationship.

INTERPRETATION

Our findings suggest that maternal childhood maltreatment experiences can be a risk factor for disease susceptibility in offspring across a variety of outcomes and emphasise the need for policies focusing on breaking the intergenerational transmission of adversity.

FUNDING

Environmental influences on Child Health Outcomes Program, Office of the Director, National Institutes of Health.

Early life adversity across different cell- types in the brain

Early life adversity (ELA)- which includes physical, psychological, emotional, and sexual abuse is one of the most common predictors to diverse psychopathologies later in adulthood. As ELA has a lasting impact on the brain at a developmental stage, recent findings from the field highlighted the specific contributions of different cell types to ELA and their association with long lasting consequences. In this review we will gather recent findings describing morphological, transcriptional and epigenetic alterations within neurons, glia and perineuronal nets and their associated cellular subpopulation. The findings reviewed and summarized here highlight important mechanisms underlying ELA and point to therapeutic approaches for ELA and related psychopathologies later in life.

Management of child maltreatment suspicions in general practice: a mixed methods study

BACKGROUND

Maltreated children have many long-term consequences throughout their lives, but often maltreated children are not recognised in time by professionals. General practice could be central to the early recognition of child maltreatment due to the long-term relationship with families.

OBJECTIVE

How do general practitioners (GPs) and practice nurses (PNs) deal with suspected maltreatment in children below 18 years of age, and which factors influence them to report cases to social authorities.

DESIGN AND SETTING

A mixed methods study set in general practice in Denmark.

METHOD AND SUBJECTS

We combined data from a nationwide questionnaire with observations from five clinics and 20 interviews with GPs and PNs. We explored our data using the concept of uncertainty as a driver that shapes action and decision-making in general practice.

RESULTS

Most GPs (94%) said they would discuss cases of suspected child maltreatment with social services, but in many cases they would prefer to discuss their suspicions with a colleague first (83%) - most likely where there are no clear-cut signs. The qualitative data added nuance to these findings by highlighting the difficulty of communicating across sectors, the importance of maintaining a connection with the child's family, and practicing watchful waiting.

CONCLUSION

General practice has an opportunity to act early in cases of suspected child maltreatment if uncertainty is accepted as a critical part of the process of reaching a diagnosis. Communication across sectors is key, as is support for GPs with suspicions and for families in need of help.Key pointsGPs are often thought to underreport child maltreatment but despite low levels of reporting, this does not mean they ignore it.Building on the connection with the family, making follow appointments, and discussing suspicions with colleagues are typical of how GPs manage suspicions of child abuse.Accepting uncertainty as a condition of raising the alarm could help GPs to act quickly to support children at risk of abuse.

Adverse childhood experiences and their impacts on subsequent depression and cognitive impairment in Chinese adults: A nationwide multi-center study

BACKGROUND

Adverse childhood experiences (ACE_S) are prevalent and have long-lasting effects. This study explored how ACE exposure is associated with subsequent depression and cognitive impairment and whether sociodemographic characteristics modify that association.

METHOD

This study used data on 14,484 participants of the 2015 China Health and Retirement Longitudinal Study (CHARLS) and 2014 CHARLS life history survey. Depression was assessed using the 10-item Center for Epidemiologic Studies Depression scale. Cognitive performance was evaluated via three composite measures: episodic memory, mental intactness, and global cognition. Twelve ACE indicators were measured using a validated questionnaire. Multiple regression models and stratified analyses explored the relationship between ACE_S and subsequent depression and cognitive impairment, as well as potential modifiers.

RESULTS

Compared with individuals without ACE_S, those who experienced four or more ACE_S had a higher risk of subsequent depression (adjusted odds ratio, aOR = 2.65, 95 % confidence intervals [CIs]: 2.21 to 3.16), poorer mental intactness (β = -0.317 [-0.508 to -0.125]), and worse global cognition (-0.437 [-0.693 to -0.181]). Trend analyses showed a dose-response association between accumulated ACE_S and subsequent depression and cognitive impairment. No modifications of those associations by age, sex, educational level, or family's financial status during childhood were observed.

LIMITATIONS

Self-reported measures could favour recall bias.

CONCLUSION

Our study suggests that ACE_S increase the risk of subsequent depression and cognitive impairment in Chinese adults regardless of sociodemographic characteristics. These findings provide important implications for mitigating the adverse effects of early-life stress and promoting health in adulthood.

Childhood Maltreatment and Mental Health Problems: A Systematic Review and Meta-Analysis of Quasi-Experimental Studies

OBJECTIVE

Childhood maltreatment is associated with mental health problems, but the extent to which this relationship is causal remains unclear. To strengthen causal inference, the authors conducted a systematic review and meta-analysis of quasi-experimental studies examining the relationship between childhood maltreatment and mental health problems.

METHODS

A search of PubMed, PsycINFO, and Embase was conducted for peer-reviewed, English-language articles from database inception until January 1, 2022. Studies were included if they examined the association between childhood maltreatment and mental health problems using a quasi-experimental method (e.g., twin/sibling differences design, children of twins design, adoption design, fixed-effects design, random-intercept cross-lagged panel model, natural experiment, propensity score matching, or inverse probability weighting).

RESULTS

Thirty-four quasi-experimental studies were identified, comprising 54,646 independent participants. Before quasi-experimental adjustment for confounding, childhood maltreatment was moderately associated with mental health problems (Cohen's d=0.56, 95% CI=0.41, 0.71). After quasi-experimental adjustment, a small association between childhood maltreatment and mental health problems remained (Cohen's d=0.31, 95% CI=0.24, 0.37). This adjusted association between childhood maltreatment and mental health was consistent across different quasi-experimental methods, and generalized across different psychiatric disorders.

CONCLUSIONS

These findings are consistent with a small, causal contribution of childhood maltreatment to mental health problems. Furthermore, the findings suggest that part of the overall risk of mental health problems in individuals exposed to maltreatment is due to wider genetic and environmental risk factors. Therefore, preventing childhood maltreatment and addressing wider psychiatric risk factors in individuals exposed to maltreatment could help to prevent psychopathology.

Understanding the effects of adverse childhood experiences on older people

There is increasing recognition that adverse childhood experiences are linked to suboptimal mental and physical health in later life. Despite this, there has been little research into the effects of adverse childhood experiences on older people. This article gives an overview of the long-term mental and physical effects of adverse childhood experiences and discusses how childhood trauma may manifest in older people. The author also discusses how nurses and unpaid family carers may themselves have been exposed to adverse childhood experiences and how this may affect their caring role. It is crucial that nurses adopt a trauma-informed approach to the care of older people to take account of possible adverse childhood experiences and prevent re-traumatisation.

Perceptions of the medical relevance of patients` stories of painful and adverse life experiences: a focus group study among Norwegian General Practitioners

Purpose

Adverse life experiences increase the risk of health problems. Little is known about General Practitioners’ (GPs') thoughts, clinical concepts, and work patterns related to eliciting, including, or excluding their patients’ stories of painful and adverse life experiences. We wanted to explore GPs’ perceptions of the medical relevance of stories of painful and adverse life experiences, and to focus on what hinders or facilitates working with such stories.

Method

Eighteen Norwegian GPs participated in three focus group interviews. The interviews were analysed using reflexive thematic analysis.

Results

The participating GPs’ views on the clinical relevance of patients’ painful and adverse experiences varied considerably. Our analysis revealed two distinct stances: a confident-accepting stance, and an ambivalent-conditional stance. GPs encountered barriers to exploring such stories: scepticism on behalf of the medical discipline; scepticism on behalf of the patients; and, uncertainty regarding how to address stories of painful and adverse experiences in consultations. Work with painful stories was best facilitated when GPs manifested personal openness and prepared availability, within the context of a doctor-patient relationship based on trust.

Conclusions

Clearer processes for handling biographical information and life experiences that affect patients’ health are needed to facilitate the work of primary care physicians.

1000 Days: The "WeCare Generation" Program-The Ultimate Model for Improving Human Mental Health and Economics: The Study Protocol

INTRODUCTION

The COVID-19 pandemic stressed the necessity of a new resilience of the human population and health system. The "WeCare Generation" program is a new proposal of territorial intervention, with a new paradigm, on the diseases of the human body and mind.

BACKGROUND

In recent decades, the independent strands of investigation on brain plasticity and early trauma consequences have demonstrated that traumatic experiences in the period from pregnancy to the age of 3 years have an enormous impact on an individual's future development, and both physical and mental health. Research shows that adverse child experiences (ACEs) are associated with a strong risk of conditions such as: harmful alcohol use, smoking, illicit drug use, high body-mass index, depression, anxiety, interpersonal violence, cancer, type 2 diabetes, cardiovascular diseases, stroke respiratory diseases and, as a consequence, to a high financial cost in Italy and also across Europe (1-9% GDP) and the USA (total annual costs estimated to be USD 581 billion in Europe and USD 748 billion in North America). All this suggests that an early intervention on that traumatized-slice of population leads to multiplied savings.

METHODS

A multi-center, randomized, controlled trial was designed. The parents of the future neonatal population (from pregnancy to delivery) with trauma will be enrolled, and randomized to treatment, or control arm. The article describes in detail how the primary outpoint (cost to the national health system), and some secondary outpoints, will be collected.

DISCUSSION

An overall rate of return on investment (ROI) statistically significant 13.0% per annum with an associated benefit/cost ratio (BCR) of 6.3 is expected as the primary outcome of the "WeCare Generation" program. Our proposed model predicts a new medical paradigm aiming to empower new generations, with a strong return on economy and health.

Estimating the Social Costs of Child Abuse in Residential Care for Children with Disabilities Using the Japanese Survey on the Interactions of Adverse and Positive Childhood Experiences toward Adulthood

We sought to calculate the extra social costs resulting from child abuse in residential care facilities (RCFs) for children with disabilities (CWD) in Japan. We distributed a survey to 260 residential facilities for CWD in 2020 and obtained responses from 91 facilities. Among the children placed in these facilities, our estimates by four different criteria determined that 23-67% were affected by child abuse. We also estimated extra costs for each of the four criteria, which we estimated to average USD 647.7 million. This study is meaningful in that there are no existing official statistics or research findings on the extra costs of residential care due to child abuse in Japan.

The effect of adverse and positive experiences on inflammatory markers in Australian and UK children

Background

The relationship between childhood adversity and inflammation is well-established. Examination of positive experiences can provide a more complete understanding of intervention opportunities. We investigated associations of adverse and positive experiences, and their intersection, with inflammation in children and adolescents.

Methods

Data sources: Longitudinal Study of Australian Children (LSAC; N = 1237) and Avon Longitudinal Study of Parents and Children (ALSPAC; N = 3488). Exposures: Adverse and positive experiences assessed repeatedly (LSAC: 0-11 years; ALSPAC: 0-15 years). Outcomes: Inflammation quantified by high sensitivity C-reactive protein (hsCRP) and glycoprotein acetyls (GlycA) (LSAC: 11-12 years; ALSPAC: 15.5 years). Analyses: Linear regression on the log-transformed outcomes estimated the relative difference in inflammatory markers with adverse/positive experiences, adjusting for socio-demographics and concurrent positive/adverse experiences, respectively.

Results

Most associations were in the expected direction but differed in magnitude by exposure, outcome and cohort. Across both cohorts, adverse experiences were associated with up to 7.3% higher hsCRP (95% CI: -18.6%, 33.2%) and up to 2.0% higher GlycA (95% CI: 0.5%, 3.5%); while positive experiences were associated with up to 22.1% lower hsCRP (95% CI: -49.0%, 4.7%) and 1.3% lower GlycA (95% CI: -2.7%, 0.2%). In LSAC, the beneficial effect of positive experiences on inflammation was more pronounced among those with fewer concurrent adverse experiences.

Conclusion

Across two cohorts, we found small but directionally consistent associations between adverse experiences and higher inflammation, and positive experiences and lower inflammation, particularly for GlycA. Future research should give further consideration to positive experiences to complement the current focus on adversity and inform the design and evaluation of early life interventions.

Psychometric evaluation of an Adverse Childhood Experiences (ACEs) measurement tool: an equitable assessment or reinforcing biases?

BACKGROUND

Utilizing Adverse Childhood Experiences (ACEs) measurement scales to assess youths' adversities has expanded exponentially in health and justice studies. However, most of the ACEs assessment scales have yet to meet critical psychometric standards, especially for key demographic and minority groups. It is critical that any assessment or screening tool is not reinforcing bias, warranting the need for validating ACEs tools that are equitable, reliable and accurate. The current study aimed to examine the structural validity of an ACEs scale. Using data from the 2019 Behavioral Risk Factor Surveillance System (BRFSS), which collected of 97,314 responses collected from adults across sixteen states. This study assessed the psychometric properties and measurement invariance of the ACEs tool under the structural equation modeling framework.

RESULTS

We found the 11-item ACEs screening tool as a second-order factor with three subscales, all of which passed the measurement invariance tests at metric and scalar levels across age, race, sex, socioeconomic status, gender identity, and sexual orientation. We also found that minority groups experienced more childhood adversity with small effect size, with the exception of the gender identity.

CONCLUSION

The ACEs measurement scale from the BRFSS is equitable and free from measurement bias regardless of one's age, race, sex, socioeconomic status, gender identity, and sexual orientation, and thus is valid to be used to compare group mean differences within these groups. The scale is a potentially valid, viable, and predictive risk assessment in health and justice and research settings to identify high-risk groups or individuals for treatments.

An Umbrella Review of the Links Between Adverse Childhood Experiences and Substance Misuse: What, Why, and Where Do We Go from Here?

BACKGROUND AND OBJECTIVES

A wealth of research has identified adverse childhood experiences (ACEs; abuse, neglect, violence or disorder in the home) as a strong risk factor for substance misuse. Synthesis of the existing evidence is critical to shape policy and inform directions for future research. Existing reviews have focused on specific substances or substance use outcomes (eg, disorder), and do not include discussion of the mechanisms that operate between ACEs and substance misuse. The current umbrella review aims to synthesize reviews on the relationship between ACEs and substance misuse, review the evidence on the mechanisms linking these, identify existing gaps in our knowledge, and discuss critical directions for future research, practice, and public policy.

METHODS

Two electronic databases (PsycINFO and Medline) were searched for reviews published between 1998 and 2022 on the link between ACEs and substance misuse. Twenty articles met eligibility criteria and were qualitatively synthesized.

RESULTS

Results overwhelmingly demonstrated an elevated risk of substance misuse or disorder, among adolescents and adults exposed to ACEs. Research on the mechanisms that explain this link highlights a multitude of potential intervention targets, with childhood stress propelling a cascade of effects across neurobiological, endocrine, immune, metabolic, and nervous systems, impacting psychosocial and cognitive functioning. Nonetheless, the literature is subject to limitations surrounding potential unmeasured cofounders and causality, as well as decontextualizing childhood adversity from broader structural issues that influence the link between ACEs and substance misuse. Research, policy, and practice that seek to holistically understand and address the relationship between ACEs and substance misuse within the broader social determinants of health is crucial.

Exposure to unpredictability and mental health: Validation of the brief version of the Questionnaire of Unpredictability in Childhood (QUIC-5) in English and Spanish

Unpredictability is increasingly recognized as a primary dimension of early life adversity affecting lifespan mental health trajectories; screening for these experiences is therefore vital. The Questionnaire of Unpredictability in Childhood (QUIC) is a 38-item tool that measures unpredictability in childhood in social, emotional and physical domains. The available evidence indicates that exposure to unpredictable experiences measured with the QUIC predicts internalizing symptoms including depression and anxiety. The purpose of the present study was to validate English and Spanish brief versions (QUIC-5) suitable for administration in time-limited settings (e.g., clinical care settings, large-scale epidemiological studies). Five representative items were identified from the QUIC and their psychometric properties examined. The predictive validity of the QUIC-5 was then compared to the QUIC by examining mental health in four cohorts: (1) English-speaking adult women assessed at 6-months postpartum (N = 116), (2) English-speaking male veterans (N = 95), (3) English-speaking male and female adolescents (N = 155), and (4) Spanish-speaking male and female adults (N = 285). The QUIC-5 demonstrated substantial variance in distributions in each of the cohorts and is correlated on average 0.84 (r's = 0.81-0.87) with the full 38-item version. Furthermore, the QUIC-5 predicted internalizing symptoms (anxiety and depression) in all cohorts with similar effect sizes (r's = 0.16-0.39; all p's < 0.05) to the full versions (r's = 0.19-0.42; all p's < 0.05). In sum, the QUIC-5 exhibits good psychometric properties and is a valid alternative to the full QUIC. These findings support the future use of the QUIC-5 in clinical and research settings as a concise way to measure unpredictability, identify risk of psychopathology, and intervene accordingly.

Study protocol: a mixed-methods study to evaluate which health visiting models in England are most promising for mitigating the harms of adverse childhood experiences

INTRODUCTION

Exposure to adverse childhood experiences (ACEs) is associated with poorer health outcomes throughout life. In England, health visiting is a long-standing, nationally implemented service that aims to prevent and mitigate the impact of adversity in early childhood, including for children exposed to ACEs. A range of health visiting service delivery practices exist across England (from the minimum five recommended contacts to tailored intensive interventions), but there is a lack of evidence on who receives what services, how this varies across local authorities (LAs) and the associated outcomes.

METHODS AND ANALYSIS

This study will integrate findings from analysis of individual-level, deidentified administrative data related to hospital admissions (Hospital Episode Statistics (HES)) and health visiting contacts (Community Services Data Set (CSDS)), aggregate LA-level data, in-depth case studies in up to six LAs (including interviews with mothers), a national survey of health visiting services, and workshops with stakeholders and experts by experience. We will use an empirical-to-conceptual approach to develop a typology of health visiting service delivery in England, starting with a data-driven classification generated from latent class analysis of CSDS-HES data, which will be refined based on all other available qualitative and quantitative data. We will then evaluate which models of health visiting are most promising for mitigating the impact of ACEs on child and maternal outcomes using CSDS-HES data for a cohort of children born on 1 April 2015 to 31 March 2019.

ETHICS AND DISSEMINATION

The University College London Institute of Education Research Ethics Committee approved this study. Results will be submitted for publication in a peer-reviewed journal and summaries will be provided to key stakeholders including the funders, policy-makers, local commissioners and families.

A Dutch Perspective on Two Health Related Issues Regarding Children and Adolescents with Intellectual Disabilities

In this opinion article, we want to inspire readers by highlighting recent Dutch developments about two important health related issues regarding the quality of life of children and adolescents with intellectual disabilities. Firstly we focus on the prevention, treatment and reduction of (disability-related) somatic and psychological problems by specialized physicians for people with intellectual disabilities. Secondly, we emphasize the importance of the prevention of adverse childhood experiences and the promotion of protective and compensatory experiences. Subsequently, we stress the need for trauma informed care to support children and adolescents with intellectual disabilities who encounter adverse events. A specialized and multidisciplinary approach is advised as is the need for promoting healthy (family) relations with a focus on (co)regulation and connection as a basis for recovery.

Adverse childhood experiences and adolescent drug use in the UK: The moderating role of socioeconomic position and ethnicity

Rationale

There is a paucity of prospective UK studies exploring the role of Adverse Childhood Experiences (ACEs) on adolescent teenage drug use and even less is known about the complex interplay between ACEs and adolescent social, demographic, and economic characteristics. To address these gaps, we use rich longitudinal data from the nationally representative Millennium Cohort Study.

Methods

Sex-stratified survey logistic regression modelling was applied using data from 9,476 adolescents and their parents to examine associations between ACEs between ages 3 and 14 years and drug use at ages 14 and 17 years. We a) explore the extent to which associations are robust to adjustment for ethnicity, family income, parental social class, and parental education, b) examine whether associations differ by these factors, and c) estimate the proportion of drug use at ages 14 and 17 years attributable to ACEs after controlling for these factors.

Results

Half of MCS cohort members had been exposed to at least one ACE and approximately 1 in 11 were exposed to 3+ ACEs. Multivariable analyses suggest that ACEs were associated with a higher likelihood of drug use at age 14 than age 17, especially for girls. No evidence was found that either advantaged socio-economic position or ethnicity acted as a buffer against the negative effects of ACEs in relation to adolescent drug use. Finally, we found that prevention of exposure to sexual violence, bullying and violence within the household (if causal) is more important for girls' drug use at age 14 than age 17.

Conclusions

ACEs are associated with adolescent drug use with potential consequences on wider aspects of young people's lives, regardless of their social, ethnic, or economic background, adding further urgency to the need to reduce the incidence of these negative experiences.

Childhood maltreatment is not associated with atopic dermatitis in adults: results from a cross-sectional population-based cohort study

BACKGROUND

Childhood maltreatment (CM) is related to poor physical and mental health outcomes in adults. Knowledge on the impact of CM on skin diseases is limited, and no study has previously addressed the association of CM with atopic dermatitis (AD) in adult age.

OBJECTIVES

To analyze the prevalence of CM in individuals with physician-diagnosed AD, and to examine the relationship between different types of CM with physician-diagnosed AD in a general population sample of German adults.

METHODS

Data from 2973 participants from the cross-sectional population-based Study of Health in Pomerania (SHIP) TREND-0 were analyzed (aged 20 to 83 years; 51.4% female). We administered the Childhood Trauma Questionnaire (CTQ) assessing emotional, physical and sexual abuse, and emotional and physical neglect. AD was diagnosed by dermatologists in a standardized clinical examination. We conducted logistic regression analyses adjusted for age, sex and school education to investigate the association of CM types with AD.

RESULTS

Among all individuals with AD, 20.6% reported to have experienced at least one type of moderate or severe CM. Emotional and physical neglect were the most frequently reported CM types. Overall, the prevalence of CM types among individuals with AD did not differ from those among individuals without AD. We found no association of CM type with AD.

CONCLUSIONS

This is the first study investigating the association of CM with AD in adults. CM was common in the present general population sample, emphasizing that CM is an important public health problem. Our findings suggest that CM is not a risk factor for AD. It might be hypothesized that AD severity is a crucial outcome, and that CM history is a factor with impact on disease severity and course rather than a risk factor for the development of AD. Longitudinal studies are required to address this question.

The exposome as the science of social-to-biological transitions

The understanding of disease etiology and pathogenesis has radically changed as a consequence of the new challenges posed by climate change, environmental degradation and emerging infectious diseases. The awareness of the influence of distal causes (e.g. planetary changes at the roots of new pandemics), of the social environment and of early life exposures calls for innovative models of disease onset. Here we propose a scheme for the practice of epidemiology and toxicology that incorporates new recent advancements in both disciplines, under the general umbrella of the "exposome". The exposome approach to disease encompasses a lifecourse perspective from conception onwards, and the investigation of the role played by all exposures individuals undergo in their lives. These include social inequalities and psychosocial influences, in addition to chemical, biological and physical exposures. We stress the role played by social differences and inequalities in the course of life as an overarching factor that influences downstream layers (including behaviours). We show that the idea of "lifecourse exposome" is compatible with the current interpretation of Adverse Outcome Pathways in toxicology, and in fact we propose an extension of the concept towards "lifecourse Adverse Outcome Pathways". We propose to merge different research perspectives and promote an encounter between the sociological perspective of "biography" (using Pierre Bourdieu's conceptual framework) and biology, according to the idea of accumulated biological capital of individuals. We also propose to treat social capital (including inequalities) no longer as a confounding factor but as an overarching determinant, perhaps the most important of all because it is the one that influences all other exposures downstream. The importance of early exposures in a lifecourse perspective leads to policy implications, i.e. investing more in the various forms of capital (social, economic, cultural) in early life.

Systematic review of health and disease in Ukrainian children highlights poor child health and challenges for those treating refugees

Aim

Millions of Ukrainian children have been internally displaced or fled to other countries because of the Russian war. This systematic review focused on their health needs and future challenges for clinicians.

Methods

A systematic literature search of the Medline, Embase and MedRxiv databases from 1 January 2010 to 31 March 2022 identified 1628 papers on the health of Ukrainian children and 112 were relevant to this review.

Results

In 2019, under‐5 mortality was 8 per 1000 live births in Ukraine. Underweight and adverse childhood experiences, including child abuse, were frequent compared to other European countries, while childhood obesity seemed less common. Alcohol consumption was common in women of reproductive age, including during pregnancy, risking foetal alcohol syndrome. Neonatal screening programmes provided low coverage. Vaccine hesitancy was common and vaccination rates were low. Other concerns were measles, HIV, antibiotic resistance and multi‐resistant tuberculosis. Many children are expected to suffer from psychological and physical trauma due to the war. Other healthcare challenges include low COVID‐19 vaccination rates and a preference for secondary and tertiary care, rather than primary care. Many people cannot afford medication.

Conclusion

Ukrainian children often have poor health and host countries need to be aware of their needs.

The Intersection of Neighborhood Environment and Adverse Childhood Experiences: Methods for Creation of a Neighborhood ACEs Index

This study evaluated methods for creating a neighborhood adverse childhood experiences (ACEs) index, a composite measure that captures the association between neighborhood environment characteristics (e.g., crime, healthcare access) and individual-level ACEs exposure, for a particular population. A neighborhood ACEs index can help understand and address neighborhood-level influences on health among individuals affected by ACEs. Methods entailed cross-sectional secondary analysis connecting individual-level ACEs data from the Philadelphia ACE Survey (n = 1677) with 25 spatial datasets capturing neighborhood characteristics. Four methods were tested for index creation (three methods of principal components analysis, Bayesian index regression). Resulting indexes were compared using Akaike Information Criteria for accuracy in explaining ACEs exposure. Exploratory linear regression analyses were conducted to examine associations between ACEs, the neighborhood ACEs index, and a health outcome—in this case body mass index (BMI). Results demonstrated that Bayesian index regression was the best method for index creation. The neighborhood ACEs index was associated with higher BMI, both independently and after controlling for ACEs exposure. The neighborhood ACEs index attenuated the association between BMI and ACEs. Future research can employ a neighborhood ACEs index to inform upstream, place-based interventions and policies to promote health among individuals affected by ACEs.

The association of adverse childhood experiences and its subtypes with adulthood sleep problems: A systematic review and meta-analysis of cohort studies

Adverse childhood experience (ACE) is a powerful risk factor for long-term sleep health. However, the degree to which ACE and its subtypes contribute to adulthood sleep problems remains unknown. For this systematic review and meta-analysis, PubMed, Embase, Web of Sciences, Cochrane library, and CNKI (Chinese) were searched from inception to 1 December 2021. Cohort studies that examined the association between ACEs (aged <18 y) and adulthood sleep outcomes (aged ≥18 y) were included. The most fully adjusted odds ratios (ORs) were extracted and pooled using the random-effects model. A total of nine articles involving 108 330 participants from five high-income countries were identified. Individuals with at least one ACE subtype were more likely to report adulthood sleep problems (OR = 1.14, 1.09-1.20, I² = 77.5%, n = 9 studies) compared with those without ACE. The pooled ORs were approximately 1.20 for sexual, physical, and emotional abuse with high heterogeneity (I² > 80%), 1.09 (95% CI: 0.99-1.19, I² = 0%, n = 2) for neglect, and 1.21 (95% CI: 1.14-1.30, I² = 73.6%, n = 3) for family dysfunction. Individuals with multiple ACEs were associated with a higher magnitude of the risk for sleep problems (OR = 1.33, 95% CI: 1.18-1.49, I² = 87.3%, n = 3). In conclusion, the magnitude of the risk for sleep problems was similar across ACE subtypes except for childhood neglect. ACE may have cumulative detrimental effects on sleep health. More longitudinal evidence regarding ACE-sleep relationships, particularly in low- and middle-income countries, is needed. Furthermore, more policy efforts and evidence-based preventions are warranted to address ACEs among children.

Using Microbiome-Based Approaches to Deprogram Chronic Disorders and Extend the Healthspan following Adverse Childhood Experiences

Adverse childhood experiences (ACEs), which can include child trafficking, are known to program children for disrupted biological cycles, premature aging, microbiome dysbiosis, immune-inflammatory misregulation, and chronic disease multimorbidity. To date, the microbiome has not been a major focus of deprogramming efforts despite its emerging role in every aspect of ACE-related dysbiosis and dysfunction. This article examines: (1) the utility of incorporating microorganism-based, anti-aging approaches to combat ACE-programmed chronic diseases (also known as noncommunicable diseases and conditions, NCDs) and (2) microbiome regulation of core systems biology cycles that affect NCD comorbid risk. In this review, microbiota influence over three key cyclic rhythms (circadian cycles, the sleep cycle, and the lifespan/longevity cycle) as well as tissue inflammation and oxidative stress are discussed as an opportunity to deprogram ACE-driven chronic disorders. Microbiota, particularly those in the gut, have been shown to affect host–microbe interactions regulating the circadian clock, sleep quality, as well as immune function/senescence, and regulation of tissue inflammation. The microimmunosome is one of several systems biology targets of gut microbiota regulation. Furthermore, correcting misregulated inflammation and increased oxidative stress is key to protecting telomere length and lifespan/longevity and extending what has become known as the healthspan. This review article concludes that to reverse the tragedy of ACE-programmed NCDs and premature aging, managing the human holobiont microbiome should become a routine part of healthcare and preventative medicine across the life course.

Adverse childhood experiences (ACEs) relate to blunted cardiovascular and cortisol reactivity to acute laboratory stress: A systematic review and meta-analysis

Adverse childhood experiences (ACEs) are associated with poor future mental and physical health. Altered biological reactivity to mental stress may be a possible mechanism linking ACEs to poor health. However, it is not clear if ACEs relate to blunted or exaggerated stress reactivity. This meta-analysis aimed to determine whether exposure to ACEs is associated with cardiovascular and cortisol stress reactivity. A systematic review yielded 37 sources. Random-effects modelling tested the aggregate effects of 83 studies of the association between ACEs and stress reactivity. Exposure to ACEs was associated with relatively blunted cardiovascular and cortisol stress reactivity. Effect sizes did not vary as a function of sample sex or reactivity measure (e.g., heart rate, blood pressure, or cortisol). Meta-regression revealed preliminary evidence of greater blunting in samples of a younger age and samples reporting greater ACE exposure. Subgroup analyses for stress task, ACE measurement instrument, and sample race were not conducted because of a lack of between-study variability. Exposure to ACEs is associated with dysregulation of multiple components of the human stress response system.

Adverse childhood experiences are associated with increased risk of hysterectomy and bilateral oophorectomy: A national retrospective cohort study of women in England

Objective

To examine the associations between adverse childhood experiences (ACE) and the risk of hysterectomy and bilateral oophorectomy in a national sample of women in England.

Design

Retrospective cohort study.

Setting

A stratified random sample of households across England.

Population

2648 women aged ≥55 years in 2007 from the English Longitudinal Study of Ageing (ELSA) were included in the bilateral oophorectomy analyses and 2622 in the hysterectomy analyses.

Methods

Logistic and multinomial logistic regression analyses of the associations between categories of the ACE summary score (0, 1, 2, ≥3 ACE), eight individual ACE, and hysterectomy and bilateral oophorectomy.

Results

615 women had undergone hysterectomy and 259 women bilateral oophorectomy. We found graded associations between the summary ACE score and risk of hysterectomy and bilateral oophorectomy. In the fully adjusted model, compared with women with no ACE, those with ≥3 ACE had double the odds of hysterectomy (odds ratio [OR] 2.01, 95% confidence interval [CI] 1.30–3.11) and more than double the odds of bilateral oophorectomy (OR 2.61, 95% CI 1.54–4.42). The exclusion of women with cancer history made the associations stronger, especially in women who underwent hysterectomy at age <40 years or bilateral oophorectomy at age ≤44 years. Several individual ACE were positively associated with both outcomes.

Conclusions

ACE are associated with increased risk of hysterectomy and bilateral oophorectomy. Individual‐level covariates did not explain these associations. Our findings highlight the importance of a life course approach to understanding surgical menopause and add to our knowledge of the societal and public health impact of ACE.

Tweetable abstract

Adverse childhood experiences are associated with increased risk of hysterectomy and bilateral oophorectomy in a national sample of women in England.

Adverse childhood experiences are associated with increased risk of hysterectomy and bilateral oophorectomy in a national sample of women in England.

Linked article: This article is commented on by Walter A. Rocca, pp. 1491–1492 in this issue. To view this minicommentary visit https://doi.org/10.1111/1471-0528.17105.