Pathways from childhood abuse and other adversities to adult health risks: The role of adult socioeconomic conditions

Abstract

Adverse Childhood Experiences (ACEs), including child abuse, have been linked with poor health outcomes in adulthood. The mechanisms that explain these relations are less understood. This study assesses whether associations of ACEs and health risks are mediated by adult socioeconomic conditions, and whether these pathways are different for maltreatment than for other types of adversities. Using the Behavioral Risk Factor Surveillance System 2012 survey (N=29,229), we employ structural equation modeling to (1) estimate associations of the number and type of ACEs with five health risks – depression, obesity, tobacco use, binge drinking, and self-reported sub-optimal health; and (2) assess whether adult socioeconomic conditions— marriage, divorce and separation, educational attainment, income and insurance status—mediate those associations. Findings suggest both direct and indirect associations between ACEs and health risks. At high numbers of ACEs, 15–20% of the association between number of ACEs and adult health risks was attributable to socioeconomic conditions. Associations of three ACEs (exposure to domestic violence, parental divorce, and residing with a person who was incarcerated) with health risks were nearly entirely explained by socioeconomic conditions in adulthood. However, child physical, emotional and sexual abuse were significantly associated with several adult health risks, beyond the effects of other adversities, and socioeconomic conditions explained only a small portion of these associations. These findings suggest that the pathways to poor adult health differ by types of ACEs, and that childhood abuse is more likely than other adversities to have a direct impact.

Childhood physical and sexual abuse experiences associated with post-traumatic stress disorder among pregnant women

“…Final logistic regression models included covariates that altered unadjusted ORs by at least 10%. Prior studies have shown associations of socioeconomic status and depression with childhood abuse (34, 55) and PTSD (56, 57). Given this, we performed a sensitivity analysis on the association between childhood abuse and PTSD after adjusting for these potential confounders.…”

Social and emotional support as a protective factor against current depression among individuals with adverse childhood experiences

“…One recent study reported that 4 or more ACE predicted a 23.9% point higher probability of ever-diagnosed depression compared with 0 ACE (Font and Maguire-Jack, 2016). Depression has a significant effect on individuals' health and is associated with enormous economic burden (Moussavi et al, 2007, Wang et al, 2003).…”

Adverse Childhood Experiences and Suicide Risk: Toward Comprehensive Prevention

“…2 ACEs do not represent the full scope of adversity that children may be exposed to, but they are a reliable proxy for what was going on in a child’s home, and the science connecting ACEs to lifelong mental and physical health disorders, health risk behaviors, and consequentially, suicide risk is robust. 2–4,15–17 …”

“…15 ACEs have been associated with markers of diminished life opportunity (e.g., reduced education, employment, and income), 17 which are also associated with suicide. 18 Importantly, the relationship among ACEs and adult depression, suicidality, and substance abuse has been well established.…”