Can the adverse childhood experiences (ACEs) checklist be utilized to predict emergency department visits among children and adolescents?

Abstract

Background Extensive literature has shown an association of Adverse Childhood Experiences (ACEs) with adverse health outcomes; however, its ability to predict events or stratify risks is less known. Individuals with mental illness and ACE exposure have been shown to visit emergency departments (ED) more often than those in the general population. This study thus examined the ability of the ACEs checklist to predict ED visits within the subsequent year among children and adolescents presenting to mental health clinics with pre-existing mental health issues. Methods The study analyzed linked data (n = 6100) from two databases provided by Alberta Health Services (AHS). The Regional Access and Intake System (RAIS 2016–2018) database provided data on the predictors (ACE items, age, sex, residence, mental health program type, and primary diagnosis) regarding children and adolescents (aged 0–17 years) accessing addiction and mental health services within Calgary Zone, and the National Ambulatory Care Reporting System (NACRS 2016–2019) database provided data on ED visits. A 25% random sample of the data was reserved for validation purposes. Two Least Absolute Shrinkage and Selection Operator (LASSO) logistic regression models, each employing a different method to tune the shrinkage parameter lambda (namely cross-validated and adaptive) and performing 10-fold cross-validation for a set of 100 lambdas in each model were examined. Results The adaptive LASSO model had a slightly better fit in the validation dataset than the cross-validated model; however, it still demonstrated poor discrimination (AUC 0.60, sensitivity 37.8%, PPV 49.6%) and poor calibration (over-triaged in low-risk and under-triaged in high-risk subgroups). The model’s poor performance was evident from an out-of-sample deviance ratio of − 0.044. Conclusion The ACEs checklist did not perform well in predicting ED visits among children and adolescents with existing mental health concerns. The diverse causes of ED visits may have hindered accurate predictions, requiring more advanced statistical procedures. Future studies exploring other machine learning approaches and including a more extensive set of childhood adversities and other important predictors may produce better predictions. Furthermore, despite highly significant associations being observed, ACEs may not be deterministic in predicting health-related events at the individual level, such as general ED use.

Childhood Adversity and Mental Health Outcomes Among University Students: A Longitudinal Study

“…Characterization of this association provides supportive evidence for incorporating risk factors such as early adversity into a more individualized risk profile, which may help with clinical triage and mapping to the appropriate supports and level of care for students seeking mental health support. 1 , 61 Psychosocial factors (i.e., perceived stress, low self-esteem, and low sleep quality) identified as mediators in the study should be further explored through intervention studies as targets to mitigate the harms to mental health associated with childhood adversities. Student-tailored mental health literacy may support the development of healthy socioemotional coping resources and facilitate timely help-seeking through reduced stigma 62 and increased emotional self-awareness.…”

Suicidal Crisis among Children and Young People: Associations with Adverse Childhood Experiences and Socio-Demographic Factors

“…Therefore, this exploratory study aims to build a better picture of CYP who experience suicidal crises, by examining the ACEs and socio-demographic characteristics associated with ED presentations at a local children's hospital over a two-year period. Furthermore, given the association between the length of the suicidal crisis and future suicide attempts [8], the study aims to examine the factors associated with repeated attendance at ED for suicidal crisis; in other words, the ACEs and other socio-demographic characteristics associated with pervasive and enduring crises. Thus, the research questions for the current study are as follows:…”

“…Indeed, research suggests that suicidal ideation often precedes a suicide attempt; for example, a longitudinal study in the US found that more than one-third of adolescents in suicidal crisis went on to attempt suicide [7]. Furthermore, it has been shown that the more pervasive the suicidal crisis, the more likely the individual is to attempt suicide [8]. In the UK, 42% of young adults reported having suicidal thoughts on at least one occasion in the previous twelve months [9].…”

Outcomes of adverse childhood experience during late adolescence: Evidence from college and community samples

“…ACEs can induce mental (Barnhart et al, 2022; Weller et al, 2021) and physical health issues (Kovács‐Tóth et al, 2021), as well as substance abuse (Bomysoad & Francis, 2020) and poor academic success (Myat Zaw et al, 2022) during the adolescence period. Consequently, ACEs lead to higher healthcare visits among adolescents (Bhattarai et al, 2021; Lackova Rebicova et al, 2022). The evidence reveals that although ACEs may negatively influence adolescents' well‐being (Kelifa et al, 2021), this warrants examination in various cultural contexts because subjective well‐being regards individuals' interests and positive effects (Diener, Heintzelman, et al, 2017) as distinctively shaped by culture (Tov & Diener, 2009).…”