Thursday, November 02, 2006

Adverse Childhood Experiences

I attended a week long, all day, all evening Family Practice Board review in Lancaster, PA last month. Of the many, many lectures that week, one really stood out as the most surprising and probably the most important- "Adverse Childhood Experiences and Their Relationship to Adult Health Status", given by Vincent Felitti, MD.

He reported on a large, well-done study of 17,000 middle-class, essentially average Americans, called the Adverse Childhood Experiences (ACE) study. The results were rather stunning- and contrary to the prevailing thoughts. ACE's were defined in the following categories, with noted prevalences:
  • Psychological Abuse (by parents) 11%
  • Physical Abuse (by parents) 11%
  • Sexual Abuse (by anyone) 22%
  • Alcoholism or drug use in home 26%
  • Depression or mental illness in home 19%
  • Mother treated violently 13%
  • Imprisoned household member 4%
  • Loss of biological parent before age 18 (divorce/abandonment/death) 22%

These numbers themselves are rather amazing, but the lifelong effect of these experiences was what was truly surprising. Essentially, the findings were that there was a direct, graded, proportionate effect of ACEs on incidence of smoking, alcoholism, drug abuse, obesity, depression, suicide, well-being, poor job performance, and disability. These increases were not at all small. For example, the increased incidence of smoking from having 0 of the above to having 4 or more was 300%. It was 800% for alcoholism. 1300% for Suicide, and so on.

What this translates into for the population as a whole is that 65% of alcoholism can be attributed to the above risk factors ("Population Attributable Risk"). It is 50% of drug use, 78% of IV drug use, 54% of Current Depression, 58% of suicide attempts.

There are also stunning increases in the risk of perpetrating domestic violence, becoming a victim of domestic violence, likelihood of >50 sexual partners (300%), history of STDs (250%), later being raped, pyschoses and hallucinations.

Obviously, many of these subsequent behaviors are themselves risk factors for serious, chronic medical disorders- heart disease, lung disease, hypertension, diabetes, strokes, and so on. Interestingly, even when the other risk factors (smoking, obesity, etc.) are taken into account (corrected for), ACEs have a very large direct impact on risk for these diseases, from 30-70%!

The summary statements from the study are:

  • Adverse Childhood Experiences (ACE's) are very common, but unrecognized
  • ACE's are strong predictors of later social functioning, well-being, health risks, and death
  • This combination makes Adverse Childhood Events the leading determinant of the health and social well-being of our nation.

The effects are typically life-long!

The authors make a big point that most of the identified risks to health (smoking, alcoholism, etc.) are apparently best viewed as attempted "self-treatment" for the true underlying causes- the Adverse Childhood Experiences.

Obviously the implications for health care- both for overall public health, individual patient care and public policy are significant.

I found myself, though, amazed once again at how insightful and pertinent the teachings of Jesus are: anger, lust, divorce (the worst risk of the "loss of parent" category, unless death was by suicide), and other similar sources of bad actions (like the ACEs) really are the heart of humanity's problems; and that the kindness, patience, gentleness, and forgiveness of Love is the cure.

1 comment:

Lisa Middleton said...

You have living proof that ACE's are true in your own family. All of the above have affected those around you. More importantly, it is ONLY through Christ that ACE's are...not ignored, but accepted and used to benefit and not to harm.