adverse childhood experiences and their relationship to adult well-being, disease, and death :...
TRANSCRIPT
Adverse Childhood Experiences and their Relationship to
Adult Well-being, Disease, and Death : Turning gold into lead
A collaborative effort between
Kaiser Permanente and the Centers for Disease Control
Robert F. Anda, M.D. Vincent J. Felitti, M.D.
Creating Safe Environments Phoenix, AZ. April 9, 2013
Origins of the ACE Study
51 weeks later
What is the core diagnosis here? Which photo depicts the problem?
408 132 lbs
Summary of the ACE Study
• The ACE Study is a retrospective and prospective analysis in 17,337 middle-class adults of the effects of ten categories of adverse life experiences in childhood.
• The very existence of these experiences was found to be quite unexpectedly high, though unrecognized because they are lost in time and protected by shame, by secrecy, and by social taboos against routinely exploring certain realms of human experience.
• Their effect a half century later is powerfully and proportionately related to the number of categories of adverse life experiences in childhood, and thereby is a major determinant of well-being, health risks, mental illness, occupational performance, social malfunction, biomedical disease, and premature death.
ACE Study Design
Survey Wave 171% response (9,508/13,454) n=13,000 71% response
Survey Wave II n=13,000
All medical evaluationsabstracted
PresentHealth Status
Mortality National Death Index
Morbidity Hospital Discharges Doctor Office Visits Emergency Room Visits Pharmacy Costs
All medical evaluationsabstracted
vs. &
17,337 adults
Empirically Selected Categories of Adverse Childhood Experiences
Abuse, by Category Psychological (by parents) 11% Physical (by parents) 28% Sexual (anyone, but typically family) 22%
Major Neglect, by Category Emotional 15% Physical 10%
Household Dysfunction, by Category Alcoholism or drug use in home 27% Loss of biological parent <18 23% Depression or mental illness in home 17% Mother treated violently 13% Imprisoned household member 5%
Prevalence (%)
Adverse Childhood Experiences ScoreNumber of categories (not events) is summed…
ACE Score Prevalence 0 33% 1 25% 2 15% 3 10% 4 6% 5 or more 11%*
• Two out of three adults experienced at least one category of ACE.
• If any one ACE is present, there is an 87% chance at least one other category of ACE is present, and a 50% chance of three or more.
• Women are 50% more likely than men to have an ACE Score >5.
Smoking to Self-Medicate
Is he describing dysfunctional behavior, or is it functional in realms of which we know nothing?
What are conventionally viewed
as Public Health problems are often
personal solutions to long-concealed
adverse childhood experiences.
A Public Health Paradox
The Hidden Threat of Weight Loss
The unspoken benefits of Obesity
Adverse Childhood Experiences vs. >1 ppd Smoking as an Adult
%
P< .001
Health Risks
Childhood Experiences vs. Adult Alcoholism
0
1
23
4+
Social function
ACE Score vs. Intravenous Drug Use
p<0.001p<0.001
Health Risks
Molestation in Childhood
Obesity runs in this family. So does speaking English. Familial obesity does not mean genetic.
Childhood Experiences Underlie Chronic Depression
Well-being
Childhood Experiences Underlie Later Suicide
11
22
00
33
4+4+
Death
Childhood Experiences Underlie Later Prescription of Antidepressants
P
resc
rip
tio
n r
ate
p
er
10
0 p
ers
on
-ye
ars)
0
1
23
45 or more
Costs
approximately 50 years later
ACE Score
Social malfunction:
ACE Score and Indicators of Impaired Worker Performance
0
5
10
15
20
25
0 1 2 3 4 or more
ACE Score
Absenteeism(>2 days/month)
SeriousFinancialProblems
SeriousProblems
Pre
vale
nce
of
Imp
aire
d P
erfo
rman
ce (
%)
Performing job
ACEs Increase Likelihood of Heart Disease*
• Emotional abuse 1.7x• Physical abuse 1.5x• Sexual abuse 1.4x• Domestic violence 1.4x• Mental illness 1.4x• Substance abuse 1.3x• Household criminal 1.7x• Emotional neglect 1.3x• Physical neglect 1.4x
*After correction for age, race, education, and conventional risk factors like smoking and diabetes. Circulation, Sept 2004.
Biomedical disease
Newly Recognized Biomedical Relationships
Childhood Experiences Underlie Rape
00
11
2233
4+4+
Well-being
ACE Score
Ever
Hallu
cin
ate
d*
(%)
AbusedAlcohol
or Drugs
*Adjusted for age, sex, race, and education.
ACE Score and HallucinationsDisease
Turning Research into Practicea beginning
• Set up properly, and in high volume, comprehensive medical evaluation affordably can be provided to all patients at the outset of ongoing medical care.
• Comprehensive biomedical evaluation provides a net 11% reduction in DOVs in the subsequent year.
• Comprehensive biopsychosocial evaluation, which incorporates ACE Study findings, provides a 35% reduction in DOVs in the subsequent year compared to the prior year. (125,000 patient sample)
Imagine the possibilities!
Further InformationFurther Information
www.acestudy.org
http://www.cdc.gov/NCCDPHP/ACE/
Medline – PubMed (Felitti or Anda as author name)
AVAHealth.org (Detailed DVD)