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Adverse childhood experiences screening key for risk profiles

The pronounced effect adverse childhood experiences have on adult health and well-being indicates a need for better screening and risk profiling.

Sara Heath
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Published: 17 Sep 2024

A new report from UCLA Health sheds light on adverse childhood experiences and how they impact individuals based on different characteristics, such as gender, prompting calls for better screening.

The study, published in Brain, Behavior, and Immunity, showed that individuals who carry significant stress from ACEs are more likely to experience a litany of health impacts later in life, and those differences vary between biological sex.

According to George Slavich, Ph.D., the director of the Laboratory for Stress Assessment and Research at UCLA, these findings indicate a need to better screen and assess people for ACEs and certain biological factors.

"Most people who have experienced significant stress or early-life trauma never get assessed," Slavich said in a press release. "These findings highlight the critical importance of screening for stress in clinical settings. They also move us beyond a one-size-fits-all approach and toward a precision medicine approach based on patients' sex and specific stress profile."

Adverse childhood experiences (ACES) are "potentially traumatic events that occur in childhood," or ages zero to 17 years, according to the CDC. Examples of ACEs can include the following:

  • Experiences of abuse or neglect.
  • Witnesses of violence in the home or community.
  • Having a family member attempt or die by suicide.
  • Experiences of poor safety or environmental stability.

For this report, the researchers asked participants to report on a subset of different ACEs, including financial distress, abuse, neglect, how often they moved, whether they lived away from their biological parents and whether they had been on welfare. This allowed researchers to group participants based on experiences with ACEs and the severity of experiences.

For female participants, researchers identified low, moderate and high stress groups, and for males, they identified low and high stress groups.

Participants also provided biological samples that allowed the researchers to assess them based on 25 disease biomarkers. From there, researchers tested whether the different ACEs were linked with those disease biomarkers or with a diagnosis of one of 20 major health conditions.

Perhaps not surprisingly, high stress and severe ACEs were linked with more major health issues, while those with low or no stress had fewer major health issues. For example, males and females in the high-stress groups had the highest risk for poor metabolic health, as well as the greatest inflammation.

But notably, there were also differences between males and females.

For example, the impact ACEs had on metabolic biomarkers was greater for females than it was for males. Conversely, males with experiences of emotional abuse and neglect had a greater risk for blood disorders, mental and behavioral health issues and thyroid issues.

These findings, especially the more granular ones related to individual disease states and biological sex, are important for healthcare providers moving forward, Slavich said. Healthcare professionals should screen for ACEs as part of taking a patient's risk profile, he indicated.

"Stress is implicated in nine of the 10 leading causes of death in the United States today," Slavich said. "It's about time we take that statistic seriously and begin screening for stress in all pediatric and adult clinics nationwide."

Evidence about ACEs continues to build

This is not the first study assessing the role ACEs play in long-term health and well-being.

In August 2022, the National Institutes of Health and Eunice Kennedy Shriver National Institute of Child Health and Human Development issued a report showing that living in poverty, separation from a parent and parental harshness or neglect are leading ACEs that can lead to premature death in adulthood.

The study of nearly 46,000 people found that living in poverty is linked to a 41% increased risk for premature death in adulthood. For every ACE an individual experience, that risk for premature death compounds.

The good news is, scientists and healthcare experts are finally able to assess the data to better understand ACEs and, ideally, improve clinical practice around that knowledge.

Studying ACEs can be a long game because it often requires researchers to follow study participants from childhood well into adulthood. As more study into ACEs concludes, researchers are getting a better look into not only the prevalence and impact of ACEs, but what healthcare providers can do to address these issues.

For example, a December 2022 JAMA Network Open study illustrated the benefit of screening for ACEs in pediatric care settings. Kaiser Permanente researchers found that screening for ACEs improved receipt of behavioral health services from 4.33% to 32.48%. Ideally, those behavioral health services will be able to mitigate some of the negative consequences of those ACEs into adulthood.

Sara Heath has covered news related to patient engagement and health equity since 2015.

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