Premium
Adverse Childhood Experiences and Disability in U.S. Adults
Author(s) -
SchüsslerFiorenza Rose Sophia Miryam,
Xie Dawei,
Stineman Margaret
Publication year - 2014
Publication title -
pmandr
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.617
H-Index - 66
eISSN - 1934-1563
pISSN - 1934-1482
DOI - 10.1016/j.pmrj.2014.01.013
Subject(s) - medicine , behavioral risk factor surveillance system , odds ratio , anxiety , marital status , population , confidence interval , adverse effect , psychiatry , environmental health
Objective To assess relationships between adverse childhood experiences and self‐reported disabilities in adult life. Design Cross‐sectional, random‐digit‐dialed, state‐population‐based survey (Behavioral Risk Factor Surveillance System). Setting Fourteen states and the District of Columbia. Participants Noninstitutionalized adults ages ≥18 years surveyed in 2009 and/or in 2010 (n = 81,184). Methods The Behavioral Risk Factor Surveillance System Adverse Childhood Experience (ACE) Module asks about abuse (physical, sexual, emotional), family dysfunction (exposures to domestic violence, living with mentally ill, substance abusing, or incarcerated family member(s), and/or parental separation and/or divorce) that occurred before age 18 years. The ACE score sums affirmed ACE categories (range, 0‐8). We controlled for demographic characteristics (age, race, education, income, and marital status) and self‐reported physical health conditions (stroke, myocardial infarction, diabetes, coronary heart disease, asthma). Five states asked participants about mental health conditions (anxiety, depression). A subset analysis of participants in these states evaluated the effect of adjusting for these conditions. Main Outcome Measurements The primary outcome was disability (self‐reported activity limitation and/or assistive device use). Results More than half of participants (57%) reported at least 1 adverse childhood experience category, and 23.2% reported disability. The odds ratio (95% confidence interval) of disability increased in a graded fashion from odds ratio 1.3 (95% confidence interval, 1.2‐1.4) among those who experienced 1 adverse experience to odds ratio 5.8 (95% confidence interval, 4.6‐7.5) among those with 7‐8 adverse experiences compared with those with no such experiences when adjusting for demographic factors. The relationship between adverse experiences and disability remained strong after adjusting for physical and mental health conditions. Conclusions There is a strong graded relationship between childhood exposure to abuse and household dysfunction and self‐reported disability in adulthood, even after adjusting for potentially mediating health conditions. Greater clinician, researcher, and policymaker awareness of the impact of childhood adversity on disability is crucial to help those affected by childhood adversity lead more functional lives.