Higher use of health care services throughout adult life linked with traumatic childhoods
- Individuals who suffered multiple types of ACEs (Adverse Childhood Experiences – physical, sexual or emotional abuse or other stresses such as living in a household with domestic violence or with adult substance abuse or mental illness) are more than twice as likely to use hospital emergency departments, require overnight hospital stays or be frequent users of general practices as adults.
- The study of 7,414 adults in England and Wales compared those who suffered ACEs with those whose childhoods were ACE free. Those with four or more ACEs showed substantially increased levels of health care use even as young adults (18-29 years) with these increases still apparent decades later.
- In young adults with no ACEs 12% needed to attend an emergency department in the last year, rising to 29% in those with four or more ACEs. By the age of 60-69 years 10% of individuals with no ACEs required at least one overnight hospital stay (in the last year) rising to 25% of those with four or more ACEs.
- High levels of ACEs are common. In this general population sample 10% of all adults had experienced four or more ACEs as a child meaning that childhood trauma may be a major contributor to pressures on adult health services.
Experiencing physical, sexual or emotional abuse as a child, or other stresses such as living in a household affected by domestic violence, substance abuse or mental illness, can lead to higher levels of health service use throughout adulthood.
A research paper in the Journal of Health Service Research & Policy provides, for the first time, the statistical evidence showing that, regardless of socio-economic class or other demographics, people who have adverse childhood experiences use more health and medical services through their lifetime.
The researchers conclude that investing in preventing or reducing adverse childhood experiences as well as addressing the resulting trauma in those who have experienced ACEs, can help reduce future health service demand and costs.
Mark Bellis, Professor of Public Health at Bangor University's College of Health & Behavioural Sciences said:
"Even at the most basic biological levels, experiencing ACEs can change children leaving them more likely to develop poor physical and mental health throughout their lives. A safe and nurturing childhood is a recipe for building stronger, happier children, with a much greater chance of becoming healthy adults."
"Our results demonstrate that the more adverse experiences people suffer as a child the more likely they are as adults to be frequent users of basic health services such as GPs and emergency services as well as requiring more specialist overnight hospital support. As costs of health care escalate in the UK and abroad, it is essential we take a life course approach to health that recognises the problems we frequently see in adults begin with childhood traumas."
Commenting on the study, Professor John Middleton, President of the UK of Faculty of Public Health said:
"The vast majority of parents want to set their children on healthy life courses and there is a great deal that health and other public services can do to help, especially in the poorest communities. Investing in quality childhoods can break cycles of adversity that have affected families for generations. However, cutting corners with support for families and children will mean we continue to pay in poor adult health and increased pressures on health services for generations to come."
Professor Karen Hughes, a co-author of the paper added:
"Adult risks of becoming smokers or heavy drinkers and of developing cancers, diabetes and other life threatening diseases are all increased in those with a history of childhood adversity. This study shows how the health consequences of ACEs impact not just on the individual but also on the health services that support them. Health professionals already play a substantive role in treating the life long impacts of childhood adversity but recognising the role ACEs play in adult ill health should provide opportunities for better treatment and a greater focus on prevention."
Prof Mark Bellis, Honorary Professor in Public Health, Bangor University. E mail [email protected] +44 1248 388275
- The Impact of adverse childhood experiences on health service use across the life course using a retrospective cohort study is published in the Journal of Health Service Research & Policy.
- Data was collected from residents in England (n=5412) and Wales (n=2002) though interviews at individuals' places of residence.
- Three indicators of healthcare use were measured in all respondents; frequent GP visits (>=6 per year) in last 12 months; use of an Emergency Department in the last 12 months and an overnight stay in hospital in the last 12 months.
- All data are corrected for demographics and deprivation.
The full article can be read here: http://journals.sagepub.com/doi/full/10.1177/1355819617706720
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