Physicians' knowledge and practices regarding screening adult patients for adverse childhood experiences: a survey

Robert G Maunder, Jonathan J Hunter, David W Tannenbaum, Thao Lan Le, Christine Lay, Robert G Maunder, Jonathan J Hunter, David W Tannenbaum, Thao Lan Le, Christine Lay

Abstract

Background: Adverse Childhood Experiences (ACEs) are common and associated with many illnesses. Most physicians do not routinely screen for ACEs. We aimed to determine if screening is related to knowledge or medical specialty, and to assess perceived barriers.

Methods: Physicians in Ontario, Canada completed an online survey in 2018-2019. Data were analyzed in 2019.

Results: Participants were 89 family physicians, 46 psychiatrists and 48 other specialists. Participants screened for ACEs "never or not usually" (N = 58, 31.7%), "when indicated" (N = 67, 36.6%), "routinely" (N = 50, 27.3%) or "other" (N = 5, 2.7%). Screening was strongly associated with specialty (Chi2 = 181.0, p < .001). The modal responses were: family physicians - "when indicated" (66.3%), psychiatrists - "routinely" (91.3%), and other specialists - "never or not usually" (77.1%). Screening was not related to knowledge of prevalence of ACEs, or of the link between ACEs and mental health, but was significantly associated with knowing that ACEs are associated with physical health. Knowing that ACEs are linked to stroke, ischemic heart disease, COPD, and diabetes predicted greater screening (Chi2 15.0-17.7, each p ≤ .001). The most prevalent perceived barriers to screening were lack of mental health resources (59.0%), lack of time (59.0%), concern about causing distress (49.7%) and lack of confidence (43.7%).

Conclusions: Enhancing knowledge about ACEs' negative influence on physical illness may increase screening. Efforts to promote screening should address concerns that screening is time-consuming and will increase referrals to mental health resources. Education should focus on increasing confidence with screening and with managing patient distress.

Keywords: Child abuse; Childhood adversity; Medical history taking; Prevention.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Relationship between medical specialty and knowledge that selected physical diseases are associated with ACEs. Ischemic Heart Disease: Chi2 = 10.9, p = .004; Stroke: Chi2 = 12.6, p = .002; Diabetes: Chi2 = 12.6, p = .002; Chronic Obstructive Pulmonary Disease: Chi2 = 10.4, p = .006; Hepatitis C: Chi2 = 4.3, p = .12
Fig. 2
Fig. 2
Relationship between usual screening behavior and knowledge that selected physical diseases are associated with ACEs. Five participants who indicated that their usual practice is “other” not shown. Ischemic Heart Disease: Chi2 = 17.7, p < .001; Stroke: Chi2 = 16.7, p < .001; Diabetes: Chi2 = 15.6, p < .001; Chronic Obstructive Pulmonary Disease: Chi2 = 15.0, p < .001; Hepatitis C: Chi2 = 6.2, p = .10

References

    1. Felitti VJ, Anda RF, Nordenberg D, Williamson DF, Spitz AM, Edwards V, et al. Relationship of childhood abuse and household dysfunction to many of the leading causes of deaths in adults: the adverse childhood experiences (ACE) study. Am J Prev Med. 1998;14:245–258. doi: 10.1016/S0749-3797(98)00017-8.
    1. Gilbert LK, Breiding MJ, Merrick MT, Thompson WW, Ford DC, Dhingra SS, et al. Childhood adversity and adult chronic disease: an update from ten states and the District of Columbia, 2010. Am J Prev Med. 2015;48(3):345–349. doi: 10.1016/j.amepre.2014.09.006.
    1. Afifi TO, MacMillan HL, Boyle M, Taillieu T, Cheung K, Sareen J. Child abuse and mental disorders in Canada. CMAJ. 2014;186(9):E324–E332. doi: 10.1503/cmaj.131792.
    1. Anda RF, Brown DW, Felitti VJ, Bremner JD, Dube SR, Giles WH. Adverse childhood experiences and prescribed psychotropic medications in adults. Am J Prev Med. 2007;32(5):389–394. doi: 10.1016/j.amepre.2007.01.005.
    1. Suglia SF, Koenen KC, Boynton-Jarrett R, Chan PS, Clark CJ, Danese A, et al. Childhood and adolescent adversity and Cardiometabolic outcomes: a scientific statement from the American Heart Association. Circulation. 2018;137(5):e15–e28. doi: 10.1161/CIR.0000000000000536.
    1. Afifi TO, MacMillan HL, Boyle M, Cheung K, Taillieu T, Turner S, et al. Child abuse and physical health in adulthood. Health Rep. 2016;27(3):10–18.
    1. Shields ME, Hovdestad WE, Gilbert CP, Tonmyr LE. Childhood maltreatment as a risk factor for COPD: findings from a population-based survey of Canadian adults. Int J Chron Obstruct Pulmon Dis. 2016;11:2641–2650. doi: 10.2147/COPD.S107549.
    1. Bellis MA, Hughes K, Leckenby N, Hardcastle KA, Perkins C, Lowey H. Measuring mortality and the burden of adult disease associated with adverse childhood experiences in England: a national survey. J Public Health (Oxf) 2015;37(3):445–454. doi: 10.1093/pubmed/fdu065.
    1. Dong M, Dube SR, Felitti VJ, Giles WH, Anda RF. Adverse childhood experiences and self-reported liver disease: new insights into the causal pathway. Arch Intern Med. 2003;163(16):1949–1956. doi: 10.1001/archinte.163.16.1949.
    1. Brown DW, Anda RF, Felitti VJ, Edwards VJ, Malarcher AM, Croft JB, et al. Adverse childhood experiences are associated with the risk of lung cancer: a prospective cohort study. BMC Public Health. 2010;10:20. doi: 10.1186/1471-2458-10-20.
    1. Fuller-Thomson E, Brennenstuhl S. Making a link between childhood physical abuse and cancer: results from a regional representative survey. Cancer. 2009;115(14):3341–3350. doi: 10.1002/cncr.24372.
    1. Kelly-Irving M, Lepage B, Dedieu D, Lacey R, Cable N, Bartley M, et al. Childhood adversity as a risk for cancer: findings from the 1958 British birth cohort study. BMC Public Health. 2013;13:767. doi: 10.1186/1471-2458-13-767.
    1. Brown MJ, Thacker LR, Cohen SA. Association between adverse childhood experiences and diagnosis of cancer. PLoS One. 2013;8(6):e65524. doi: 10.1371/journal.pone.0065524.
    1. Hughes K, Bellis MA, Hardcastle KA, Sethi D, Butchart A, Mikton C, et al. The effect of multiple adverse childhood experiences on health: a systematic review and meta-analysis. Lancet Public Health. 2017;2(8):e356–ee66. doi: 10.1016/S2468-2667(17)30118-4.
    1. Jacobs MB, Boynton-Jarrett RD, Harville EW. Adverse childhood event experiences, fertility difficulties and menstrual cycle characteristics. J Psychosom Obstet Gynaecol. 2015;36(2):46–57. doi: 10.3109/0167482X.2015.1026892.
    1. Chartier MJ, Walker JR, Naimark B. Childhood abuse, adult health, and health care utilization: results from a representative community sample. Am J Epidemiol. 2007;165(9):1031–1038. doi: 10.1093/aje/kwk113.
    1. Afifi TO, Enns MW, Cox BJ, Asmundson GJ, Stein MB, Sareen J. Population attributable fractions of psychiatric disorders and suicide ideation and attempts associated with adverse childhood experiences. Am J Public Health. 2008;98(5):946–952. doi: 10.2105/AJPH.2007.120253.
    1. Maunder RG, Hunter JJ, Atkinson L, Steiner M, Wazana A, Fleming AS, et al. An attachment-based model of the relationship between childhood adversity and somatization in children and adults. Psychosom Med. 2017;79(5):506–513. doi: 10.1097/PSY.0000000000000437.
    1. Porcerelli JH, Jones JR, Klamo R, Heeney R. Childhood abuse in adults in primary care: empirical findings and clinical implications. Int J Psychiatry Med. 2017;52(3):265–276. doi: 10.1177/0091217417730290.
    1. Chartier MJ, Walker JR, Naimark B. Separate and cumulative effects of adverse childhood experiences in predicting adult health and health care utilization. Child Abuse Negl. 2010;34(6):454–464. doi: 10.1016/j.chiabu.2009.09.020.
    1. Kamiya Y, Timonen V, Kenny RA. The impact of childhood sexual abuse on the mental and physical health, and healthcare utilization of older adults. Int Psychogeriatr. 2016;28(3):415–422. doi: 10.1017/S1041610215001672.
    1. Fang X, Brown DS, Florence CS, Mercy JA. The economic burden of child maltreatment in the United States and implications for prevention. Child Abuse Negl. 2012;36(2):156–165. doi: 10.1016/j.chiabu.2011.10.006.
    1. Tink W, Tink JC, Turin TC, Kelly M. Adverse childhood experiences: survey of resident practice, knowledge, and attitude. Fam Med. 2017;49(1):7–13.
    1. Friedman LS, Samet JH, Roberts MS, Hudlin M, Hans P. Inquiry about victimization experiences. A survey of patient preferences and physician practices. Arch Intern Med. 1992;152(6):1186–1190. doi: 10.1001/archinte.1992.00400180056008.
    1. Gillespie RJ, Folger AT. Feasibility of assessing parental ACEs in pediatric primary care: implications for practice-based implementation. J Child Adolesc Trauma. 2017;10(3):249–256. doi: 10.1007/s40653-017-0138-z.
    1. Berry KM, Rutledge CM. Factors that influence women to disclose sexual assault history to health care providers. J Obstet Gynecol Neonatal Nurs. 2016;45(4):553–564. doi: 10.1016/j.jogn.2016.04.002.
    1. Schachter CL, Radomsky NA, Stalker CA, Teram E. Women survivors of child sexual abuse. How can health professionals promote healing? Can Fam Physician. 2004;50:405–412.
    1. Weinreb L, Savageau JA, Candib LM, Reed GW, Fletcher KE, Hargraves JL. Screening for childhood trauma in adult primary care patients: a cross-sectional survey. Prim Care Companion J Clin Psychiatry. 2010;12(6). 10.4088/PCC.10m00950blu.
    1. Esden JL. Adverse childhood experiences and implementing trauma-informed primary care. Nurs Pract. 2018;43(12):10–21. doi: 10.1097/01.NPR.0000547550.48517.e9.
    1. Glowa PT, Olson AL, Johnson DJ. Screening for adverse childhood experiences in a family medicine setting: a feasibility study. J Am Board Fam Med. 2016;29(3):303–307. doi: 10.3122/jabfm.2016.03.150310.

Source: PubMed

Sponzoři a spolupracovníci

Zdravotní podmínky

Drogové intervence

3
Předplatit