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Separate and cumulative effects of adverse childhood experiences in predicting adult health and health care utilization
Abstract
Objectives Objectives of this population-based study were: (1) to examine the relative contribution of childhood abuse and other adverse childhood experiences to poor adult health and increased health care utilization and (2) to examine the cumulative effects of adverse childhood experiences on adult health and health care utilization.Methods Data from the Ontario Health Survey, a representative population sample (n=9,953) of respondents aged 15 years and older, were analyzed using logistic regression. Adverse childhood experiences examined were childhood physical and sexual abuse, parental marital conflict, poor parent-child relationship, low parental education and parental psychopathology.Results Most (72%) respondents reported at least one adverse childhood experience and a considerable proportion of respondents (37%) reported two or more of these experiences. In examining the bivariate models, childhood physical and sexual abuse had a stronger influence than other types of adverse childhood experiences. With the addition of other adverse childhood experiences in the model, the odds ratios for childhood abuse were attenuated but remained statistically significant for most health outcomes. This suggests that childhood abuse may have a unique adverse influence on the development of poor adult health. When an aggregate variable was created to explore the cumulative effects of adverse childhood experience, the odds were increased, with each additional experience, for reporting multiple health problems [odds ratio (OR): 1.22], poor self-rated health (OR: 1.18), pain (OR: 1.24), disability (OR: 1.24), general practitioner use (OR: 1.12), emergency room use (OR: 1.29) and health professional use (OR: 1.19).Conclusions This study suggests that childhood abuse and other adverse childhood experiences are overlapping risk factors for long-term adult health problems and that the accumulation of these adverse experiences increases the risk of poor adult health.Practice implications This study highlights the importance of the many adverse childhood experiences influencing long-term health. In practice, childhood abuse is often difficult to identify as families tend to keep it hidden and reported cases represent only a small percentage of the actual cases. Assessments and interventions which focus on improving socio-economic status, strengthening marital and parent-child relationships, and supporting parents with mental health issues are less threatening for families than assessing their experiences with abuse and neglect and are more likely to be effective in identifying and supporting at-risk families.
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“Moreover, there is some evidence that the effects of trauma are cumulative, thus youth who experience a greater number of traumatic events are more at risk for adverse outcomes and more complex symptoms through adulthood (Chartier, Walker, & Naimark, 2010; Cloitre et al., 2009; Hodges et al., 2013).”
From Effects of trauma-informed approaches in schools: A systematic review (2019) · cites this paper as Chartier et al., 2010
In the citing paper
“ACE literature has found that parental mental illness and subsequent parenting behaviours contribute to an increased risk of offspring developing a range of medical and psychological disorders (Anda et al. 2002;Chartier et al. 2010).”
From The effects of paternal depression on child and adolescent outcomes: A systematic review (2016) · cites this paper as Chartier et al. 2010
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“marital conflict can be considered an adverse childhood experience which may result in suboptimal development for offspring (Chartier et al. 2010).”
From The effects of paternal depression on child and adolescent outcomes: A systematic review (2016) · cites this paper as Chartier et al. 2010
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Cites
Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., Koss, M. P., & Marks, J. S. (1998) · American Journal of Preventive Medicine · doi:10.1016/s0749-3797(98)00017-8 · Cited by 18,943
From Neurons to Neighborhoods: The Science of Early Childhood Development
(2000) · doi:10.17226/9824 · Cited by 4,484
Anda, R. F., Felitti, V. J., Bremner, J. D., Walker, J. D., Whitfield, C., Perry, B. D., Dube, S. R., & Giles, W. H. (2006) · European archives of psychiatry and clinical neuroscience · doi:10.1007/s00406-005-0624-4 · Cited by 4,292
Self-citationBurden and consequences of child maltreatment in high-income countries
Gilbert, R., Widom, C. S., Browne, K., Fergusson, D., Webb, E., & Janson, S. (2009) · The Lancet · doi:10.1016/s0140-6736(08)61706-7 · Cited by 3,876
Validity of adult retrospective reports of adverse childhood experiences: review of the evidence
Hardt, J., & Rutter, M. (2004) · Journal of Child Psychology and Psychiatry · doi:10.1111/j.1469-7610.2004.00218.x · Cited by 2,827
From Neurons to Neighborhoods: The Science of Early Childhood Development
Carey, W. B. (2001) · Journal of Developmental & Behavioral Pediatrics · doi:10.1097/00004703-200104000-00011 · Cited by 2,678
Self-rated health: a predictor of mortality among the elderly.
Mossey, J. M., & Shapiro, E. (1982) · American Journal of Public Health · doi:10.2105/ajph.72.8.800 · Cited by 2,145
McEWEN, B. S., & SEEMAN, T. (1999) · Annals of the New York Academy of Sciences · doi:10.1111/j.1749-6632.1999.tb08103.x · Cited by 1,824
Kraemer, H. C., Stice, E., Kazdin, A., Offord, D., & Kupfer, D. (2001) · American Journal of Psychiatry · doi:10.1176/appi.ajp.158.6.848 · Cited by 1,712
The interrelatedness of multiple forms of childhood abuse, neglect, and household dysfunction
Dong, M., Anda, R. F., Felitti, V. J., Dube, S. R., Williamson, D. F., Thompson, T. J., Loo, C. M., & Giles, W. H. (2004) · Child Abuse & Neglect · doi:10.1016/j.chiabu.2004.01.008 · Cited by 1,679
Psychopathology and early experience: A reappraisal of retrospective reports.
Brewin, C. R., Andrews, B., & Gotlib, I. H. (1993) · Psychological Bulletin · doi:10.1037/0033-2909.113.1.82 · Cited by 1,495
Etiology of child maltreatment: A developmental€cological analysis.
Belsky, J. (1993) · Psychological Bulletin · doi:10.1037/0033-2909.114.3.413 · Cited by 1,323
Physical Violence in American Families, 1985
Gelles, R. J., & Straus, M. A. (1989) · ICPSR Data Holdings · doi:10.3886/icpsr09211 · Cited by 1,251
The APSAC Handbook on Child Maltreatment
Myers, J. E. B. (2001) · Medical Entomology and Zoology · Cited by 1,228
Physical Violence in American Families, 1985
Gelles, R. J., & Straus, M. A. (1989) · ICPSR Data Holdings · doi:10.3886/icpsr09211.v3 · Cited by 1,184
When more is not better: the role of cumulative risk in child behavior outcomes
Carmody, K. A., Egeland, B. R., van Dulmen, M. H. M., & Sroufe, L. A. (2004) · Journal of Child Psychology and Psychiatry · doi:10.1111/j.1469-7610.2004.00351.x · Cited by 1,144
Exposure to childhood sexual and physical abuse and adjustment in early adulthood
Fergusson, D. M., Boden, J. M., & Horwood, L. J. (2008) · Child Abuse & Neglect · doi:10.1016/j.chiabu.2006.12.018 · Cited by 910
Clinical Characteristics of Women With a History of Childhood Abuse: Unhealed Wounds
McCauley, J. (1997) · JAMA · doi:10.1001/jama.1997.03540410040028 · Cited by 904
Lansford, J. E., Dodge, K. A., Pettit, G. S., Bates, J. E., Crozier, J., & Kaplow, J. (2002) · Archives of Pediatrics & Adolescent Medicine · doi:10.1001/archpedi.156.8.824 · Cited by 838
Child abuse and neglect and the brain–a review
Glaser, D. (2000) · Journal of Child Psychology and Psychiatry · doi:10.1017/s0021963099004990 · Cited by 827
Accuracy of adult recollections of childhood victimization, Part 2: Childhood sexual abuse.
Widom, C. S., & Morris, S. (1997) · Psychological Assessment · doi:10.1037/1040-3590.9.1.34 · Cited by 785
Polyvictimization and trauma in a national longitudinal cohort
FINKELHOR, D., ORMROD, R. K., & TURNER, H. A. (2007) · Development and Psychopathology · doi:10.1017/s0954579407070083 · Cited by 704
Developmental systems and psychopathology
SAMEROFF, A. J. (2000) · Development and Psychopathology · doi:10.1017/s0954579400003035 · Cited by 670
Interventions to prevent child maltreatment and associated impairment
MacMillan, H. L., Wathen, C. N., Barlow, J., Fergusson, D. M., Leventhal, J. M., & Taussig, H. N. (2009) · The Lancet · doi:10.1016/s0140-6736(08)61708-0 · Cited by 654
Adult health status of women with histories of childhood abuse and neglect
Walker, E. A., Gelfand, A., Katon, W. J., Koss, M. P., Von Korff, M., Bernstein, D., & Russo, J. (1999) · The American Journal of Medicine · doi:10.1016/s0002-9343(99)00235-1 · Cited by 634
Programs for parents of infants and toddlers: recent evidence from randomized trials
Olds, D. L., Sadler, L., & Kitzman, H. (2007) · Journal of Child Psychology and Psychiatry · doi:10.1111/j.1469-7610.2006.01702.x · Cited by 548
Perry, B. D. (2002) · Brain and Mind · doi:10.1023/a:1016557824657 · Cited by 480
MacMillan, H. L. (1997) · JAMA · doi:10.1001/jama.1997.03550020063039 · Cited by 457
Costs of Health Care Use by Women HMO Members With a History of Childhood Abuse and Neglect
Walker, E. A., Unützer, J., Rutter, C. M., Gelfand, A. N., Saunders, K. W., VonKorff, M., Koss, M. P., & Katon, W. J. (1999) · Archives of General Psychiatry · doi:10.1001/archpsyc.56.7.609 · Cited by 457
The Conflict Tactics Scales and Its Critics: An Evaluation and New Data on Validity and Reliability
Straus, M. A. (2017) · Routledge eBooks · doi:10.4324/9781315126401-5 · Cited by 431
Relationship of chronic pelvic pain to psychiatric diagnoses and childhood sexual abuse
Walker, E., Katon, W. J., Harrop-Griffiths, J., Holm, L., Russo, J. E., & Hickok, L. R. (1988) · American Journal of Psychiatry · doi:10.1176/ajp.145.1.75 · Cited by 407
KAPLAN, S. J., PELCOVITZ, D., & LABRUNA, V. (1999) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1097/00004583-199910000-00009 · Cited by 402
Accuracy of adult recollections of childhood victimization: Part 1. Childhood physical abuse.
Widom, C. S., & Shepard, R. L. (1996) · Psychological Assessment · doi:10.1037/1040-3590.8.4.412 · Cited by 399
Aggression and Violence Throughout the Life Span
Peters, R. D., McMahon, R. J., & Quinsey, V. L. (1992) · Medical Entomology and Zoology · Cited by 377
Exposure to childhood sexual and physical abuse and subsequent educational achievement outcomes
Boden, J. M., Horwood, L. J., & Fergusson, D. M. (2007) · Child Abuse & Neglect · doi:10.1016/j.chiabu.2007.03.022 · Cited by 323
Child Sexual Abuse: Immediate and Long-Term Effects and Intervention
Green, A. H. (1993) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1097/00004583-199309000-00002 · Cited by 239
Canadian Incidence Study of Reported Child Abuse and Neglect -2008: Major Findings
Public Health Agency of Canada (2005) · PsycEXTRA Dataset · doi:10.1037/e614232012-001 · Cited by 223
Healthy Families America: Using Research to Enhance Practice
Daro, D. A., & Harding, K. (1999) · The Future of Children · doi:10.2307/1602726 · Cited by 212
Self rated health as a predictor of coronary heart disease in Copenhagen, Denmark.
Møller, L., Kristensen, T. S., & Hollnagel, H. (1996) · Journal of Epidemiology & Community Health · doi:10.1136/jech.50.4.423 · Cited by 211
Chartier, M., Walker, J. R., & Naimark, B. J. (2007) · American Journal of Epidemiology · doi:10.1093/aje/kwk113 · Cited by 209
Self-citationClinical characteristics of women with a history of childhood abuse: unhealed wounds
McCauley, J. (1997) · JAMA · doi:10.1001/jama.277.17.1362 · Cited by 199
Jonson‐Reid, M., Drake, B., Kim, J., Porterfield, S. L., & Han, L. (2004) · Child Maltreatment · doi:10.1177/1077559504269192 · Cited by 196
Stein, A., Malmberg, L. ‐., Sylva, K., Barnes, J., Leach, P., & the FCCC team (2008) · Child: Care, Health and Development · doi:10.1111/j.1365-2214.2008.00837.x · Cited by 195
Relationships between Different Types of Maltreatment during Childhood and Adjustment in Adulthood
Higgins, D. J., & McCabe, M. P. (2000) · Child Maltreatment · doi:10.1177/1077559500005003006 · Cited by 191
Healthy Families New York (HFNY) randomized trial: Effects on early child abuse and neglect
Dumont, K. A., Mitchell-Herzfeld, S. D., Greene, R., Lee, E., Lowenfels, A. A., Rodríguez, M., & Dorabawila, V. (2008) · Child Abuse & Neglect · doi:10.1016/j.chiabu.2007.07.007 · Cited by 191
A Life Course Approach to Chronic Disease Epidemiology
Olsen, J. (1998) · Epidemiology · doi:10.1097/00001648-199809000-00021 · Cited by 187
Importance of Early Neglect for Childhood Aggression
Kotch, J. B., Lewis, T., Hussey, J. M., English, D., Thompson, R., Litrownik, A. J., Runyan, D. K., Bangdiwala, S. I., Margolis, B., & Dubowitz, H. (2008) · Pediatrics · doi:10.1542/peds.2006-3622 · Cited by 183
Chronic pain and health care utilization in women with a history of childhood sexual abuse
Finestone, H. M., Stenn, P. G., Davies, F., Stalker, C., Fry, R., & Koumanis, J. (2000) · Child Abuse & Neglect · doi:10.1016/s0145-2134(00)00112-5 · Cited by 181
Chartier, M., Walker, J. R., & Naimark, B. J. (2009) · American Journal of Public Health · doi:10.2105/ajph.2007.122408 · Cited by 167
Self-citationGreen, P. E., Lee, E. S., Forthofer, R. N., & Lorimar, R. J. (1991) · Journal of Marketing Research · doi:10.2307/3172794 · Cited by 158
Children’s Exposure to Violence
Margolin, G. (2004) · Journal of Interpersonal Violence · doi:10.1177/0886260504268371 · Cited by 155
MacMillan, H. L. (1997) · JAMA · doi:10.1001/jama.278.2.131 · Cited by 134
Social pathways between childhood and adult health
Kuh, D. J., Power, C., Blane, D., & Bartley, M. (1997) · doi:10.1093/oso/9780192627827.003.0008 · Cited by 125
Newman, M. G., Clayton, L. T., Zuellig, A. R., Cashman, L., Arnow, B. A., Dea, R., & Taylor, C. B. (2000) · Psychological Medicine · doi:10.1017/s003329179900272x · Cited by 123
Flaherty, E. G., Jones, R., & Sege, R. D. (2004) · Child Abuse & Neglect · doi:10.1016/j.chiabu.2004.03.013 · Cited by 103
Walsh, K., Bridgstock, R., Farrell, A., Rassafiani, M., & Schweitzer, R. (2008) · Child Abuse & Neglect · doi:10.1016/j.chiabu.2008.03.002 · Cited by 102
Social Subordinance as a Marker of Hypercortisolism
Sapolsky, R. M. (1995) · Annals of the New York Academy of Sciences · doi:10.1111/j.1749-6632.1995.tb44715.x · Cited by 100
Integrating Neuroscience and Psychological Approaches in the Study of Early Experiences
Gunnar, M. R. (2003) · Annals of the New York Academy of Sciences · doi:10.1196/annals.1301.024 · Cited by 97
Mental Health Supplement to the Ontario Health Survey: Methodology
Boyle, M. H., Offord, D. R., Campbell, D., Catlin, G., Goering, P. N., Lin, E. H. B., & Racine, Y. A. (1996) · The Canadian Journal of Psychiatry · doi:10.1177/070674379604100903 · Cited by 95
Adult physical illness and childhood sexual abuse
Fry, R. P. W. (1993) · Journal of Psychosomatic Research · doi:10.1016/0022-3999(93)90075-q · Cited by 86
(1990) · Computers Environment and Urban Systems · doi:10.1016/0198-9715(90)90065-2 · Cited by 75
Adverse childhood experiences and health-related quality of life as an adult.
Edwards, V. J., Anda, R. F., Felitti, V. J., & Dube, S. R. (2004) · American Psychological Association eBooks · doi:10.1037/10674-005 · Cited by 75
Health consequences of abuse in the family: A clinical guide for evidence-based practice.
(2004) · American Psychological Association eBooks · doi:10.1037/10674-000 · Cited by 66
Ascertaining psychiatric diagnoses with the family history method in a substance abuse population
Kosten, T. A., Anton, S. F., & Rounsaville, B. J. (1992) · Journal of Psychiatric Research · doi:10.1016/0022-3956(92)90005-9 · Cited by 60
Sanders, M. R., Markie‐Dadds, C., Turner, K., & Ralph, A. (2004) · doi:10.1002/9780470753385.ch20 · Cited by 39
Evaluating nurses’ knowledge and skills in the detection of child abuse in the Emergency Department
Keane, C., & Chapman, R. (2008) · International Emergency Nursing · doi:10.1016/j.ienj.2007.11.006 · Cited by 25
Child maltreatment in the context of substance abuse.
Kelley, S. J. (2002) · Cited by 22
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Hughes, K., Bellis, M. A., Hardcastle, K. A., Sethi, D., Butchart, A., Mikton, C., Jones, L., & Dunne, M. P. (2017) · The Lancet Public Health · doi:10.1016/s2468-2667(17)30118-4 · Cited by 5,255
Supporting the Health Care Transition From Adolescence to Adulthood in the Medical Home
White, P. H., Cooley, W. C., & TRANSITIONS CLINICAL REPORT AUTHORING GROUP, A. A. O. P. (2018) · Pediatrics · doi:10.1542/peds.2018-2587 · Cited by 1,417
Adverse childhood experiences and associated health outcomes: A systematic review and meta-analysis
Petruccelli, K., Davis, J. J., & Berman, T. (2019) · Child Abuse & Neglect · doi:10.1016/j.chiabu.2019.104127 · Cited by 1,154
Carr, C. P., Martins, C. M. S., Stingel, A. M., Lemgruber, V. B., & Juruena, M. F. (2013) · Journal of Nervous & Mental Disease · doi:10.1097/nmd.0000000000000049 · Cited by 802
Associations Between Adverse Childhood Experiences, High-Risk Behaviors, and Morbidity in Adulthood
Campbell, J. A., Walker, R. J., & Egede, L. E. (2015) · American Journal of Preventive Medicine · doi:10.1016/j.amepre.2015.07.022 · Cited by 719
Metadata
- Authors
- Chartier, M. J., Walker, J. R., & Naimark, B.
- Affiliations
- University of Manitoba (CA)
- Corresponding author
- Chartier, Mariette J.
- Venue
- Child Abuse & Neglect
- Publisher
- Elsevier BV
- Published
- 2010-06
- Volume
- 34
- Issue
- 6
- Pages
- 454-464
- ISSN
- 0145-2134 (ISSN-L)
- OpenAlex
- W2109548593
- Cited by
- 519
- References
- 69
- Citations by year
- 2026: 16 · 2025: 17 · 2024: 36 · 2023: 37 · 2022: 46 · 2021: 54 · 2020: 45 · 2019: 60 · 2018: 33 · 2017: 32 · 2016: 38 · 2015: 36 · 2014: 26 · 2013: 24 · 2012: 9
- FWCI
- 14.37
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Child Abuse & Neglect (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Canadian Institutes of Health Research
- Topics
- Social Sciences › Psychology › Clinical Psychology › Child Abuse and Trauma
- Social Sciences › Health › Intimate Partner and Family Violence
- Social Sciences › Sociology and Political Science › Child Welfare and Adoption
- Keywords
- adverse childhood experiences, child physical abuse, child sexual abuse, cumulative effects, adult health, health care utilization, parental marital conflict, parent-child relationship, parental education, parental psychopathology, self-rated health, pain, disability, emergency department utilization, general practitioner use
- MeSH terms
- Adolescent, Adult, Aged, Aged, 80 and over, Child, Preschool, Female, Forecasting, Health Services, Health Status, Health Surveys, Humans, Male, Middle Aged, Ontario, Risk Factors, Logistic Models, Adult Survivors of Child Abuse, Family Conflict, Young Adult
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