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ACEs Research Corner — November 2019


[Editor's note: Dr. Harise Stein at Stanford University edits a web site -- -- that focuses on the health effects of abuse, and includes research articles on ACEs. Every month, she's posting the summaries of the abstracts and links to research articles that address only ACEs. Thank you, Harise!! -- Jane Stevens]

Jackson DB, Chilton M, Johnson KR, Vaughn MG.
Adverse Childhood Experiences and Household Food Insecurity. Am J Prev Med. 2019 Nov;57(5):667-674. PMID: 31522923 Using national data from over 50,000 children, children exposed to 3+ ACEs as opposed to none were over 8 times more likely to experience food insecurity.

Zeng S, Corr CP, O'Grady C, Guan Y.
Adverse childhood experiences and preschool suspension expulsion: A population study. Child Abuse Negl. 2019 Nov; 97:104149. PMID: 31473382 Using a US national dataset of 6,100 children aged 3-5 years, 2.0% were suspended and 0.2% were expelled from preschool annually. Projecting nationally, this represents 4,842 suspended and 479 expelled every week. The likelihood of being suspended or expelled was increased by 80% for every increased number of ACEs, and specifically for  domestic violence (10.6 times increased risk), family mental illness (9.8), adult substance abuse (4.8), living in high poverty (3.9), divorced parents (3.3), and parent incarceration (3.0).

Bellis MA, Hughes K, Ford K, et. al. Life course health consequences and associated annual costs of adverse childhood experiences across Europe and North America: a systematic review and meta-analysis. Lancet Public Health. 2019 Oct;4(10):e517-e528. PMID: 31492648 “Total annual costs attributable to ACEs were estimated to be $581 billion in Europe and $748 billion in North America…Our findings suggest that a 10% reduction in ACE prevalence could equate to annual savings of $105 billion…Rebalancing expenditure towards ensuring safe and nurturing childhoods would be economically beneficial and relieve pressures on health-care systems.”

Merrick MT, Ford DC, Ports KA, et. al.
Vital Signs: Estimated Proportion of Adult Health Problems Attributable to Adverse Childhood Experiences and Implications for Prevention - 25 States, 2015-2017. MMWR Morb Mortal Wkly Rep. 2019 Nov 8;68(44):999-1005. PMID: 31697656 Using data from 25 states, “Nearly one in six adults in the study population (15.6%) reported four or more types of adverse childhood experiences. Adverse childhood experiences were significantly associated with poorer health outcomes, health risk behaviors, and socioeconomic challenges.”

You DS, Meagher MW.
Childhood Adversity and Pain Facilitation. Psychosom Med. 2018 Nov/Dec;80(9):869-879. PMID: 30211795 For 31 participants with high childhood adversity vs. 31 with low childhood adversity, the high adversity group (especially those with symptoms of PTSD), showed larger areas of secondary allodynia. This means that when an irritating substance was applied to the skin, a large surrounding area of skin was perceived as painful also. This increased hypersensitivity of the surrounding skin reflects increased sensitivity of central pain neurons, which may be a mechanism for known chronic widespread pain conditions after childhood abuse.

Lane RD, Anderson FS, Smith R.
Biased Competition Favoring Physical Over Emotional Pain: A Possible Explanation for the Link Between Early Adversity and Chronic Pain. Psychosom Med. 2018 Nov/Dec;80(9):880-890. PMID: 30222711 “Survivors of early adversity with chronic pain often seem impaired in their ability to be aware of, understand, and express distressing emotions such as anger and fear in social contexts.” Authors hypothesize that “physical pain and emotional pain are conscious experiences that can compete for selective attention”, and that some people may reinforce attention to physical pain and away from emotions. “Attending to, expressing, and understanding previously unacknowledged psychological distress unrelated to pain may facilitate recovery from chronic pain after early adversity.”

Sarafim-Silva BAM, Duarte GD, Sundefeld MLMM, et. al.
Childhood trauma is predictive for clinical staging, alcohol consumption, and emotional symptoms in patients with head and neck cancer. Cancer. 2018 Sep 15;124(18):3684-3692. PMID: 30079469 Of 110 head and neck cancer patients before starting cancer treatment, 95.5% had experienced at least 1 type of childhood trauma.  Emotional neglect was the most reported childhood trauma (43.8%) and was an independent variable associated with advanced clinical stage of cancer and higher alcohol consumption. Patients who had experienced more traumatic events were almost 12 times more likely to have significant depression, and physical child neglect was a predictive factor for increased anxiety.

Stillerman A.
Childhood adversity and lifelong health: From research to action. J Fam Pract. 2018 Nov;67(11):690-699. PMID: 30481245 Good review article on the science as well as practical aspects of incorporating awareness of ACEs into medical care. “Because at least 60% of Americans have had 1 or more experiences of childhood adversity, family physicians care for affected patients every day…updating our medical model to incorporate research that confirms the critical and widespread impact of childhood experience on health and illness is an essential task for family medicine.”  

Purkey E, Patel R, Phillips SP.
Trauma-informed care: Better care for everyone. Can Fam Physician. 2018 Mar;64(3):170-172. PMID: 29540379 “Here we present the principles of trauma-informed care followed by a description of how to apply them…We propose that ACEs are a key determinant—a root cause—of many of the pathologic conditions we treat on a daily basis. Viewing patients through a trauma-informed lens can lead to considerable patient healing and much greater professional satisfaction.”

Ortiz R.
Building Resilience Against the Sequelae of Adverse Childhood Experiences: Rise Up, Change Your Life, and Reform Health Care. Am J Lifestyle Med. 2019 Apr 15;13(5):470-479. PMID: 31523212 “This review aims to cultivate awareness and will discuss 3 objectives: to discuss the effects and hypothesized pathophysiological underpinnings of traumatic experiences in childhood on health and wellbeing throughout life, to present ways we can promote resilience in our daily lives and patient encounters, and to demonstrate how advocacy for the reduction of ACEs and promotion of resilient, trauma-informed environments are fundamental to health care reform.” 

Skar AS, Ormhaug SM, Jensen TK.
Reported Levels of Upset in Youth After Routine Trauma Screening at Mental Health Clinics. JAMA Netw Open. 2019 May 3;2(5):e194003. PMID: 31099873 Of 10,157 Norwegian youths aged 6 to 18 from 40 youth mental health clinics, 79.1% reported exposure to at least one potentially traumatizing event. 4.5% reported high levels of upset, 27.2% moderate and 68.4% no or low levels after filling out the questionnaires. Those reporting a history of sexual abuse and those with higher levels of PTSD symptoms reported higher upset.

Jorm AF, Mulder RT.
Prevention of mental disorders requires action on adverse childhood experiences. Aust N Z J Psychiatry. 2018 Apr;52(4):316-319. PMID: 29506400 “The big risk factors are adverse childhood experiences, which have major effects on most classes of mental disorder across the lifespan…Taking action on adverse childhood experiences may be our best chance of emulating the success of public health action to prevent chronic physical diseases, and thereby reduce the large global burden of mental disorders.”

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