Adverse Childhood Experiences in Alberta, Canada: a population based study
Main Article Content
Abstract
Objective: Adverse childhood experiences (ACEs) are associated with poor health outcomes in adulthood. We developed a four category ACE risk profile variable using a domain-specific approach and examined ACEs as risk factors for diagnosed physical and mental health conditions.
Method: A computer-assisted telephone survey was conducted with a random sample of adults in Alberta, Canada. Eight questions were asked on adversity during childhood, based on the original ACE survey and modified to reflect the Canadian context and research methodology. Descriptive and multivariable analyses were conducted.
Results: Among the 1207 respondents, the majority were married or living common-law (65.8%), had completed post-secondary education (78.2%), and were Caucasian (86.2%) with a mean age of 52.4 years (SD=16.3). Approximately one-third (27.3%) experienced at least one type of abuse, and almost half (49.5%) experienced at least one form of household dysfunction. ACEs were highly interrelated. Sixty-three percent fell into the low risk profile category, with the remaining 37% divided among the three higher risk profile categories. Overall, the ACE risk profile variable was significantly associated with diagnosed mental health condition/addiction and chronic pain, controlling for sociodemographic characteristics.
Conclusion: The ACE risk profile category of adversity in both the abuse domain and the household dysfunction domain conferred the greatest risk for poor health outcomes in adulthood. Given the interrelated nature of ACEs, a more comprehensive approach to conceptualization of ACEs is warranted. Results have implications for prevention of ACEs and recovery from ACEs to decrease disease burden. Strategies may include effective programs to prevent exposure to toxic stress and support nurturing and stable relationships for children and families.
Article Details
How to Cite
MCDONALD, Sheila et al.
Adverse Childhood Experiences in Alberta, Canada: a population based study.
Medical Research Archives, [S.l.], n. 3, june 2015.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/142>. Date accessed: 16 dec. 2024.
Keywords
Adverse Childhood Experiences; Population-based Survey; Canada; Chronic Pain; Mental Health Condition
Issue
Section
Research Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
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Chapman, D. P., Whitfield, C. L., Felitti, V. J., Dube, S. R.,
Edwards, V. J., & Anda, R. F. (2004). Adverse childhood experiences and the risk of depressive disorders in adulthood. J Affect Disord., 82(2), 217-225.
Chartier, M. J., Walker, J. R., & Naimark, B. (2010). Separate and cumulative effects of adverse childhood experiences in predicting adult health and health care utilization. Child Abuse Negl., 34(6), 454-464. doi: 410.1016/j.chiabu.2009.1009.1020. Epub 2010 Apr 1020.
Danese, A., & McEwen, B. S. (2012). Adverse childhood experiences, allostasis, allostatic load, and age-related disease. Physiol Behav., 106(1), 29-39. doi: 10.1016/j.physbeh.2011.1008.1019. Epub 2011 Aug 1025.
Della Femina, D., Yeager, C. A., & Lewis, D. O. (1990). Child abuse: adolescent records vs. adult recall. Child Abuse Negl, 14(2), 227-231.
Dong, M., Anda, R. F., Felitti, V. J., Dube, S. R., Williamson, D. F., Thompson, T. J., . . . Giles, W. H. (2004). The interrelatedness of multiple forms of childhood abuse, neglect, and household dysfunction. Child Abuse Negl., 28(7), 771-784.
Douglas, K. R., Chan, G., Gelernter, J., Arias, A. J., Anton, R. F., Weiss, R. D., . . . Kranzler, H. R. (2010). Adverse childhood events as risk factors for substance dependence: partial mediation by mood and anxiety disorders. Addict Behav., 35(1), 7-13. doi: 10.1016/j.addbeh.2009.1007.1004. Epub 2009 Aug 1018.
Dube, S. R., Felitti, V. J., Dong, M., Chapman, D. P., Giles, W. H., & Anda, R. F. (2003). Childhood abuse, neglect, and household dysfunction and the risk of illicit drug use: the adverse childhood experiences study. Pediatrics., 111(3), 564-572.
Dube, S. R., Williamson, D. F., Thompson, T., Felitti, V. J., & Anda, R. F. (2004). Assessing the reliability of retrospective reports of adverse childhood experiences among adult HMO members attending a primary care clinic. Child Abuse Negl, 28(7), 729-737. doi: 10.1016/j.chiabu.2003.08.009
Edwards, V. J., Anda, R. F., Nordenberg, D. F., Felitti, V. J., Williamson, D. F., & Wright, J. A. (2001). Bias assessment for child abuse survey: factors affecting probability of response to a survey about childhood abuse. Child Abuse Negl, 25(2), 307-312.
Edwards, V. J., Holden, G. W., Felitti, V. J., & Anda, R. F. (2003). Relationship between multiple forms of childhood maltreatment and adult mental health in community respondents: results from the adverse childhood experiences study. Am J Psychiatry., 160(8), 1453-1460.
Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., . . . Marks, J. S. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The Adverse Childhood Experiences (ACE) Study. Am J Prev Med., 14(4), 245-258.
Garner, A. S., & Shonkoff, J. P. (2012). Early childhood adversity, toxic stress, and the role of the pediatrician: translating developmental science into lifelong health. Pediatrics., 129(1), e224-231. doi: 210.1542/peds.2011-2662. Epub 2011 Dec 1526.
Hackman, D. A., Farah, M. J., & Meaney, M. J. (2010). Socioeconomic status and the brain: mechanistic insights from human and animal research. Nat Rev Neurosci., 11(9), 651-659. doi: 610.1038/nrn2897.
Hillis, S. D., Anda, R. F., Dube, S. R., Felitti, V. J., Marchbanks, P. A., & Marks, J. S. (2004). The association between adverse childhood experiences and adolescent pregnancy, long-term psychosocial consequences, and fetal death. Pediatrics., 113(2), 320-327.
Holt, S., Buckley, H., & Whelan, S. (2008). The impact of exposure to domestic violence on children and young people: a review of the literature. Child Abuse Negl., 32(8), 797-810. doi: 710.1016/j.chiabu.2008.1002.1004. Epub 2008 Aug 1026.
Kessler, R. C., McLaughlin, K. A., Green, J. G., Gruber, M. J., Sampson, N. A., Zaslavsky, A. M., . . . Williams, D. R. (2010). Childhood adversities and adult psychopathology in the WHO World Mental Health Surveys. Br J Psychiatry., 197(5), 378-385. doi: 310.1192/bjp.bp.1110.080499.
Kingston, D., McDonald, S., Tough, S., Austin, M. P., Hegadoren, K., & Lasiuk, G. (2014). Public views of acceptability of perinatal mental health screening and treatment preference: a population based survey. BMC Pregnancy Childbirth., 14:67.(doi), 10.1186/1471-2393-1114-1167.
Langlois, K. A., & Garner, R. (2013). Trajectories of psychological distress among Canadian adults who experienced parental addiction in childhood. Health Rep., 24(3), 14-21.
Lanza, S. T., Rhoades, B. L., Greenberg, M. T., & Cox, M. (2011). Modeling multiple risks during infancy to predict quality of the caregiving environment: contributions of a person-centered approach. Infant Behav Dev., 34(3), 390-406. doi: 310.1016/j.infbeh.2011.1002.1002. Epub 2011 Apr 1017.
Lanza, S. T., Rhoades, B. L., Nix, R. L., & Greenberg, M. T. (2010). Modeling the interplay of multilevel risk factors for future academic and behavior problems: a person-centered approach. Dev Psychopathol., 22(2), 313-335. doi: 310.1017/S0954579410000088.
Liu, C. H., & Tronick, E. (2013). Re-conceptualising prenatal life stressors in predicting post-partum depression: cumulative-, specific-, and domain-specific approaches to calculating risk. Paediatr Perinat Epidemiol., 27(5), 481-490. doi: 410.1111/ppe.12072.
Marchand, F., Perretti, M., & McMahon, S. B. (2005). Role of the immune system in chronic pain. Nat Rev Neurosci., 6(7), 521-532.
McCrory, E., De Brito, S. A., & Viding, E. (2010). Research review: the neurobiology and genetics of maltreatment and adversity. J Child Psychol Psychiatry., 51(10), 1079-1095. doi: 1010.1111/j.1469-7610.2010.02271.x.
McEwen, B. S. (2012). Brain on stress: how the social environment gets under the skin. Proc Natl Acad Sci U S A., 109(Suppl 2), 17180-17185. doi: 17110.11073/pnas.1121254109. Epub 1121252012 Oct 1121254108.
Monk, C., Spicer, J., & Champagne, F. A. (2012). Linking prenatal maternal adversity to developmental outcomes in infants: the role of epigenetic pathways. Dev Psychopathol., 24(4), 1361-1376. doi: 1310.1017/S0954579412000764.
Oliver, B. R., Kretschmer, T., & Maughan, B. (2014). Configurations of early risk and their association with academic, cognitive, emotional and behavioural outcomes in middle childhood. Soc Psychiatry Psychiatr Epidemiol., 49(5), 723-732. doi: 710.1007/s00127-00013-00756-00121. Epub 02013 Aug 00123.
Patten, S. B., Beck, C. A., Kassam, A., Williams, J. V., Barbui, C., & Metz, L. M. (2005). Long-term medical conditions and major depression: strength of association for specific conditions in the general population. Can J Psychiatry., 50(4), 195-202.
Patten, S. B., Wilkes, T. C., Williams, J. V., Lavorato, D. H., El-Guebaly, N., Schopflocher, D., . . . Bulloch, A. G. (2014). Retrospective and prospectively assessed childhood adversity in association with major depression, alcohol consumption and painful conditions. Epidemiol Psychiatr Sci, 31, 1-8.
Population Research Laboratory. (2013). Alberta Survey Methodology Report: Department of Sociology, University of Alberta.
Raphael, K. G., Chandler, H. K., & Ciccone, D. S. (2004). Is childhood abuse a risk factor for chronic pain in adulthood? Curr Pain Headache Rep., 8(2), 99-110.
Reiser, S. J., McMillan, K. A., Wright, K. D., & Asmundson,
G. J. (2014). Adverse childhood experiences and health anxiety in adulthood. Child Abuse Negl., 38(3), 407-413. doi: 410.1016/j.chiabu.2013.1008.1007. Epub 2013 Sep 1016.
Shonkoff, J. P., Boyce, W. T., & McEwen, B. S. (2009). Neuroscience, molecular biology, and the childhood roots of health disparities: building a new framework for health promotion and disease prevention. JAMA., 301(21), 2252-2259. doi: 2210.1001/jama.2009.2754.
Slavich, G. M., & Irwin, M. R. (2014). From stress to inflammation and major depressive disorder: a social signal transduction theory of depression. Psychol Bull., 140(3), 774-815. doi: 710.1037/a0035302. Epub 0032014 Jan 0035313.
Springer, K. W., Sheridan, J., Kuo, D., & Carnes, M. (2007). Long-term physical and mental health consequences of childhood physical abuse: results from a large population-based sample of men and women. Child Abuse Negl., 31(5), 517-530.
Statistics Canada. (2012) Census Profile (2011 Census). Ottawa, ON: Statistics Canada.
Williams, L. M. (1995). Recovered memories of abuse in women with documented child sexual victimization histories. J Trauma Stress., 8(4), 649-673.
Wolfe, D. A., Crooks, C. V., Lee, V., McIntyre-Smith, A., & Jaffe, P. G. (2003). The effects of children's exposure to domestic violence: a meta-analysis and critique. Clin Child Fam Psychol Rev., 6(3), 171-187.
Wu, L. J., Toyoda, H., Zhao, M. G., Lee, Y. S., Tang, J., Ko, S. W., . . . Zhuo, M. (2005). Upregulation of forebrain NMDA NR2B receptors contributes to behavioral sensitization after inflammation. J Neurosci., 25(48), 11107-11116.
Anda, R. F., Felitti, V. J., Bremner, J. D., Walker, J. D., Whitfield, C., Perry, B. D., . . . Giles, W. H. (2006). The enduring effects of abuse and related adverse experiences in childhood. A convergence of evidence from neurobiology and epidemiology. Eur Arch Psychiatry Clin Neurosci., 256(3), 174-186. Epub 2005 Nov 2029.
Chapman, D. P., Whitfield, C. L., Felitti, V. J., Dube, S. R.,
Edwards, V. J., & Anda, R. F. (2004). Adverse childhood experiences and the risk of depressive disorders in adulthood. J Affect Disord., 82(2), 217-225.
Chartier, M. J., Walker, J. R., & Naimark, B. (2010). Separate and cumulative effects of adverse childhood experiences in predicting adult health and health care utilization. Child Abuse Negl., 34(6), 454-464. doi: 410.1016/j.chiabu.2009.1009.1020. Epub 2010 Apr 1020.
Danese, A., & McEwen, B. S. (2012). Adverse childhood experiences, allostasis, allostatic load, and age-related disease. Physiol Behav., 106(1), 29-39. doi: 10.1016/j.physbeh.2011.1008.1019. Epub 2011 Aug 1025.
Della Femina, D., Yeager, C. A., & Lewis, D. O. (1990). Child abuse: adolescent records vs. adult recall. Child Abuse Negl, 14(2), 227-231.
Dong, M., Anda, R. F., Felitti, V. J., Dube, S. R., Williamson, D. F., Thompson, T. J., . . . Giles, W. H. (2004). The interrelatedness of multiple forms of childhood abuse, neglect, and household dysfunction. Child Abuse Negl., 28(7), 771-784.
Douglas, K. R., Chan, G., Gelernter, J., Arias, A. J., Anton, R. F., Weiss, R. D., . . . Kranzler, H. R. (2010). Adverse childhood events as risk factors for substance dependence: partial mediation by mood and anxiety disorders. Addict Behav., 35(1), 7-13. doi: 10.1016/j.addbeh.2009.1007.1004. Epub 2009 Aug 1018.
Dube, S. R., Felitti, V. J., Dong, M., Chapman, D. P., Giles, W. H., & Anda, R. F. (2003). Childhood abuse, neglect, and household dysfunction and the risk of illicit drug use: the adverse childhood experiences study. Pediatrics., 111(3), 564-572.
Dube, S. R., Williamson, D. F., Thompson, T., Felitti, V. J., & Anda, R. F. (2004). Assessing the reliability of retrospective reports of adverse childhood experiences among adult HMO members attending a primary care clinic. Child Abuse Negl, 28(7), 729-737. doi: 10.1016/j.chiabu.2003.08.009
Edwards, V. J., Anda, R. F., Nordenberg, D. F., Felitti, V. J., Williamson, D. F., & Wright, J. A. (2001). Bias assessment for child abuse survey: factors affecting probability of response to a survey about childhood abuse. Child Abuse Negl, 25(2), 307-312.
Edwards, V. J., Holden, G. W., Felitti, V. J., & Anda, R. F. (2003). Relationship between multiple forms of childhood maltreatment and adult mental health in community respondents: results from the adverse childhood experiences study. Am J Psychiatry., 160(8), 1453-1460.
Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., . . . Marks, J. S. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The Adverse Childhood Experiences (ACE) Study. Am J Prev Med., 14(4), 245-258.
Garner, A. S., & Shonkoff, J. P. (2012). Early childhood adversity, toxic stress, and the role of the pediatrician: translating developmental science into lifelong health. Pediatrics., 129(1), e224-231. doi: 210.1542/peds.2011-2662. Epub 2011 Dec 1526.
Hackman, D. A., Farah, M. J., & Meaney, M. J. (2010). Socioeconomic status and the brain: mechanistic insights from human and animal research. Nat Rev Neurosci., 11(9), 651-659. doi: 610.1038/nrn2897.
Hillis, S. D., Anda, R. F., Dube, S. R., Felitti, V. J., Marchbanks, P. A., & Marks, J. S. (2004). The association between adverse childhood experiences and adolescent pregnancy, long-term psychosocial consequences, and fetal death. Pediatrics., 113(2), 320-327.
Holt, S., Buckley, H., & Whelan, S. (2008). The impact of exposure to domestic violence on children and young people: a review of the literature. Child Abuse Negl., 32(8), 797-810. doi: 710.1016/j.chiabu.2008.1002.1004. Epub 2008 Aug 1026.
Kessler, R. C., McLaughlin, K. A., Green, J. G., Gruber, M. J., Sampson, N. A., Zaslavsky, A. M., . . . Williams, D. R. (2010). Childhood adversities and adult psychopathology in the WHO World Mental Health Surveys. Br J Psychiatry., 197(5), 378-385. doi: 310.1192/bjp.bp.1110.080499.
Kingston, D., McDonald, S., Tough, S., Austin, M. P., Hegadoren, K., & Lasiuk, G. (2014). Public views of acceptability of perinatal mental health screening and treatment preference: a population based survey. BMC Pregnancy Childbirth., 14:67.(doi), 10.1186/1471-2393-1114-1167.
Langlois, K. A., & Garner, R. (2013). Trajectories of psychological distress among Canadian adults who experienced parental addiction in childhood. Health Rep., 24(3), 14-21.
Lanza, S. T., Rhoades, B. L., Greenberg, M. T., & Cox, M. (2011). Modeling multiple risks during infancy to predict quality of the caregiving environment: contributions of a person-centered approach. Infant Behav Dev., 34(3), 390-406. doi: 310.1016/j.infbeh.2011.1002.1002. Epub 2011 Apr 1017.
Lanza, S. T., Rhoades, B. L., Nix, R. L., & Greenberg, M. T. (2010). Modeling the interplay of multilevel risk factors for future academic and behavior problems: a person-centered approach. Dev Psychopathol., 22(2), 313-335. doi: 310.1017/S0954579410000088.
Liu, C. H., & Tronick, E. (2013). Re-conceptualising prenatal life stressors in predicting post-partum depression: cumulative-, specific-, and domain-specific approaches to calculating risk. Paediatr Perinat Epidemiol., 27(5), 481-490. doi: 410.1111/ppe.12072.
Marchand, F., Perretti, M., & McMahon, S. B. (2005). Role of the immune system in chronic pain. Nat Rev Neurosci., 6(7), 521-532.
McCrory, E., De Brito, S. A., & Viding, E. (2010). Research review: the neurobiology and genetics of maltreatment and adversity. J Child Psychol Psychiatry., 51(10), 1079-1095. doi: 1010.1111/j.1469-7610.2010.02271.x.
McEwen, B. S. (2012). Brain on stress: how the social environment gets under the skin. Proc Natl Acad Sci U S A., 109(Suppl 2), 17180-17185. doi: 17110.11073/pnas.1121254109. Epub 1121252012 Oct 1121254108.
Monk, C., Spicer, J., & Champagne, F. A. (2012). Linking prenatal maternal adversity to developmental outcomes in infants: the role of epigenetic pathways. Dev Psychopathol., 24(4), 1361-1376. doi: 1310.1017/S0954579412000764.
Oliver, B. R., Kretschmer, T., & Maughan, B. (2014). Configurations of early risk and their association with academic, cognitive, emotional and behavioural outcomes in middle childhood. Soc Psychiatry Psychiatr Epidemiol., 49(5), 723-732. doi: 710.1007/s00127-00013-00756-00121. Epub 02013 Aug 00123.
Patten, S. B., Beck, C. A., Kassam, A., Williams, J. V., Barbui, C., & Metz, L. M. (2005). Long-term medical conditions and major depression: strength of association for specific conditions in the general population. Can J Psychiatry., 50(4), 195-202.
Patten, S. B., Wilkes, T. C., Williams, J. V., Lavorato, D. H., El-Guebaly, N., Schopflocher, D., . . . Bulloch, A. G. (2014). Retrospective and prospectively assessed childhood adversity in association with major depression, alcohol consumption and painful conditions. Epidemiol Psychiatr Sci, 31, 1-8.
Population Research Laboratory. (2013). Alberta Survey Methodology Report: Department of Sociology, University of Alberta.
Raphael, K. G., Chandler, H. K., & Ciccone, D. S. (2004). Is childhood abuse a risk factor for chronic pain in adulthood? Curr Pain Headache Rep., 8(2), 99-110.
Reiser, S. J., McMillan, K. A., Wright, K. D., & Asmundson,
G. J. (2014). Adverse childhood experiences and health anxiety in adulthood. Child Abuse Negl., 38(3), 407-413. doi: 410.1016/j.chiabu.2013.1008.1007. Epub 2013 Sep 1016.
Shonkoff, J. P., Boyce, W. T., & McEwen, B. S. (2009). Neuroscience, molecular biology, and the childhood roots of health disparities: building a new framework for health promotion and disease prevention. JAMA., 301(21), 2252-2259. doi: 2210.1001/jama.2009.2754.
Slavich, G. M., & Irwin, M. R. (2014). From stress to inflammation and major depressive disorder: a social signal transduction theory of depression. Psychol Bull., 140(3), 774-815. doi: 710.1037/a0035302. Epub 0032014 Jan 0035313.
Springer, K. W., Sheridan, J., Kuo, D., & Carnes, M. (2007). Long-term physical and mental health consequences of childhood physical abuse: results from a large population-based sample of men and women. Child Abuse Negl., 31(5), 517-530.
Statistics Canada. (2012) Census Profile (2011 Census). Ottawa, ON: Statistics Canada.
Williams, L. M. (1995). Recovered memories of abuse in women with documented child sexual victimization histories. J Trauma Stress., 8(4), 649-673.
Wolfe, D. A., Crooks, C. V., Lee, V., McIntyre-Smith, A., & Jaffe, P. G. (2003). The effects of children's exposure to domestic violence: a meta-analysis and critique. Clin Child Fam Psychol Rev., 6(3), 171-187.
Wu, L. J., Toyoda, H., Zhao, M. G., Lee, Y. S., Tang, J., Ko, S. W., . . . Zhuo, M. (2005). Upregulation of forebrain NMDA NR2B receptors contributes to behavioral sensitization after inflammation. J Neurosci., 25(48), 11107-11116.