scholarly journals Exploring the health and service utilisation of general practice patients with a history of adverse childhood experiences (ACEs): an observational study using electronic health records

BMJ Open ◽  
2020 ◽  
Vol 10 (9) ◽  
pp. e036239
Author(s):  
Katie Hardcastle ◽  
Mark A Bellis ◽  
Catherine A Sharp ◽  
Karen Hughes
Keyword(s):  
Mental Health ◽  
Health Service ◽  
Adverse Childhood Experiences ◽  
Mental Health Problems ◽  
Health Problems ◽  
Service Utilisation ◽  
Health Records ◽  
Childhood Experiences ◽  
Adverse Childhood ◽  
History Of

ObjectivesTo examine the relationships between adverse childhood experiences (ACEs), chronic health and health service utilisation among a sample of general practice patients.DesignCross-sectional observational study using anonymised data from electronic health records for 763 patients.SettingFour general practices in northwest England and North Wales.Outcome measuresPatient demographic data (age, gender); body mass index; self-reported smoking status; self-reported ACEs; diagnosis of chronic health conditions; current mental health problems; total number of service contacts and repeat medication use in the previous 6 months.ResultsA history of ACEs (experiencing abuse or neglect as a child, and/or growing up in a household characterised by violence, substance use, mental health problems or criminal behaviour) was strongly independently associated with current mental health problems, smoking and chronic obstructive pulmonary disease, showing a dose–response relationship with level of ACE exposure. Medication use and contact were significantly greater among patients with high ACE exposure (≥4 ACEs), compared with those with no ACEs. However, contrary to findings from population studies, health service utilisation was not significantly different for patients with increased ACE exposure (1–3 ACEs) and their ACE-free counterparts.ConclusionsFindings highlight the contribution ACEs make to unequal distributions of risk to health and well-being and patterns of health service use in the UK.

scholarly journals The Clustering of Adverse Childhood Experiences in the Avon Longitudinal Study of Parents and Children: Are Gender and Poverty Important?

2020 ◽  
pp. 088626052093509 ◽  
Author(s):  
Rebecca E. Lacey ◽  
Laura D. Howe ◽  
Michelle Kelly-Irving ◽  
Mel Bartley ◽  
Yvonne Kelly
Keyword(s):  
Mental Health ◽  
Mental Health Problems ◽  
Health Problems ◽  
Parental Mental Health ◽  
Childhood Experiences ◽  
Close Family Member ◽  
Parents And Children ◽  
Adverse Childhood ◽  
Avon Longitudinal Study ◽  
Close Family

Previous research has demonstrated a graded relationship between the number of Adverse Childhood Experiences reported (an ACE score) and child outcomes. However, ACE scores lack specificity and ignore the patterning of adversities, which are informative for interventions. The aim of the present study was to explore the clustering of ACEs and whether this clustering differs by gender or is predicted by poverty. Data on 8,572 participants of the Avon Longitudinal Study of Parents and Children (ALSPAC) were used. ALSPAC is a regionally representative prenatal cohort of children born between 1991 and 1992 in the Avon region of South-West England. ACEs included parental divorce, death of a close family member, interparental violence, parental mental health problems, parental alcohol misuse, parental drug use, parental convictions, and sexual, emotional, and physical abuse, between birth and 19 years. Latent class analysis was used to derive ACE clusters and associations between poverty, gender, and the derived classes tested using multinomial logistic regression. Five latent classes were identified: “Low ACEs” (55%), “Parental separation and mother’s mental health problems” (18%), “Parental mental health problems, convictions and separation” (15%), “Abuse and mental health problems” (6%), and “Poly adversity” (6%). Death of a close family member and sexual abuse did not cluster with other adversities. The clustering did not differ by gender. Poverty was strongly related to both individual ACEs and clusters. These findings demonstrate that ACEs cluster in specific patterns and that poverty is strongly related to this. Therefore, reducing child poverty might be one strategy for reducing ACEs.

Adverse Childhood Experiences, Brain Development, and Mental Health: A Call for Neurocounseling

2018 ◽  
Vol 40 (3) ◽  
pp. 266-278 ◽  
Author(s):  
Carryl P. Navalta ◽  
Lesley McGee ◽  
Jolene Underwood
Keyword(s):  
Mental Health ◽  
Adverse Childhood Experiences ◽  
Brain Structures ◽  
Cumulative Exposure ◽  
Childhood Experiences ◽  
Psychotherapeutic Interventions ◽  
Ace Study ◽  
Adverse Childhood ◽  
Health Related ◽  
History Of

The Adverse Childhood Experiences (ACE) Study provided compelling evidence that abuse, neglect, and other ACEs are the most potent risk factors for the development of health, mental health, and substance use problems. Such negative health-related outcomes parallel the cumulative exposure of the developing brain to the stress response, with resulting impairment in multiple brain structures and functions. Collectively, these sequelae can manifest during childhood, adolescence, or adulthood. We and others have posited that counseling and other psychotherapeutic interventions need to address the individual's multilayered ecology (i.e., biological, psychological, social, cultural/contextual). Neurocounseling can provide a heuristic framework to more effectively assess, conceptualize, and counsel people with a history of ACEs. We provide an update of the clinical neuroscience of ACEs and its implications for counseling, including how contemporary interventions (e.g., mindfulness) can potentially have positive benefits for such individuals.

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