1. Childhood adversity and frequent medical consultations
M Fiddler; J Jackson; N Kapur; A Wells; F Creed
We assessed possible psychological mediators of the relationship between childhood adversity
and frequent medical consultations among new outpatients at neurology, cardiology, and
gastroenterology clinics. We assessed whether these differed in patients with and without
organic disease that explained their symptoms. At first clinic visit we recorded Hospital Anxiety
and Depression scale (HADS—anxiety and depression subscale scores), Illness Perception
Questionnaire (IPQ—four subscales: consequences, cure, identity, timeline), Health Anxiety
Questionnaire (total score), and Symptom Amplification Scale (total score). Subjects were
divided into two groups according to whether they had experienced any type of childhood
adversity using the Childhood Experience of Care and Abuse Schedule. Outcome was the (log)
number of medical consultations for 12 months before and 6 months after the index clinic visits.
Multiple regression analysis was used to determine mediators; this was performed separately
for patients with symptoms explained and not explained by organic disease. One-hundred and
twenty-nine patients (61% response) were interviewed. Fifty-two (40.3%) had experienced
childhood adversity; they made a median of 16 doctor visits compared with 10 for those without
adversity (adjusted P=.026). IPQ identity score (number of symptoms attributed to the illness)
and HAD depression scores were significantly associated with both childhood adversity and
number of medical consultations and these variables acted as mediators between childhood
adversity and frequency of consultation in the multiple regression analyses. This association was
limited to patients with medically unexplained symptoms and was mediated by IPQ Identity
Score (number of symptoms attributed to the patient's illness) and HAD depression score.
Sexual abuse and overt neglect were the adversities most closely associated with frequent
consultations. In patients with medically unexplained symptoms the association between
childhood adversity and frequent medical consultations is mediated by the number of bodily
symptoms attributed to the illness. Psychological treatments should be targeted at these
patients with a view to reducing their frequent doctor visits.
2. Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of
Death in Adults: The Adverse Childhood Experiences (ACE) Study
Background: The relationship of health risk behavior and disease in adulthood to the breadth of
exposure to childhood emotional, physical, or sexual abuse, and household dysfunction during
childhood has not previously been described.
Methods: A questionnaire about adverse childhood experiences was mailed to 13,494 adults
who had completed a standardized medical evaluation at a large HMO; 9,508 (70.5%)
responded. Seven categories of adverse childhood experiences were studied: psychological,
physical, or sexual abuse; violence against mother; or living with household members who were
substance abusers, mentally ill or suicidal, or ever imprisoned. The number of categories of
these adverse childhood experiences was then compared to measures of adult risk behavior,
health status, and disease. Logistic regression was used to adjust for effects of demographic
factors on the association between the cumulative number of categories of childhood exposures
(range: 0–7) and risk factors for the leading causes of death in adult life.
Results: More than half of respondents reported at least one, and one-fourth reported ≥2
categories of childhood exposures. We found a graded relationship between the number of
categories of childhood exposure and each of the adult health risk behaviors and diseases that
were studied (P < .001). Persons who had experienced four or more categories of childhood
exposure, compared to those who had experienced none, had 4- to 12-fold increased health
risks for alcoholism, drug abuse, depression, and suicide attempt; a 2- to 4-fold increase in
smoking, poor self-rated health, ≥50 sexual intercourse partners, and sexually transmitted
disease; and a 1.4- to 1.6-fold increase in physical inactivity and severe obesity. The number of
categories of adverse childhood exposures showed a graded relationship to the presence of
adult diseases including ischemic heart disease, cancer, chronic lung disease, skeletal fractures,
and liver disease. The seven categories of adverse childhood experiences were strongly
interrelated and persons with multiple categories of childhood exposure were likely to have
multiple health risk factors later in life.
Conclusions: We found a strong graded relationship between the breadth of exposure to abuse
or household dysfunction during childhood and multiple risk factors for several of the leading
causes of death in adults.
3. Validity of adult retrospective reports of adverse childhood experiences: review of the
Background: Influential studies have cast doubt on the validity of retrospective reports by
adults of their own adverse experiences in childhood. Accordingly, many researchers view
retrospective reports with skepticism.
Method: A computer-based search, supplemented by hand searches, was used to identify
studies reported between 1980 and 2001 in which there was a quantified assessment of the
validity of retrospective recall of sexual abuse, physical abuse, physical/emotional neglect or
family discord, using samples of at least 40. Validity was assessed by means of comparisons with
contemporaneous, prospectively obtained, court or clinic or research records; by agreement
between retrospective reports of two siblings; and by the examination of possible bias with
respect to differences between retrospective and prospective reports in their correlates and
consequences. Medium- to long-term reliability of retrospective recall was determined from
studies in which the test–retest period extended over at least 6 months.
Results: Retrospective reports in adulthood of major adverse experiences in childhood, even
when these are of a kind that allow reasonable operationalisation, involve a substantial rate of
false negatives, and substantial measurement error. On the other hand, although less easily
quantified, false positive reports are probably rare. Several studies have shown some bias in
retrospective reports. However, such bias is not sufficiently great to invalidate retrospective
case-control studies of major adversities of an easily defined kind. Nevertheless, the findings
suggest that little weight can be placed on the retrospective reports of details of early
experiences or on reports of experiences that rely heavily on judgment or interpretation.
Conclusion: Retrospective studies have a worthwhile place in research, but further research is
needed to examine possible biases in reporting.
4. Adverse childhood experiences and health-related quality of life as an adult.
Edwards, Valerie J.; Anda, Robert F.; Felitti, Vincent J.; Dube, Shanta R.
Domestic violence is only one type of family violence that leads people to seek medical care.
Adult survivors of childhood abuse also often present in health care settings. Past abuse can
lead to a number of health difficulties, and the more types of abuse patients experience, the
greater the negative impact on health. This chapter presents new data on the health effects of
multiple types of abuse and offers suggestions for providers on how to screen for and address
the full range of traumatic events patients might have experienced. The Family Health History
questionnaire and the Medical Outcome Study Short-Form 36-Item Health Survey were
administered to participants in The Averse Childhood Experiences Study. Results suggest that
traumatic experiences decades earlier exerted a powerful influence on perceptions of current
well-being across a range of health dimensions.
Kendall-Tackett, Kathleen A. (Ed), (2004). Health consequences of abuse in the family: A clinical
guide for evidence-based practice, Application and practice in health psychology (pp. 81-94).
Washington, DC, US: American Psychological Association, xiii, 289 pp.