Adverse Childhood Experiences and Mental Health in Young Adults: A Longitudinal Survey

ADVERSE CHILDHOOD EXPERIENCES AND MENTAL HEALTH IN YOUNG ADULTS: A LONGITUDINAL SURVEY

Schilling, Elizabeth A., Robert H. Aseltine, Jr., and Susan Gore. “Adverse Childhood Experiences and Mental Health in Young Adults: A Longitudinal Survey.” BMC Public Health 7 (March 7, 2007). 

IMPORTANT DATA AND TAKEAWAYS

From the Abstract:
"Where racial/ethnic differences existed, the adverse mental health impact of ACEs on Whites was consistently greater than on Blacks and Hispanics." (1)

Study Design:
The current study investigates the prevalence of a variety of lifetime ACEs reported by a sample of racially and economically diverse high school seniors, and estimates the impact of these experiences on three mental health outcomes–depression, drug use, and antisocial behavior–assessed two years later. In addition, this study investigates under-explored gender and racial/ethnic differences in these associations. (2)

Significant racial/ethnic differences are also evident in the prevalence data in Table 2. Approximately 1 in 6 White respondents reported that one of their parents had a drinking or drug problem, a rate approximately 50% higher than the rate reported by Blacks, and 30% higher than the rate reported by Hispanics. 1 in 4 Black and Hispanic respondents reported witnessing a serious injury or murder, a rate twice as high as that reported by Whites. Finally, about 1 in 6 Hispanics reported being threatened with a weapon, held captive, or kidnapped. This rate was 43% higher than the rate reported by Whites and almost two times higher than the rate reported by Blacks.

Hispanics reported the highest depressive symptoms (M =1.88, SD = .55) followed by Blacks (M = 1.80, SD = .52) and Whites (M = 1.65, SD = .49). Whites reported the highest levels of drug use (M = 1.34, SD = .57) followed by Hispanics (M = 1.13, SD = .31) and Blacks (M = 1.08, SD = .15). The frequency of antisocial behaviors did not differ between these three groups: Whites (M = .14, SD =.53), Blacks (M = .14, SD = .52), Hispanics (M = .12, SD =.31). Table 5 presents racial/ethnic differences in the effects of ACEs among Whites, Blacks, and Hispanics. These data indicate that the mental health effects of a number of ACEs are consistently stronger among Whites than among Blacks or Hispanics. In fact, the cumulative effect of adversity as well as three individual ACEs–(a) sent away from home, (b) parent with drinking/drug problem and, (c) being threatened with a weapon or held captive–are significantly associated with drug use among Whites only.

Because of the fluidity and malleability of roles during this period (see [40]), the transition to adulthood offers a potential "turning point" in the lives of disadvantaged youth. For example, previous research has shown that both post-secondary education and supportive romantic relationships positively influence the lifecourse trajectories of at-risk young adults [41-45]. Moreover, these roles are likely synergistic in their influence: One of the benefits of higher education in women is that it delays establishment of committed romantic relationships, resulting in higher quality marriages [43,44] which promote better mental health [46]. Clearly, strategies for preventing serious childhood adversity would be most beneficial: however, the malleability of young adulthood may provide additional opportunities to re-direct lifecourse trajectories in a positive direction and to prevent the adult mental health consequences of ACEs. (8)

Our results indicate that when racial/ethnic differences exist, young Whites consistently
exhibit greater vulnerability to ACEs, particularly for externalizing behaviors. One explanation is that these results may illustrate a "steeling effect" [48] in which youths in some ethnic groups are better able to successfully cope with stress and adversity and are consequently less prone to mental health difficulties. Research on coping processes may provide support for this explanation, as there is evidence that cognitive coping styles more typical among ethnic subcultures may explain differential racial/ethnic vulnerability to stress [26]. For example, differences in coping styles partially explain greater vulnerability to PTSD among Hispanic compared to Black and White police officers (see [27]), and greater religiosity, found among Blacks compared to Whites, has been found to be protective [49]. (8)

The Prevalence of Adverse Childhood Experiences (ACE) in the Lives of Juvenile Offenders

The Prevalence of Adverse Childhood Experiences (ACE) in the Lives of Juvenile Offenders

Baglivio, Michael T., Kimberly Swartz, Mona Sayedul Huq, Amy Sheer, and Nancy S. Hardt. “The Prevalence of Adverse Childhood Experiences (ACE) in the Lives of Juvenile Offenders.” OJJDP Journal of Juvenile Justice 3, no. 2 (Spring 2014): 1–23.

Summary: "Florida study confirms link between juvenile offenders, ACEs; rates much higher than CDC's ACE Study" (From Aces Too High)

IMPORTANT DATA AND TAKEAWAYS

From the Abstract:
This study examines the prevalence of ACEs in a population of 64,329 juvenile offenders in Florida. This article reports the prevalence of each ACE and assigns an ACE composite score across genders and a risk to reoffend level classification, and compares these with ACE studies conducted on adults. Analyses indicate offenders report disturbingly high rates of ACEs and have higher composite scores than previously examined populations. Policy implications underline the need to screen for and address ACEs as early as possible to prevent reoffending and other well-documented sequelae.

ACE Prevalence
The top three most prevalent ACE indicators were the same for both males and females: family violence, parental separation or divorce, and household member incarceration. Two-thirds or more of the Florida juvenile offenders reported these three ACEs. The least commonly reported ACE indicator for males were sexual abuse, household mental illness, and physical neglect, while the lowest three for females were household mental illness, physical neglect, and emotional neglect. Sexual abuse was reported 4.4 times more frequently by females than by males (31% and 7%, respectively). With the exception of sexual abuse, the ACE rank order by prevalence across genders was similar. However, as illustrated by Figure 1, females had a higher prevalence than males on every single ACE indicator. (8)

"The top three most prevalent ACE indicators were the same for both males and females: family violence, parental separation or divorce, and household member incarceration. Two-thirds or more of the Florida juvenile offenders reported these three ACEs. The least commonly reported ACE indicator for males were sexual abuse, household mental illness, and physical neglect, while the lowest three for females were household mental illness, physical neglect, and emotional neglect. ... These results are consistent with prior findings that the main gender difference in ACEs is the prevalence of sexual abuse." (9)

"Only 3.1% of males and 1.8% of the females reported no ACEs. ... These results indicated female youth reported more ACEs than males, and a higher percentage of those who reported at least one ACE also reported others. The average composite ACE score for females was 4.29, while the average for males was 3.48 (difference statistically significant at p < .001). That is, the average female in our sample reported at least four ACE indicators while the average male reported three or four ACE indicators." (9)

Juvenile offenders are 13 times less likely to report zero ACES (2.8% compared to 36%) and four times more likely to report four or more ACEs (50% compared to 13%) than Felitti and Anda’s Kaiser Permanente–insured population of mostly college-educated adults. These results suggest that the juvenile offenders in this study were significantly more likely to have ACE exposure and to have multiple ACE exposures than the adults in Felitti and Anda’s study population. (10)

ACEs not only increase the chances of involvement in the juvenile justice system, but increase the risk of re-offense. A focused effort on early identification of ACEs, and intervention for ACEs with a goal of improving youth life circumstances and preventing criminal behavior, may reduce the likelihood of and costs related to juvenile criminal activities. Most current policies in child welfare focus on secondary prevention instead of primary prevention of ACEs. (11)

IT IS NOT TOO EARLY TO TEACH BRAIN DEVELOPMENT SKILLS IN HIGH SCHOOL, SINCE HIGH SCHOOL STUDENTS ARE MERELY ONE SEXUAL EXPERIENCE AWAY FROM BEING TOMORROW’S PARENTS. FURTHERMORE, MANY HIGH SCHOOL STUDENTS PARTICIPATE IN THE CARE OF SMALLER CHILDREN. (11)

When school or health professionals observe behaviors such as overeating, substance abuse, smoking, disruptive classroom behavior, and bullying, a screening for a history of ACEs can be obtained and used to determine the appropriate intervention. When school personnel observe such behaviors, suspending or expelling students from school may deprive youth of the safest environment they can access. In-school programs to address bullying, disruptive classroom behavior, and aggression can keep youth in safe environments while they learn self-regulatory skills. Law enforcement and judicial awareness of ACES will enhance the likelihood that the root causes of problematic behaviors will be addressed with social and behavioral health services. Individuals with ACEs often use maladaptive or antisocial behaviors as strategies to cope with stress; such behaviors will not dissipate during periods of detention or incarceration without focused intervention. (11)

Early childhood intervention programs addressing ACEs have demonstrated significant benefit–cost ratios. One such intervention displayed a return of $5.70 for every dollar spent by the time a child reached age 27, $8.70 in life-cost savings, and notable cost savings in crime reduction (Larkin & Records, 2007). (12)

A SCHOOL OR COMMUNITY-BASED SAFE PLACE THAT FOCUSES ON RELAXATION ACTIVITIES SUCH AS YOGA, MEDITATION, TAI CHI, AND PRAYER CAN BUILD RESILIENCE AND REDUCE STRESS BY EMPOWERING CHILDREN TO MODULATE THEIR STRESS RESPONSES AND ENHANCE THEIR PERSONAL PERCEPTIONS OF SAFETY. CHILDREN WITH HIGH RESILIENCE TEND TO BE MORE SUCCESSFUL IN SCHOOL, HAPPIER, AND LESS DEPRESSED. YOUTH DEVELOPMENT PROGRAMS FOR CHILDREN, PARENTS, AND TEACHERS SHOULD INTEGRATE ACTIVITIES THAT BUILD RESILIENCE AND ADDRESS ACES SO THAT CHILDREN DEVELOP CONFIDENCE, SELF-CONTROL, AND RESPONSIBILITY. THESE INTERVENTIONS AND PROGRAMS HAVE THE POTENTIAL TO KEEP CHILDREN FROM ENGAGING IN RISKY SOCIAL AND HEALTH BEHAVIORS. (12)

A FUNDAMENTAL TOOL IN SECONDARY PREVENTION IS THE IMPLEMENTATION OF TRAUMA-INFORMED CARE (TIC), WITH A CENTRAL PRECEPT OF ASKING “WHAT HAS HAPPENED TO YOU?” RATHER THAN THE CUSTOMARY “WHAT IS WRONG WITH YOU?” THE ACE COMPOSITE SCORE IS PRECISELY A MEASURE OF “WHAT HAS HAPPENED TO YOU.” (13)

In light of findings that females have higher rates of exposure to all ACE indicators than males (especially sexual abuse and the ACE composite score), yet have lower rates of delinquent involvement, gender-specific intervention strategies should be examined since there may be gender differences in response to exposure to traumatic circumstances. Exposure to ACEs manifests itself differently among females than males (e.g., females have more internalizing behaviors, mental health symptoms, and self-mutilation; males exhibit more externalizing and acting out behaviors). Furthermore, a much higher percentage of female violent offenses exclusively involve domestic violence, as opposed to more heterogeneous violent offenses for males (Herrera & McCloskey, 2001). (13)

Screening

Research Participants Telling the Truth About Their Lives: The Ethics of Asking and Not Asking about Abuse

Becker-Blease, Kathryn A., and Jennier J. Freyd. “Research Participants Telling the Truth about Their Lives: The Ethics of Asking and Not Asking about Abuse.” American Psychologist 61, no. 3 (April 2006): 218–26.

Participants themselves provide information that both adds to the overall accuracy of information on abuse and is unavailable in any other way. Finkelhor and Hashima (2001) found that caretaker reports of physical abuse resulted in twice the incidence reported by child protective agencies. Hardt and Rutter (2004) reviewed studies that included both retrospective and corroborative reports of abuse. They concluded that adult retrospective reports underrepresent the true prevalence of maltreatment and do not inflate estimates. (218)

In the end, we conclude that carefully asking about abuse is not only ethically defensible, but required. (218)