Showing papers by "Robert F. Anda published in 2007"

Adverse Childhood Events as Risk Factors for Negative Mental Health Outcomes

Abstract: 359 Adverse Childhood Events as Risk Factors for Negative Mental Health Outcomes The successful resolution of developmental tasks during childhood has long been recognized as crucial to adult mental health. Specifi cally, theorists such as Sigmund Freud, Erik Erikson, and Jean Piaget posited that the negotiation of stages of human development facilitates psychosocial and cognitive adaptation and is vital to the emergence of creativity throughout life.1 Conversely, much recent research attests to the deleterious consequences of adverse childhood events on functioning throughout the lifespan.2-4 This review examines the association between adverse childhood events (which include emotional, physical, and sexual abuse; neglect; childhood household dysfunction; and other forms of childhood trauma) and the emergence of psychiatric symptomatology across the lifespan. The strong interrelationship between these events and the need for communication among clinicians is also noted, because such communication appears essential for prompt intervention to prevent the sequelae commonly associated with these events. Specifi cally, the association between adverse childhood events and affective and anxiety disorders, personality disorders, and substance abuse are reviewed. Then, key fi ndings derived from the Adverse Childhood Experiences (ACE) Study — which strongly corroborate the need to examine multiple trau-

Adverse childhood experiences and smoking persistence in adults with smoking-related symptoms and illness.

Abstract: Objectives: Little is known about why people continue to smoke after learning that they have diseases and conditions that contraindicate smoking. Using data from the Adverse Childhood Experiences (ACE) Study, we examined the relation between ACEs and smoking behavior when smoking-related illnesses or conditions are present, both with and without depression as a mediator. Methods: Participants were more than 17,000 adult HMO members who retrospectively reported on eight categories of ACEs (emotional, physical, and sexual abuse; witnessing interparental violence; parental divorce; and growing up with a substance-abusing, mentally ill, or incarcerated household member). The number of maltreatment categories was summed to form an ordinal variable called the ACE Score. We measured current smoking, conditions that contraindicate smoking (heart disease, chronic lung disease, and diabetes), and symptoms of these illnesses (chronic bronchitis, chronic cough, and shortness of breath). Logistic regression models compared the ACE Score of smokers with smokingrelated illnesses to participants who reported these illnesses but were not current smokers (n = 7483). Results: Significant dose—response relations between the ACE Score and smoking persistence were found (odds ratio = 1.69; confidence interval = 1.34‐2.13 for participants with ≥4 ACEs). Depression was a significant independent predictor of smoking persistence as well as a mediator. Depression only slightly attenuated the relation between the ACE Score and persistent smoking, however. Conclusion: Medical practitioners should consider the maltreatment history and depression status of their patients when a smoking-related diagnosis fails to elicit smoking cessation. Programs should be developed that better address the underlying motivations for continuing to smoke in the face of health problems that contraindicate smoking.

It's ok to ask about past abuse.

Abstract: Comments on the article by K. Becker-Blease and J. Freyd, which addressed the ethics of asking and not asking research subjects about abuse. In their article, they systematically reviewed often-voiced concerns about and objections to asking questions about child maltreatment in survey research. They concluded that by failing to ask about a history of child maltreatment, an important predictor of later-life problems may be overlooked. The current authors discuss the Adverse Childhood Experiences (ACE) study, which provides strong evidence of the association between early traumatic experiences and some of the major public health problems facing our nation. Results from the ACE study have shown an association between traumatic childhood experiences and a broad range of health outcomes, including liver disease, ischemic heart disease, reproductive health, and mental illness, as well as a variety of health risks such as obesity, smoking, and alcoholism. The associations that these studies showed demonstrate that researchers studying health outcomes who do not ask study subjects about traumatic childhood experiences are overlooking an important risk factor for many of the major health issues of our day. Language: en

Root causes and organic budgeting: funding health from conception to the grave

Abstract: Place: ‘Developed’ country. Time: Present day. Event: A sperm penetrates an egg. Months later, a child born at term, without identifiable genetic defects, normal birth weight, APGAR 10, and all organ systems exquisitely formed. Fantastic! Supposition 1: For a child like this, social determinants of health [101] are the major forces that affect your public-health goal of ‘wellness in every stage of life’ [102]. Supposition 2: You have sole power over the economic resources of your nation. Challenge: As holder of this economic power, your challenge is to choose the major predictor of this newborn child’s future social and cognitive development, health and wellbeing, adolescent and adult behavior, physical and mental health, adult functioning, risk for a variety of diseases, and cause of death. To determine where to place the money that will shape public-health policy and services that meets all of these needs, you must place a bet on the ‘root’ origins of health and wellbeing for children. Your choices: We live in a world of categorical thinking and categorical funding, so you only get one choice for your bet. Would you choose access to healthcare [1]? School achievement [103]? Racial disparities in health [2]? Socioeconomic status [3]? Poverty [104]? Now, consider the life stages in reverse order, since a ranking of health expenditures – from highest to lowest – would be ranked similarly. Start with the last stage of life: dying. In 1993, McGinnis and Foege quantified the contribution of adverse health behaviors (e.g., smoking, alcohol use and physical inactivity) to the leading causes of death, which they termed the ‘actual’ causes of death, in the

Ergebnisse der Adverse Childhood Experiences (ACE) – Studie zu Kindheitstrauma und Gewalt

Abstract: Die Adverse Childhood Experiences (ACE) Studie ist eine gros angelegte epidemiologische Studie zu den Determinanten von Gesundheit und Wohlbefinden, in der uber 17 000 Erwachsene der amerikanischen Mittelschicht untersucht wurden. In dieser noch nicht abgeschlossenen retrospektiven und prospektiven Studie fanden wir aus epidemiologischer Sicht vielfaltige Belege fur eine Reihe zentraler psychoanalytischer Annahmen. In der ACE-Studie werden zehn haufige Kategorien traumatischer oder gewalttatiger Kindheitserfahrungen mit dem aktuellen Gesundheitszustand der mittlerweile Erwachsenen etwa ein halbes Jahrhundert spater in Beziehung gesetzt. Diese zehn Kategorien erwiesen sich als unerwartet haufig, obwohl sie aufgrund von Zeit, Scham, Geheimhaltung und sozialen Tabus typischerweise verborgen und unerkannt blieben; aber auch 50 Jahre spater haben sie noch einen tief greifenden Einfluss, obwohl aus psychosozialen Erfahrungen inzwischen organische Krankheiten und psychische Storungen geworden sind. Es fanden sich enge Zusammenhange zwischen der Anzahl der Kategorien der belastenden Kindheitserfahrungen (dabei haben wir innerhalb der Kategorien weder Haufigkeit noch Schwere berucksichtigt, wodurch die Starke des Zusammenhanges eher unterschatzt wird) und spateren Gesundheitsrisiken, korperlichen Erkrankungen, psychischen Storungen und Indikatoren fur medizinische Inanspruchnahme. Die ACE-Studie hat eine Verbindung zwischen Traumatisierung in der Kindheit einerseits und Pathophysiologie und Psychopathologie im Erwachsenenalter andererseits gezeigt. Diese Ergebnisse sind von groser Wichtigkeit fur die tagliche Praxis in der Medizin und Psychiatrie, denn sie verweisen darauf, dass eine Dosis-Wirkungsbeziehung besteht zwischen dem, was in der Kindheit nicht gesehen wurde, und dem, was in der Erwachsenenmedizin und im Sozialverhalten haufig gesehen wird. Die tief greifenden Implikationen fur die medizinische Praxis eroffnen die Moglichkeit einer neuen Basis fur die arztliche Primarversorgung. Die Ergebnisse sind von Interesse fur Arzte mit einem breiten medizinischen Horizont, fur diejenigen, die sich fur die menschliche Entwicklung und gesellschaftliche Entwurfe interessieren, sowie naturlich auch fur Psychoanalytiker, Psychiater und Psychologen.