Psychosocial complexity in multimorbidity: the legacy of adverse childhood experiences

Fam Pract. 2015 Jun;32(3):269-75. doi: 10.1093/fampra/cmv016. Epub 2015 Apr 21.


Background: To effectively meet the health care needs of multimorbid patients, the most important psychosocial factors associated with multimorbidity must be discerned. Our aim was to examine the association between self-reported adverse childhood experiences (ACEs) and multimorbidity and the contribution of other social, behavioural and psychological factors to this relationship.

Methods: We analysed cross-sectional data from the Mitchelstown study, a population-based cohort recruited from a large primary care centre. ACE was measured by self-report using the Centre for Disease Control ACE questionnaire. Multimorbidity status was categorized as 0, 1 or ≥2 chronic diseases, which were ascertained by self-report of doctor diagnosis. Ordinal logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (95% CIs) for multimorbidity, using ACE as the independent variable with adjustment for social (education, public health cover), behavioural (smoking, exercise, diet, body mass index) and psychological factors (anxiety/depression scores).

Results: Of 2047 participants, 45.3% (n = 927, 95% CI: 43.1-47.4) reported multimorbidity. ACE was reported by 28.4% (n = 248, 95% CI: 25.3-31.3%) of multimorbid participants, 21% (n = 113, 95% CI: 18.0-25.1%) of single chronic disease participants and 16% (n = 83, 95% CI: 13.2-19.7%) of those without chronic disease. The OR for multimorbidity with any history of ACE was 1.6 (95% CI: 1.4-2.0, P < 0.001). Adjusting for social, behavioural and psychological factors only marginally ameliorated this association, OR 1.4 (95% CI: 1.1-1.7, P = 0.002).

Conclusions: Multimorbidity is independently associated with a history of ACEs. These findings demonstrate the psychosocial complexity associated with multimorbidity and should be used to inform health care provision in this patient cohort.

Keywords: Child abuse; chronic disease/epidemiology; comorbidity; general practice; health services needs and demand; psychological; stress..

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Anxiety / diagnosis
  • Body Mass Index
  • Child
  • Chronic Disease / epidemiology
  • Chronic Disease / psychology*
  • Cohort Studies
  • Comorbidity
  • Cross-Sectional Studies
  • Depression / diagnosis
  • Educational Status
  • Female
  • Health Behavior*
  • Health Status*
  • Health Surveys
  • Humans
  • Ireland / epidemiology
  • Logistic Models
  • Long Term Adverse Effects / psychology*
  • Male
  • Middle Aged
  • Prevalence
  • Primary Health Care / methods
  • Primary Health Care / statistics & numerical data
  • Self Report
  • Social Class