The prevalence and clinical correlates of adverse childhood experiences in a cross-sectional study of primary care patients with cardiometabolic disease or risk factors

Robert G Maunder, David W Tannenbaum, Joanne A Permaul, Melissa Nutik, Cleo Haber, Mira Mitri, Daniela Costantini, Jonathan J Hunter, Robert G Maunder, David W Tannenbaum, Joanne A Permaul, Melissa Nutik, Cleo Haber, Mira Mitri, Daniela Costantini, Jonathan J Hunter

Abstract

Background: Adverse childhood experiences (ACEs) are associated with risk of poor adult health, including cardiometabolic diseases. Little is known about the correlates of ACEs for adults who have already developed cardiometabolic diseases, or who are at elevated risk.

Methods: Adult primary care patients with cardiometabolic disease (hypertension, diabetes, stroke, angina, myocardial infarction, coronary artery bypass graft, angioplasty) or with a risk factor (obesity, smoking, high cholesterol, family history) were surveyed regarding ACEs, psychological distress, attachment insecurity, quality of life, behavior change goals, stages of change, and attitudes toward potential prevention strategies.

Results: Of 387 eligible patients, 74% completed the ACEs survey. Exposure to ACEs was reported by 174 participants (61%). Controlling for age, gender, relationship status and income, number of ACEs was associated with psychological distress (F = 3.7, p = .01), quality of life (F = 8.9, p = .001), attachment anxiety (F = 3.4, p = .02), drinking alcohol most days (F = 4.0, p = .008) and smoking (F = 2.7, p = .04). Greater ACE exposure was associated with less likelihood of selecting diet or physical activity as a behavior change goal (linear-by-linear association p = .009). Stage of change was not associated with ACEs. ACEs exposure was not related to preferred resources for behavior change.

Conclusions: ACEs are common among patients at cardiometabolic risk and are related to quality of life, psychological factors that influence cardiometabolic outcomes and behavior change goals. ACEs should be taken into account when managing cardiometabolic risk in family medicine.

Keywords: Cardiovascular risk; Childhood adversity; Prevention; Quality of life.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Relationship between ACE exposure and (a) psychological distress, (b) quality of life and (c) attachment anxiety
Fig. 2
Fig. 2
Relationship between ACE category and patients’ goals for behavior change

References

    1. Felitti VJ, Anda RF, Nordenberg D, Williamson DF, Spitz AM, Edwards V, Koss MP, Marks JS. 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.
    1. Gilbert LK, Breiding MJ, Merrick MT, Thompson WW, Ford DC, Dhingra SS, Parks SE. 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.
    1. Dong M, Giles WH, Felitti VJ, Dube SR, Williams JE, Chapman DP, Anda RF. Insights into causal pathways for ischemic heart disease: adverse childhood experiences study. Circulation. 2004;110(13):1761–1766.
    1. Bellis MA, Lowey H, Leckenby N, Hughes K, Harrison D. Adverse childhood experiences: retrospective study to determine their impact on adult health behaviours and health outcomes in a UK population. J Public Health (Oxf) 2014;36(1):81–91.
    1. Kelly-Irving M, Lepage B, Dedieu D, Bartley M, Blane D, Grosclaude P, Lang T, Delpierre C. Adverse childhood experiences and premature all-cause mortality. Eur J Epidemiol. 2013;28(9):721–734.
    1. Pretty C, O'Leary DD, Cairney J, Wade TJ. Adverse childhood experiences and the cardiovascular health of children: a cross-sectional study. BMC Pediatr. 2013;13:208.
    1. Su S, Wang X, Kapuku GK, Treiber FA, Pollock DM, Harshfield GA, McCall WV, Pollock JS. Adverse childhood experiences are associated with detrimental hemodynamics and elevated circulating endothelin-1 in adolescents and young adults. Hypertension. 2014;64(1):201–207.
    1. Su S, Wang X, Pollock JS, Treiber FA, Xu X, Snieder H, McCall WV, Stefanek M, Harshfield GA. Adverse childhood experiences and blood pressure trajectories from childhood to young adulthood: the Georgia stress and heart study. Circulation. 2015;131(19):1674–1681.
    1. Burke NJ, Hellman JL, Scott BG, Weems CF, Carrion VG. The impact of adverse childhood experiences on an urban pediatric population. Child Abuse Negl. 2011;35(6):408–413.
    1. Williamson DF, Thompson TJ, Anda RF, Dietz WH, Felitti V. Body weight and obesity in adults and self-reported abuse in childhood. Int J Obes Relat Metab Disord. 2002;26(8):1075–1082.
    1. Le TL, Mann RE, Levitan RD, George TP, Maunder RG. Sex differences in the relationships between childhood adversity, attachment anxiety and current smoking. Addict Res Theory. 2017;25(2):7.
    1. Danese A, Moffitt TE, Harrington H, Milne BJ, Polanczyk G, Pariante CM, Poulton R, Caspi A. Adverse childhood experiences and adult risk factors for age-related disease: depression, inflammation, and clustering of metabolic risk markers. Arch Pediatr Adolesc Med. 2009;163(12):1135–1143.
    1. Garad Y, Maximova K, MacKinnon N, McGrath JJ, Kozyrskyj AL, Colman I. Sex-specific differences in the association between childhood adversity and cardiovascular disease in adulthood: evidence from a national cohort study. Can J Cardiol. 2017;33(8):1013–1019.
    1. Huffhines L, Noser A, Patton SR. The link between adverse childhood experiences and diabetes. Curr Diab Rep. 2016;16(6):54.
    1. Rich-Edwards JW, Spiegelman D, Lividoti Hibert EN, Jun HJ, Todd TJ, Kawachi I, Wright RJ. Abuse in childhood and adolescence as a predictor of type 2 diabetes in adult women. Am J Prev Med. 2010;39(6):529–536.
    1. Suglia SF, Koenen KC, Boynton-Jarrett R, Chan PS, Clark CJ, Danese A, Faith MS, Goldstein BI, Hayman LL, Isasi CR, Pratt CA, Slopen N, Sumner JA, Turer A, Turer CB, Zachariah JP, American Heart Association Council on E, Prevention, Council on Cardiovascular Disease in the Y, Council on Functional G, Translational B, Council on C, Stroke N, Council on Quality of C, Outcomes R Childhood and Adolescent Adversity and Cardiometabolic Outcomes: A Scientific Statement From the American Heart Association. Circulation. 2018;137(5):e15–e28.
    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.
    1. Schilling EA, Aseltine RH, Jr, Gore S. Adverse childhood experiences and mental health in young adults: a longitudinal survey. BMC Public Health. 2007;7:30.
    1. Bifulco A, Kwon J, Jacobs C, Moran PM, Bunn A, Beer N. Adult attachment style as mediator between childhood neglect/abuse and adult depression and anxiety. Soc Psychiatry Psychiatr Epidemiol. 2006;41(10):796–805.
    1. Murphy A, Steele M, Dube SR, Bate J, Bonuck K, Meissner P, Goldman H, Steele H. Adverse childhood experiences (ACEs) questionnaire and adult attachment interview (AAI): implications for parent child relationships. Child Abuse Negl. 2014;38(2):224–233.
    1. Waldinger RJ, Schulz MS, Barsky AJ, Ahern DK. Mapping the road from childhood trauma to adult somatization: the role of attachment. Psychosom Med. 2006;68(1):129–135.
    1. Corso PS, Edwards VJ, Fang X, Mercy JA. Health-related quality of life among adults who experienced maltreatment during childhood. Am J Public Health. 2008;98(6):1094–1100.
    1. Endicott J, Nee J, Harrison W, Blumenthal R. Quality of life enjoyment and satisfaction questionnaire: a new measure. Psychopharmacol Bull. 1993;29(2):321–326.
    1. Janssen MF, Pickard AS, Golicki D, Gudex C, Niewada M, Scalone L, Swinburn P, Busschbach J. Measurement properties of the EQ-5D-5L compared to the EQ-5D-3L across eight patient groups: a multi-country study. Qual Life Res. 2013;22(7):1717–1727.
    1. Lo C, Walsh A, Mikulincer M, Gagliese L, Zimmermann C, Rodin G. Measuring attachment security in patients with advanced cancer: psychometric properties of a modified and brief experiences in close relationships scale. Psychooncology. 2009;18(5):490–499.
    1. Maunder RG, Hunter JJ. An internet resource for self-assessment of mental health and health behavior: development and implementation of the self-assessment kiosk. JMIR Ment Health. 2018;5(2):e39.
    1. Kessler RC, Andrews G, Colpe LJ, Hiripi E, Mroczek DK, Normand SL, Walters EE, Zaslavsky AM. Short screening scales to monitor population prevalences and trends in non-specific psychological distress. Psychol Med. 2002;32(6):959–976.
    1. Carra G, Sciarini P, Segagni-Lusignani G, Clerici M, Montomoli C, Kessler RC. Do they actually work across borders? Evaluation of two measures of psychological distress as screening instruments in a non Anglo-Saxon country. Eur Psychiatry. 2011;26(2):122–127.
    1. American Psychiatric Association . Diagnostic and statistical manual of mental disorders (DSM-IV) 4. Washington DC: American Psychiatric Association; 1994.
    1. Bohn MJ, Babor TF, Kranzler HR. The alcohol use disorders identification test (AUDIT): validation of a screening instrument for use in medical settings. J Stud Alcohol. 1995;56(4):423–432.
    1. Sutton K, Logue E, Jarjoura D, Baughman K, Smucker W, Capers C. Assessing dietary and exercise stange of change to optimize weight loss interventions. Obes Res. 2003;11(5):641–652.
    1. MacMillan HL, Fleming JE, Trocmé N, Boyle MH, Wong M, Racine YA, Beardslee WR, Offord DR. Prevalence of child physical and sexual abuse in the community. J Am Med Assoc. 1997;278:131–135.
    1. Elliott DE, Bjelajac P, Fallot RD, Markoff LS, Reed BG. Trauma-informed or trauma-denied: principles and implementation of trauma-informed services for women. J Community Psychol. 2005;33(3):461–467.
    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.
    1. Purkey E, Patel R, Phillips SP. Trauma-informed care: better care for everyone. Can Fam Physician. 2018;64(3):170–172.

Source: PubMed

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