ACEtimation-The Combined Effect of Adverse Childhood Experiences on Violence, Health-Harming Behaviors, and Mental Ill-Health: Findings across England and Wales

Int J Environ Res Public Health. 2023 Aug 23;20(17):6633. doi: 10.3390/ijerph20176633.

Abstract

Adverse childhood experiences (ACEs) encompass various adversities, e.g., physical and/or emotional abuse. Understanding the effects of different ACE types on various health outcomes can guide targeted prevention and intervention. We estimated the association between three categories of ACEs in isolation and when they co-occurred. Specifically, the relationship between child maltreatment, witnessing violence, and household dysfunction and the risk of being involved in violence, engaging in health-harming behaviors, and experiencing mental ill-health. Data were from eight cross-sectional surveys conducted in England and Wales between 2012 and 2022. The sample included 21,716 adults aged 18-69 years; 56.6% were female. Exposure to child maltreatment and household dysfunction in isolation were strong predictors of variant outcomes, whereas witnessing violence was not. However, additive models showed that witnessing violence amplified the measured risk beyond expected levels for being a victim or perpetrator of violence. The multiplicative effect of all three ACE categories demonstrated the highest level of risk (RRs from 1.7 to 7.4). Given the increased risk associated with co-occurring ACEs, it is crucial to target individuals exposed to any ACE category to prevent their exposure to additional harm. Implementing universal interventions that safeguard children from physical, emotional, and sexual violence is likely to mitigate a range of subsequent issues, including future involvement in violence.

Keywords: adverse childhood experiences; child maltreatment; childhood adversity; cross sectional; health-harming behaviors; household dysfunction; mental health; survey data; violence.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Adverse Childhood Experiences*
  • Child
  • Cross-Sectional Studies
  • England / epidemiology
  • Female
  • Humans
  • Male
  • Violence
  • Wales / epidemiology

Grants and funding

This work was supported by funding from the Health Care Research Wales (grant number: NA; National Centre for Population Health and Wellbeing Research); the UK Prevention Research Partnership (grant number: MR-VO49879/1; VISION), and Public Health Wales (grant number: NA). R.A.’s post is funded by the National Centre for Population Health and Wellbeing Research, K.H. is an employee of Public Health Wales, and K.C.’s post is funded by Public Health Wales.