The impact of cumulative childhood adversity on young adult mental health: measures, models, and interpretations.

Institute for Public Health Research, University of Connecticut Health Center, East Hartford, CT 06108, USA.
Social Science & Medicine (Impact Factor: 2.56). 04/2008; 66(5):1140-51. DOI: 10.1016/j.socscimed.2007.11.023
Source: PubMed

ABSTRACT Research studies investigating the impact of childhood cumulative adversity on adult mental health have proliferated in recent years. In general, little attention has been paid to the operationalization of cumulative adversity, with most studies operationalizing this as the simple sum of the number of occurrences of distinct events experienced. In addition, the possibility that the mathematical relationship of cumulative childhood adversity to some mental health dimensions may be more complex than a basic linear association has not often been considered. This study explores these issues with 2 waves of data drawn from an economically and racially diverse sample transitioning to adulthood in Boston, Massachusetts, USA. A diverse set of childhood adversities were reported in high school and 3 mental health outcomes -- depressed mood, drug use, and antisocial behavior -- were reported 2 years later during the transition to adulthood. Our results suggest that both operationalization and statistical modeling are important and interrelated and, as such, they have the potential to influence substantive interpretation of the effect of cumulative childhood adversity on adult mental health. In our data, total cumulative childhood adversity was related to depressive symptoms, drug use, and antisocial behavior in a positive curvilinear manner with incremental impact increasing as adversities accumulate, but further analysis revealed that this curvilinear effect was an artifact of the confounding of high cumulative adversity scores with the experience of more severe events. Thus, respondents with higher cumulative adversity had disproportionately poorer mental health because of the severity of the adversities they were exposed to, not the cumulative number of different types of adversities experienced. These results indicate that public health efforts targeting prevention of childhood adversities would best be aimed at the most severe adversities in order to have greatest benefit to mental health in young adulthood.

1 Follower
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Objective: Adverse childhood experiences, including abuse, neglect and house-hold instability, affect lifelong health and economic potential. The present study investigates how adverse childhood experiences are associated with food insecurity by exploring caregivers' perceptions of the impact of their childhood adversity on educational attainment, employment and mental health. Design: Semi-structured audio-recorded in-person interviews that included (i) quantitative measures of maternal and child health, adverse childhood experiences (range: 0–10) and food security using the US Household Food Security Survey Module; and (ii) qualitative audio-recorded investigations of experiences with abuse, neglect, violence and hunger over participants' lifetimes. Setting: Households in Philadelphia, PA, USA. Subjects: Thirty-one mothers of children <4 years old who reported low or very low household food security. Results: Twenty-one caregivers (68 %) reported four or more adverse childhood experiences, and this severity was significantly associated with reports of very low food security (Fisher's exact P = 0·021). Mothers reporting emotional and physical abuse were more likely to report very low food security (Fisher's exact P = 0·032). Qualitatively, participants described the impact of childhood adverse experiences with emotional and physical abuse/neglect, and household substance abuse, on their emotional health, school performance and ability to maintain employment. In turn, these experiences negatively affected their ability to protect their children from food insecurity. Conclusions: The associations between mothers' adverse experiences in child-hood and reports of current household food security should inspire researchers, advocates and policy makers to comprehensively address family hardship through greater attention to the emotional health of caregivers. Programmes meant to address nutritional deprivation and financial hardship should include trauma-informed approaches that integrate behavioural interventions. Keywords Food insecurity Very low food security Adverse childhood experiences Violence Household food insecurity includes two aspects of food security: (i) low food security, which includes multiple indications of food access problems and reduced diet quality; and (ii) very low food security, which indicates that food intake of at least one household member was reduced and eating patterns were disrupted at times during the year because the household lacked money and other resources for food. In 2012, among all US house-holds with children under the age of 6 years, 15 868 000 individuals (21·5 %), including 8 246 000 children (22·7 %), lived in households reporting household food insecurity. The number of people living in households with young children under the age of 6 years reporting household very low food security was 4 261 000 (5·8 %). Food security is also calculated at the child level to capture a more severe form of food security in which food hardship is reported to affect children directly. The percentage of individuals in households where there was low food security among children was 11·1 %, representing 4 040 000 children
    Public Health Nutrition 01/2015; DOI:10.1017/S1368980014003036 · 2.48 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Stressful life events can impact both substance use initiation and the quantity of substances consumed by adolescents; however, the effect of stress on substance use may be contingent on other factors including social support, peers, and genotype. DAT1, a polymorphic dopamine transporter gene, is one such factor that may be responsible for differential susceptibility to cumulative life pressures. Data from the National Longitudinal Study of Adolescent Health were utilized to determine whether adolescents with the 10-repeat allele are more likely to respond to life stresses by engaging in alcohol use than those without the allele. Respondents’ self-reports of key stressors were used to create a composite life stress scale. The interaction of this measure with the number of 10-repeat DAT1 alleles was evaluated in series of logistic regression models. A significant interaction emerged between stressful life experiences and DAT1 for alcohol use among females, but this pattern was not seen in males. Females with the 10-repeat allele appear to be more sensitive to life stress as compared to those without the allele. It appears that variation in the DAT1 gene may help explain why some women are more likely to consume alcohol when confronted with stress. It, however, does not appear to condition the reaction of men, in terms of alcohol use, to stress.
    Criminal Justice Studies 01/2015; 28(1). DOI:10.1080/1478601X.2014.1000003
  • British Journal of Criminology 10/2011; 51(6):960-977. DOI:10.1093/bjc/azr051 · 2.13 Impact Factor


Available from