Article Title:
Approaches for measuring cumulative childhood adversity: A study of youth from 5 sub-Saharan countries
Authors:
Gilbert, LK, Matthews, S., Dube SR, Annor FB.
Summary:
While evidence abounds to indicate that adverse childhood experiences (ACES) such as abuse, community violence and family dysfunction are associated with negative health and mental health outcomes in adulthood, much of the research comes from high-income countries and many of the studies measure childhood adversity using a simple cumulative score that only considers the total number of trauma events experienced. There is limited research on ACES in low- and middle-income countries (LMIC) and relatively few studies that consider potential moderators such as the context of the event, or the differential impact of specific ACES on health outcomes. This study helps to address some of these issues by using nationally representative samples of nearly 11,500 young adults (18-24 years) from 5 sub-Saharan LMICs who completed the Violence Against Youth and Children surveys. Data was collected from Lesotho, Cote d’Ivoire, Kenya, Namibia and Mozambique. The researchers looked at the impact of 6 ACES (physical, emotional and sexual violence, witnessing interparental violence and community violence, and orphanhood (loss of at least 1 parent) occurring in varied contexts before age 18 years) on mental distress in young adulthood. They used 3 methods to study the relationship: measurement of the cumulative ACE score (1-6); the context of the ACE (household, community, peer, intimate partner); and the impact of each ACE on mental distress (no/low significant impact; medium impact; and high impact).
Major Results Included:
• Exposure to > 3 ACES was associated with significant mental distress for both boys and girls (Kessler K-6 scale; symptoms of depression, anxiety, fatigue); on average, nearly 20% of participants reported 3 or more ACES.
• For girls, parental emotional violence and physical violence had the greatest impact on mental distress (high impact), followed by sexual violence and witnessing community violence (medium impact). For boys, high impact ACES included sexual violence and parental emotional violence, while physical violence and witnessing community violence had a medium impact on mental distress.
• Girls had a higher prevalence of ‘high impact’ ACES than boys (38.5 vs 14.0%)
• For girls, experiencing household, intimate partner and community ACES were associated with significant mental distress, while for boys, experiencing household and community ACES were most impactful.
• Girls reported more intimate partner ACES relative to boys, while the latter were more likely to report community, household and peer ACES.
How Can We Use This Study's Results?
• Clustering of multiple ACES is relatively common, and professionals should be aware of this possibility when assessing allegations of violence.
• More attention needs to be paid to assessing and responding to emotional violence in the home, given its high impact on mental distress among both boys and girls.
• It is important to examine not only the number of ACES experienced by a child, but also the impact they had on the individual’s level of mental distress. Not all ACES were associated with major mental health distress in this study so simply tallying up a total score on the basis of number of ACES experienced may not adequately demonstrate their impact.
• Context of ACES is important to consider in prevention and intervention efforts. We should take into account the relationship of the victim to the perpetrator, and the setting in which the ACE occurs (e.g., community, family).
Don’t forget the limitations of this study. There are several (see citation) but chief among them are the reliance on self-report, the possibility of recall bias, the exclusion of some well-known ACES from consideration, and the inability to assess cause/effect due to the cross-sectional nature of the study.
