Many US Adults Had Tough Childhoods: CDC Report

From Medscape Medical News > Psychiatry

Megan Brooks

December 20, 2010 — More than half of US adults have a history of at least 1 adverse childhood experience (ACE), such as abuse (verbal, physical, or sexual) or family dysfunction (domestic violence, divorce, or a family member who is mentally ill, incarcerated, or abusing drugs).

That's according to a report from the Centers for Disease Control and Prevention (CDC) appearing in the December 17 issue of the Morbidity and Mortality Weekly Report.

The findings are based on data from the 2009 ACE module of the Behavioral Risk Factor Surveillance System (BRFSS), an ongoing state-based telephone health survey of US adults.

"State-based surveillance of ACEs can provide guidance for the allocation of maltreatment prevention strategies and trauma-related intervention services," the CDC notes.

Among 26,229 adults from 5 states (Arkansas, Louisiana, New Mexico, Tennessee, and Washington), roughly 59% reported 1 or more ACEs.

Approximately one-quarter (25.9%) of respondents reported experiencing verbal abuse as a child, 14.8% reported physical abuse, and 12.2% reported sexual abuse; 29.1% reported household substance abuse, whereas 7.2% reported an incarcerated family member.

For ACEs measuring family dysfunction, 26.6% reported separated or divorced parents; 19.4% reported that they had lived with someone who was depressed, mentally ill, or suicidal; and 16.3% reported witnessing domestic violence.

Men and women reported similar prevalence rates for each ACE, with the exception of sexual abuse (17.2% for women and 6.7% for men; P < .05), living with a mentally ill household member (22.0% for women and 16.7% for men; P < .05), and living with a substance-abusing family member (30.6% for women and 27.5% for men; P < .05).

Younger respondents more often reported living with an incarcerated and/or mentally ill household member (P < .05).

Non-Hispanic black respondents reported the lowest prevalence of each ACE category among all racial/ethnic groups (P < .05), with the exception of having had an incarcerated family member, parental separation or divorce, and witnessing domestic violence.

Hispanics reported a higher prevalence than non-Hispanic whites of physical abuse, witnessing domestic violence, and having an incarcerated family member (P < .05 for all).

Adults with less than a high school education compared with those with more than a high school education had a greater prevalence of physical abuse, an incarcerated family member, substance abuse, and separation or divorce (P < .05 for all). There was little variation among the 5 states.

The CDC notes that adverse events experienced in childhood have been linked to a range of problems in adulthood, including substance abuse, depression, cardiovascular disease, diabetes, cancer, and premature death.

For each ACE, a sharp decrease was observed in prevalence reported by adults 55 years and older. For example, the prevalence of reported physical abuse was 16.9% among adults aged 18 to 24 years compared with 9.6% among those 55 years and older. These findings, they say, suggest that “a higher number of ACEs were associated with premature mortality (up to 20 years of life lost).”

These survey data have several limitations, the CDC notes. Because BRFSS excludes persons in institutions and hospitals who might have experienced ACEs disproportionately, the data might underestimate the true prevalence of ACEs.

Furthermore, the 18-year to 35-year age group might be underrepresented given that the BRFSS also excludes persons who rely on cellular telephones as their only telephone service. The study only covered 5 states and so may not be generalizable to the entire US adult population, and the BRFSS response rates were low, which increases the risk for response bias, the researchers point out.

"More research," the CDC concludes, "is needed to disentangle the specific role each ACE plays in the development of health problems later in life. As it currently exists, the ACE total captures the cumulative risk associated with child maltreatment and family dysfunction but could be further refined to address issues of unequal severity."

MMWR Morb Mortal Wkly Rep. 2010;59:1609-1613.