The Adverse Childhood Experiences (ACE) Study
As health care professionals, we are familiar with chemical signals and cellular processes. Cortisol, for example, is secreted by the adrenal glands under times of stress. Among its many functions, it signals the liver to undergo gluconeogenesis, raising blood sugar levels and supplying the body with quick energy. Cortisol also constricts blood vessels, raising the blood pressure, in order to deliver more oxygen to tissues and enabling the fight or flight mechanism when faced with a threat.
We are comfortable with this process. It raises no eyebrows, and stifles no slow yawns from overworked students. These are easily digestible facts.
Cortisol is a useful chemical during short-term stress, but has terrible consequences if chronically present in the body. Long-term elevated blood sugar and blood pressure levels can have disastrous effects on health. One thing that causes chronic cortisol release is childhood trauma, or Adverse Childhood Experiences (ACEs). Childhood trauma is a less easy topic to digest than simple chemical processes, but a very important one to learn about and address.
A 1998 study by Felliti et. al. called, “Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults: The Adverse Childhood Experiences (ACE) Study” explores the result of chronic trauma on health. This study surveyed 8,000 adults in San Diego about their childhood experiences, controlled for known related factors, and compared the results to data that had already been collected from the respondents concerning future health risk behaviors, health status, and disease.
To take the questionnaire yourself: https://acestoohigh.com/got-your-ace-score/
This study found that more than half of people surveyed have experienced at least one adverse childhood experience, 25% have experienced more than one, and 12.5% have experienced four or more ACEs. The prevalence of ACEs in the population was found to be similar to a separate study conducted in Philadelphia and to a census of the US conducted by the government. Childhood trauma is much too prevalent. A majority, not a minority, of the population has experienced one or more ACE.
Four or more ACEs predicts:
- 4-12 times increased risk of: alcoholism, drug abuse, depression, suicide attempt
- 2-4 times increased risk of smoking, poor self-rated health, >50 sexual partners, sexual transmitted disease
- 1.4-1.6 times increased risk of physical inactivity and severe obesity
Several follow-up studies have expanded further, to demonstrate a relationship between childhood trauma and greater pharmaceutical use, many diseases, and premature death.
The proposed mechanism for how childhood trauma leads to disease is illustrated below:
Source: Centers for Disease Control and Prevention, Kaiser Permanente.
The prevalence and cascade of health issues that trauma is linked to is too important for us to ignore. It is absolutely essential that health care workers are talking about childhood trauma and furthering efforts to prevent and treat its effects on the health of our communities.
To explore the original ACE study go to the Center for Disease Control and Prevention:
1. Felitti, Anda, Nordenber, Williamson, Spitz, Edwards, … Marks. (1998). Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults: The Adverse Childhood Experiences (ACE) Study. American Journal of Preventive Medicine, 14(4), 1998, 245-258.
For a fascinating TED talk concerning childhood trauma and health:
If you are concerned that screening for trauma will have negative effects on your patients:
2. Edwards, V., Dube, S., Felitti, V., & Anda, R. (2007). It’s ok to ask about past abuse. The American Psychologist, 62(4), 327-8.