ResearchPDF Available

Adverse Childhood Experiences (ACEs) and their association with mental well-being in the Welsh adult population

Authors:

Abstract and Figures

ACEs) in the Welsh adult population and their impact on health and well-being across the life course. The series will include reports on: ■■ The prevalence of Adverse Childhood Experiences and their association with health-harming behaviours in the Welsh adult population. ■■ The impact of Adverse Childhood Experiences on chronic ill health, use of health and social care services and premature mortality in Welsh adults. ■■ The impact of Adverse Childhood Experiences on mental well-being in Welsh adults. Preface Over 2,000 adults aged 18-69 years participated in the ACE Study for Wales, providing anonymous information on their exposure to ACEs before the age of 18 years and their health and lifestyles as adults. The study achieved a compliance rate of 49.1% and the sample was designed to be representative of the general population in Wales. Data were collected in participants’ places of residence using an established questionnaire incorporating the short ACE tool developed by the US Centers for Disease Control and Prevention and based on work by Felitti et al (1998) [1].
Content may be subject to copyright.
Adverse Childhood
Experiences
and their association
with Mental Well-being
in the Welsh adult
population
Welsh Adverse Childhood
Experiences (ACE) Study
ISBN 978-1-910768-30-3
© 2016 Public Health Wales NHS Trust.
Material contained in this document may be reproduced under the terms of the Open Government Licence (OGL)
www.nationalarchives.gov.uk/doc/open-government-licence/version/3/ provided it is done so accurately and is not used
in a misleading context.
Acknowledgement to Public Health Wales NHS Trust to be stated.
Copyright in the typographical arrangement, design and layout belongs to Public Health Wales NHS Trust.
This is one in a series of reports examining the prevalence of Adverse Childhood Experiences
(ACEs) in the Welsh adult population and their impact on health and well-being across the life
course. The series will include reports on:
The prevalence of Adverse Childhood Experiences and their association with health-harming
behaviours in the Welsh adult population.
The impact of Adverse Childhood Experiences on chronic ill health, use of health and social care
services and premature mortality in Welsh adults.
The impact of Adverse Childhood Experiences on mental well-being in Welsh adults.
Preface
Over 2,000 adults aged 18-69 years participated
in the ACE Study for Wales, providing anonymous
information on their exposure to ACEs before
the age of 18 years and their health and lifestyles
as adults. The study achieved a compliance rate
of 49.1% and the sample was designed to be
representative of the general population in Wales.
Data were collected in participants’ places of
residence using an established questionnaire
incorporating the short ACE tool developed by the
US Centers for Disease Control and Prevention and
based on work by Felitti et al (1998) [1].
Kathryn Ashtoni, Professor Mark A. Bellisi, Katie Hardcastlei, Professor Karen Hughesii, Susan Mablyi and
Marie Evansi
Adverse Childhood Experiences
and their association with
Mental Well-being
in the Welsh adult population
i
Public Health Wales
Hadyn Ellis Building
Maindy Road
Cathays
Cardiff CF24 4HQ
Tel: 02921 841 933
ii
Centre for Public Health
Liverpool John Moores University
Henry Cotton Campus
Level 2, 15-21 Webster Street
Liverpool L3 2ET
Tel: 0151 231 4542
Welsh Adverse Childhood
Experiences (ACE) Study
1
Adverse Childhood Experiences (ACEs) have harmful impacts on health and well-being
across the life course. The Welsh ACE Study measured exposure to nine ACEs in the
Welsh population and their effect on mental well-being in adulthood.
0 ACEsAll adults 1 ACE 2-3 ACEs 4+ ACEs
14%
19% 16%
23%
41%
*Low mental well-being was classified as >1 standard deviation below the mean overall mental well-being
SWEMWBS score of all respondents (mean = 24.47, SD = 4.57, low <20).
Adverse Childhood Experiences
and Adult Mental Well-Being in Wales
47% of adults in Wales suffered at least one ACE during their
childhood and 14% suffered 4 or more.
The prevalence of low mental well-being in adults increased
with the number of ACEs suffered in childhood
Prevalence of low mental well-being in adults by the number
of ACEs suffered in childhood
Mental well-being was measured using the Short Warwick-Edinburgh Mental Well-being Scale
(SWEMWBS) which includes seven questions to assess mental wellbeing over the last two weeks. Scores
for these questions are combined to provide an overall mental well-being score ranging from 7 to 35.
Individuals scoring below 20 were categorised as having low mental well-being.*
CHILDHOOD HOUSEHOLD INCLUDED
CHILD MALTREATMENT
How many adults in Wales have been exposed to each ACE?
Verbal abuse
23%
Alcohol
abuse
14%
Physical abuse
17%
Sexual abuse
10%
Parental
separation
20%
Domestic
violence
16%
Mental
illness
14%
Drug
use
5%
Incarceration
5%
Adverse Childhood Experiences (ACEs) have harmful impacts on health and well-being
across the life course. The Welsh ACE Study measured exposure to nine ACEs in the
Welsh population and their effect on mental well-being in adulthood.
0 ACEsAll adults 1 ACE 2-3 ACEs 4+ ACEs
14%
19% 16%
23%
41%
*Low mental well-being was classified as >1 standard deviation below the mean overall mental well-being
SWEMWBS score of all respondents (mean = 24.47, SD = 4.57, low <20).
Adverse Childhood Experiences
and Adult Mental Well-Being in Wales
47% of adults in Wales suffered at least one ACE during their
childhood and 14% suffered 4 or more.
The prevalence of low mental well-being in adults increased
with the number of ACEs suffered in childhood
Prevalence of low mental well-being in adults by the number
of ACEs suffered in childhood
Mental well-being was measured using the Short Warwick-Edinburgh Mental Well-being Scale
(SWEMWBS) which includes seven questions to assess mental wellbeing over the last two weeks. Scores
for these questions are combined to provide an overall mental well-being score ranging from 7 to 35.
Individuals scoring below 20 were categorised as having low mental well-being.*
CHILDHOOD HOUSEHOLD INCLUDED
CHILD MALTREATMENT
How many adults in Wales have been exposed to each ACE?
Verbal abuse
23%
Alcohol
abuse
14%
Physical abuse
17%
Sexual abuse
10%
Parental
separation
20%
Domestic
violence
16%
Mental
illness
14%
Drug
use
5%
Incarceration
5%
Adverse Childhood Experiences (ACEs) have harmful impacts on health and well-being
across the life course. The Welsh ACE Study measured exposure to nine ACEs in the
Welsh population and their effect on mental well-being in adulthood.
0 ACEsAll adults 1 ACE 2-3 ACEs 4+ ACEs
14%
19% 16%
23%
41%
*Low mental well-being was classified as >1 standard deviation below the mean overall mental well-being
SWEMWBS score of all respondents (mean = 24.47, SD = 4.57, low <20).
Adverse Childhood Experiences
and Adult Mental Well-Being in Wales
47% of adults in Wales suffered at least one ACE during their
childhood and 14% suffered 4 or more.
The prevalence of low mental well-being in adults increased
with the number of ACEs suffered in childhood
Prevalence of low mental well-being in adults by the number
of ACEs suffered in childhood
Mental well-being was measured using the Short Warwick-Edinburgh Mental Well-being Scale
(SWEMWBS) which includes seven questions to assess mental wellbeing over the last two weeks. Scores
for these questions are combined to provide an overall mental well-being score ranging from 7 to 35.
Individuals scoring below 20 were categorised as having low mental well-being.*
CHILDHOOD HOUSEHOLD INCLUDED
CHILD MALTREATMENT
How many adults in Wales have been exposed to each ACE?
Verbal abuse
23%
Alcohol
abuse
14%
Physical abuse
17%
Sexual abuse
10%
Parental
separation
20%
Domestic
violence
16%
Mental
illness
14%
Drug
use
5%
Incarceration
5%
Adverse Childhood Experiences (ACEs) have harmful impacts on health and well-being
across the life course. The Welsh ACE Study measured exposure to nine ACEs in the
Welsh population and their effect on mental well-being in adulthood.
0 ACEsAll adults 1 ACE 2-3 ACEs 4+ ACEs
14%
19% 16%
23%
41%
*Low mental well-being was classified as >1 standard deviation below the mean overall mental well-being
SWEMWBS score of all respondents (mean = 24.47, SD = 4.57, low <20).
Adverse Childhood Experiences
and Adult Mental Well-Being in Wales
47% of adults in Wales suffered at least one ACE during their
childhood and 14% suffered 4 or more.
The prevalence of low mental well-being in adults increased
with the number of ACEs suffered in childhood
Prevalence of low mental well-being in adults by the number
of ACEs suffered in childhood
Mental well-being was measured using the Short Warwick-Edinburgh Mental Well-being Scale
(SWEMWBS) which includes seven questions to assess mental wellbeing over the last two weeks. Scores
for these questions are combined to provide an overall mental well-being score ranging from 7 to 35.
Individuals scoring below 20 were categorised as having low mental well-being.*
CHILDHOOD HOUSEHOLD INCLUDED
CHILD MALTREATMENT
How many adults in Wales have been exposed to each ACE?
Verbal abuse
23%
Alcohol
abuse
14%
Physical abuse
17%
Sexual abuse
10%
Parental
separation
20%
Domestic
violence
16%
Mental
illness
14%
Drug
use
5%
Incarceration
5%
Adverse Childhood Experiences (ACEs) have harmful impacts on health and well-being
across the life course. The Welsh ACE Study measured exposure to nine ACEs in the
Welsh population and their effect on mental well-being in adulthood.
0 ACEsAll adults 1 ACE 2-3 ACEs 4+ ACEs
14%
19% 16%
23%
41%
*Low mental well-being was classified as >1 standard deviation below the mean overall mental well-being
SWEMWBS score of all respondents (mean = 24.47, SD = 4.57, low <20).
Adverse Childhood Experiences
and Adult Mental Well-Being in Wales
47% of adults in Wales suffered at least one ACE during their
childhood and 14% suffered 4 or more.
The prevalence of low mental well-being in adults increased
with the number of ACEs suffered in childhood
Prevalence of low mental well-being in adults by the number
of ACEs suffered in childhood
Mental well-being was measured using the Short Warwick-Edinburgh Mental Well-being Scale
(SWEMWBS) which includes seven questions to assess mental wellbeing over the last two weeks. Scores
for these questions are combined to provide an overall mental well-being score ranging from 7 to 35.
Individuals scoring below 20 were categorised as having low mental well-being.*
CHILDHOOD HOUSEHOLD INCLUDED
CHILD MALTREATMENT
How many adults in Wales have been exposed to each ACE?
Verbal abuse
23%
Alcohol
abuse
14%
Physical abuse
17%
Sexual abuse
10%
Parental
separation
20%
Domestic
violence
16%
Mental
illness
14%
Drug
use
5%
Incarceration
5%
Adverse Childhood Experiences (ACEs) have harmful impacts on health and well-being
across the life course. The Welsh ACE Study measured exposure to nine ACEs in the
Welsh population and their effect on mental well-being in adulthood.
0 ACEsAll adults 1 ACE 2-3 ACEs 4+ ACEs
14%
19% 16%
23%
41%
*Low mental well-being was classified as >1 standard deviation below the mean overall mental well-being
SWEMWBS score of all respondents (mean = 24.47, SD = 4.57, low <20).
Adverse Childhood Experiences
and Adult Mental Well-Being in Wales
47% of adults in Wales suffered at least one ACE during their
childhood and 14% suffered 4 or more.
The prevalence of low mental well-being in adults increased
with the number of ACEs suffered in childhood
Prevalence of low mental well-being in adults by the number
of ACEs suffered in childhood
Mental well-being was measured using the Short Warwick-Edinburgh Mental Well-being Scale
(SWEMWBS) which includes seven questions to assess mental wellbeing over the last two weeks. Scores
for these questions are combined to provide an overall mental well-being score ranging from 7 to 35.
Individuals scoring below 20 were categorised as having low mental well-being.*
CHILDHOOD HOUSEHOLD INCLUDED
CHILD MALTREATMENT
How many adults in Wales have been exposed to each ACE?
Verbal abuse
23%
Alcohol
abuse
14%
Physical abuse
17%
Sexual abuse
10%
Parental
separation
20%
Domestic
violence
16%
Mental
illness
14%
Drug
use
5%
Incarceration
5%
Public Health Wales
2
Prevenng ACEs in future generaons could reduce levels of:
Over the past two weeks, compared to people with no ACEs,
those with 4+ ACEs were also:
Low mental
well-being
by 27%
Not feeling optimistic
about the future
by 43%
Not feeling
useful
by 48%
Not feeling
relaxed
by 38%
Not dealing with
problems well
by 31%
Not thinking
clearly
by 34%
Not feeling close
to other people
by 25%
Not being able to make
their mind up about things
by 26%
Adults with 4+ ACEs were five times$ more likely to have
low mental well-being than those with no ACEs
6
6
6
6
5
5
4
3
3times more likely to have never or rarely felt relaxed
times more likely to have never or rarely felt close to other people
times more likely to have never or rarely been thinking clearly
times more likely to have never or rarely to have dealt with problems well
times more likely to have never or rarely been able to make up their own mind about things
times more likely to have never or rarely felt optimistic about the future
times more likely to have never or rarely felt useful
The national survey of Adverse Childhood Experiences in Wales interviewed
approximately 2000 people (aged 18-69 years) from across Wales at their homes
in 2015. Of those eligible to participate, just under half agreed to take part and
we are grateful to all those who freely gave their time.
Prevenng ACEs in future generaons could reduce levels of:
Over the past two weeks, compared to people with no ACEs,
those with 4+ ACEs were also:
Low mental
well-being
by 27%
Not feeling optimistic
about the future
by 43%
Not feeling
useful
by 48%
Not feeling
relaxed
by 38%
Not dealing with
problems well
by 31%
Not thinking
clearly
by 34%
Not feeling close
to other people
by 25%
Not being able to make
their mind up about things
by 26%
Adults with 4+ ACEs were five times$ more likely to have
low mental well-being than those with no ACEs
6
6
6
6
5
5
4
3
3times more likely to have never or rarely felt relaxed
times more likely to have never or rarely felt close to other people
times more likely to have never or rarely been thinking clearly
times more likely to have never or rarely to have dealt with problems well
times more likely to have never or rarely been able to make up their own mind about things
times more likely to have never or rarely felt optimistic about the future
times more likely to have never or rarely felt useful
The national survey of Adverse Childhood Experiences in Wales interviewed
approximately 2000 people (aged 18-69 years) from across Wales at their homes
in 2015. Of those eligible to participate, just under half agreed to take part and
we are grateful to all those who freely gave their time.
Prevenng ACEs in future generaons could reduce levels of:
Over the past two weeks, compared to people with no ACEs,
those with 4+ ACEs were also:
Low mental
well-being
by 27%
Not feeling optimistic
about the future
by 43%
Not feeling
useful
by 48%
Not feeling
relaxed
by 38%
Not dealing with
problems well
by 31%
Not thinking
clearly
by 34%
Not feeling close
to other people
by 25%
Not being able to make
their mind up about things
by 26%
Adults with 4+ ACEs were five times$ more likely to have
low mental well-being than those with no ACEs
6
6
6
6
5
5
4
3
3times more likely to have never or rarely felt relaxed
times more likely to have never or rarely felt close to other people
times more likely to have never or rarely been thinking clearly
times more likely to have never or rarely to have dealt with problems well
times more likely to have never or rarely been able to make up their own mind about things
times more likely to have never or rarely felt optimistic about the future
times more likely to have never or rarely felt useful
The national survey of Adverse Childhood Experiences in Wales interviewed
approximately 2000 people (aged 18-69 years) from across Wales at their homes
in 2015. Of those eligible to participate, just under half agreed to take part and
we are grateful to all those who freely gave their time.
6
6
Prevenng ACEs in future generaons could reduce levels of:
Compared with people with no ACEs, those with 4+ ACEs are:
Heroin/crack cocaine
use (lifetime)
by 66%
Incarceration
(lifetime)
by 65%
Violence perpetration
(past year)
by 60%
Violence victimisation
(past year)
by 57%
Cannabis use
(lifetime)
by 42%
Unintended teen
pregnancy
by 41%
High-risk drinking
(current)
by 35%
Early sex
(before age 16)
by 31%
Smoking tobacco or
e-cigarettes
(current)
by 24%
Poor diet
(current; <2 fruit & veg
portions daily)
by 16%
ACEs increase individuals’ risks of
developing health-harming behaviours
The national survey of Adverse Childhood Experiences in Wales interviewed
approximately 2000 people (aged 18-69 years) from across Wales at their homes
in 2015. Of those eligible to participate, just under half agreed to take part and
we are grateful to all those who freely gave their time.
20
16
15
14
11
6
6
6
4times more likely to be a high-risk drinker
times more likely to have had or caused unintended teenage pregnancy
times more likely to smoke e-cigarettes or tobacco
times more likely to have had sex under the age of 16 years
times more likely to have smoked cannabis
times more likely to have been a victim of violence over the last 12 months
times more likely to have committed violence against another person in the last 12 months
times more likely to have used crack cocaine or heroin
times more likely to have been incarcerated at any point in their lifetime
$ After taking demographic factors (age, sex, ethnicity and residential deprivation) into account
Adverse Childhood Experiences and their association with Mental Well-being in the Welsh adult population
3
An increasing body of international evidence is
identifying the substantial negative impacts that
adverse experiences during childhood have on an
individual’s physical and mental health [1-4]. These
childhood experiences are termed Adverse Childhood
Experiences (ACEs). They include child maltreatment
(such as physical, sexual and verbal abuse) and wider
experiences of household dysfunction (such as growing
up in a household affected by domestic violence, parental
separation, substance misuse, mental illness or criminal behaviour).
Introduction
Chronic exposure to ACEs can affect neurological,
immunological and hormonal system development.
As a result, individuals exposed to such experiences
during childhood may develop problems with
emotional regulation, cognitive response, attachment,
memory and learning that can continue into and
throughout adult life [5]. Adults previously exposed to
ACEs have been shown to be more likely to struggle
with social situations, have difficulties building
relationships and become detached from society [6].
Evidence indicates that they may also adopt health-
harming behaviours (e.g. smoking, high calorie diets
and alcohol and drug use) in part as mechanisms to
cope with a history of ACEs [3, 4, 7].
Existing studies have highlighted associations between
childhood adversity and adult mental health disorders.
For example, studies in the United States have
identified relationships between ACEs and personality
disorders in adulthood, such as schizophrenic,
antisocial behaviour and narcissistic personality
disorders [8]. In addition, children who experience
the most ACEs are at greater risk of mental health
conditions such as depression, anxiety, hallucinations,
panic attacks and suicide attempts [9-11].
Although this provides a sound evidence base for
the links between adversity in childhood and mental
health outcomes, the majority of existing studies
focus on individual mental illnesses rather than
the overall wider spectrum of mental well-being.
Recent research in England has highlighted strong
relationships between exposure to ACEs and low
mental well-being in adults [12]. No such work has
previously been undertaken in Wales. However, the
importance of mental well-being and the role of poor
mental well-being in developing physical diseases,
unhealthy lifestyles and in drivers of health inequalities
is acknowledged in the Public Health Outcomes
Framework for Wales (PHOF) [13]. Within the PHOF,
measures of both child and adult mental well-being
have been adopted as key indicators of the nations’
health and as mechanisms to assess the impact of
health improving policy measures such as the Well-
being of Future Generations Act in Wales [14]. Using
data from the Welsh ACE survey [4], this report
examines the associations between a history of ACEs
and poor adult mental well-being, looking at mental
well-being and provides estimates for the potential
impact of eradicating ACEs on the mental well-being
of the Welsh population.
Public Health Wales
4
ACE survey for Wales
In 2015, Public Health Wales in collaboration with
Liverpool John Moores University undertook the first
ACE study for Wales. The survey used a face-to-face
interview methodology with a representative sample
of adults aged 18-69 years, resident across Wales.
Interviews were undertaken at individuals’ place
of residence. A total of 14,893 households were
visited and out of 4,127 eligible people approached,
2,028 agreed to participate and provided the
necessary information on the ACEs they experienced
during childhood [2] and details of their current
demographics, physical and mental health. Initial
analysis of the study focussed on how health-harming
behaviours are linked with experiencing ACEs during
childhood; the results of which were published in
January 2016 in Adverse Childhood Experiences
and their impact on health-harming behaviours
in the Welsh adult population [4]. Full details of the
general study methodology and analytical techniques
can be found in this previous report, while details of
those aspects relating to mental well-being are given
below.
Levels of ACEs in the Welsh Population
Just under half of all individuals surveyed had
experienced at least one ACE before the age of 18
years (46.5%) and 13.6% of all respondents had
experienced four or more ACEs1. The prevalence of
individual ACEs ranged from 4.6% of respondents
reporting living with a drug-using household member
during their childhood, to 22.8% experiencing verbal
abuse as a child (see Figure 1).
How we measured mental well-being
in the Welsh ACE survey
Mental well-being covers a spectrum of aspects
of how individuals feel and interact with others.
Within the Welsh ACE survey, mental well-being
was measured using the Short Warwick-Edinburgh
Mental Well-being Scale (SWEMWBS)2. SWEMWBS is
an internationally validated self-completion tool3. The
questions asked individuals about how often over the
past two weeks they have been: (1) feeling optimistic
about the future; (2) feeling useful; (3) feeling relaxed;
(4) dealing with problems well; (5) thinking clearly;
(6) feeling close to other people; (7) able to make
up their mind about things. Responses to all these
questions were scored from 1 (none of the time) to 5
(all of the time) and an overall mental well-being score
was calculated. Scores ranged from 7 (lowest possible
mental well-being) to 35 (highest possible mental
well-being). Low mental well-being was classified as all
individuals who had an overall score of less than 20.
This was calculated using methods previously used in
existing research as >1 standard deviation below the
mean overall mental well-being SWEMWBS score of all
respondents (mean = 24.47, SD = 4.57, low <20) [12].
1 Each category of ACE, e.g. child physical abuse or growing up in house with domestic violence, counts as one ACE.
2 Warwick-Edinburgh Mental Well-being Scale (WEMWBS) © NHS Health Scotland, University of Warwick and University of Edinburgh, 2006, all
rights reserved
3 More information on SWEMWBS can be found at the following web page: http://www2.warwick.ac.uk/fac/med/research/platform/wemwbs/
Figure 1: Prevalence of the number of ACEs and individual ACEs experienced in Wales
Verbal abuse
Parental separation
Physical abuse
Domestic violence
Alcohol abuse
Mental illness
Sexual abuse
Incarceration
Drug abuse
Experienced 0 ACEs
Experienced 1 ACE
Experienced 2–3 ACEs
Experienced 4 or more ACEs
0 10 20 30 40 50 60
%
5
Adverse Childhood Experiences and their association with Mental Well-being in the Welsh adult population
0 Text
Low overall mental well-being4
Within the Welsh ACE survey, one fifth of respondents
were classified as having a low mental well-being4
(19.4%). The prevalence of low mental well-being
increased with ACE count, rising from 14.2% of
those reporting no ACEs to 41.1% of those with
four or more ACEs (see Appendix 1, Table ii). After
adjustment for socio-demographics, the relationship
between ACE count and low mental well-being
remained with those experiencing four or more ACEs
being 4.7 times more likely to have a low mental well-
being than those with no ACEs (see Figure 2).
Other demographics
After accounting for confounding demographic and
other factors (e.g. ACE count) individuals living within
the most deprived areas in Wales were also more likely
to experience low mental well-being compared to
those who resided in more affluent areas.
0
1
2
3
4
5
6
7
0
10
20
30
40
50
60
0 ACEs 1 ACE 2-3 ACEs 4+ ACEs
ACE Count %
AORs (95%CIs)
% AORs
Figure 2: Prevalence and adjusted odds ratio (AOR) for low mental well-being by ACE counta
4 Consistent with other studies, low mental well-being was classified as >1 standard deviation below the mean overall mental well-being
SWEMWBS score of all respondents (mean = 24.47, SD = 4.57, low <20) [12].
a p<0.001. AORs (adjusted odds ratios) have been adjusted for age, sex, deprivation and ethnicity. 0 ACEs is used as the
reference category. 95%CIs= 95% Confidence Intervals
Public Health Wales
6
0 Text
Individual components of well-being and
their association with ACEs
Table 1: Prevalence of the individual components of the Short Warwick-Edinburgh Mental
Well-being Scale (SWEMWBS)
Individual components of SWEMWBS
Prevalence (%)
Overall Individuals who
experienced
0 ACEs
Individuals who
experienced
4+ ACEs
Never or rarely feeling optimistic
about the future 8.9 5.3 20.6
Never or rarely feeling useful 8.8 4.7 21.7
Never or rarely feeling relaxed 11.4 7.1 19.0
Never or rarely dealing with
problems well 7.1 4.8 20.2
Never or rarely thinking clearly 4.9 3.3 10.7
Never or rarely feeling close to
other people 7.3 5.6 14.2
Never or rarely being able to
make up their mind about things 3.3 2.5 9.1
Individuals were classified as having low individual
well-being component scores when reporting either a
score of 1 (never) or 2 (rarely) for how often they had
experienced each positive well-being factor in the last
two weeks.
The proportion of individuals reporting low measures5
for the individual components of SWEMWBS ranged
from 3.3% (not being able to make up their mind
about things) to 11.4% (not feeling relaxed). As
outlined in Table 1, the prevalence of individuals
reporting low measures of each of the components
increased with the number of ACEs experienced. For
example, 4.7% of individuals who had experienced
no ACEs reported not having felt useful over the past
two weeks, increasing to 21.7% of individuals who
had experienced four or more ACEs (see Table 1 and
Appendix 1 Table ii).
5 Low measures were defined as cases where respondents selected never or rarely over the last 2 weeks.
Adverse Childhood Experiences and their association with Mental Well-being in the Welsh adult population
7
0 Text
3 times more likely to have never/rarely felt relaxed
3 times more likely to have never/rarely felt close to other people
4 times more likely to have never/rarely been thinking clearly
5 times more likely to never/rarely have dealt with problems well
5 times more likely to have never/rarely been able to make up their own mind about things
6 times more likely to have never/rarely felt optimistic about the future
6 times more likely to have never/rarely felt useful.
Other demographics
After controlling for socio-demographic factors such
as age, sex, ethnicity and residential deprivation
(using binary logistic regression methods), the strong
associations between ACE count and all individual
components of mental well-being remained. The odds of
reporting a low measure for each individual component
of SWEMWBS increased with ACE count (see Appendix
1 Table iii). Thus, compared to respondents who
experienced no ACEs, individuals who had experienced
four or more ACEs were (over the last two weeks):
Never or rarely feeling optimistic about the future
was significantly more likely to be reported amongst
individuals from the most deprived areas in Wales
compared to the least deprived (11.4%, most
deprived; 5.5%, least deprived; see Appendix 1, Table
i). Individuals in the most deprived areas were also
significantly more likely to report never or rarely feeling
relaxed at 11.6% compared to 5.2% in the least
deprived areas, and were more likely to never or rarely
feel like they have been thinking clearly (5.7%, most
deprived; 3.0%, least deprived; see Appendix 1, Table
i). Males were significantly more likely than females to
have reported never or rarely feeling relaxed (13.6%,
males; 9.1%, females) and never or rarely feeling close
to other people (9.1%, males; 5.5%, females; see
Appendix 1, Table i). The only significant association
between age and the individual components of
well-being was seen for individuals aged 50-59 year
olds, who were more likely to report never or rarely
feeling optimistic compared to all other age groups.
No significant relationships were reported between
individual components of SWEMWBS and ethnicity.
8
Public Health Wales
0 Text
Estimated impact of reducing exposure to ACEs
on mental well-being
After adjusting the figures to match national population demographics (aged 18-69
years), results suggest that if no individuals in this age range in Wales were exposed
to ACEs as children, then the prevalence of low mental well-being in adults could
be as much as 27% lower. This would be equivalent to approximately 108,275 fewer
individuals (aged 18-69 years) living in Wales with a low mental well-being (see
Appendix 1, Table iv for more details).
Results also suggest the prevalence of low measures
of the individual components of SWEMWBS could also
be substantially reduced by reducing exposure to ACEs
(see Table 2 and Appendix 1, Table iv). Estimated
potential changes in prevalence ranged from a 24.7%
reduction in those who never or rarely feel close to
other people to 47.5% less individuals never or rarely
feeling useful (see Table 2).
Table 2: Modelled impact of preventing ACEs at national population levels on the components
of the Short Warwick-Edinburgh Mental Well-being Scale (SWEMWBS)
SWEMWBS % change in
prevalence
Potential number of
individuals (18-69 years)
with improved outcomes
Overall low mental well-being 27.0 108,275
Never or rarely feeling optimistic
about the future 43.3 66,598
Never or rarely feeling useful 47.5 83,729
Never or rarely feeling relaxed 37.8 91,908
Never or rarely dealing with
problems well 31.4 44,045
Never or rarely thinking clearly 34.2 33,518
Never or rarely feeling close to
other people 24.7 36,227
Never or rarely being able to
make up their mind about things 26.1 17,435
Adverse Childhood Experiences and their association with Mental Well-being in the Welsh adult population
9
0 Text
Preventing ACEs to improve mental well-being in Wales
This report is not intended to provide a comprehensive
review of activities being undertaken in Wales either to
reduce ACEs or improve mental well-being. Critically
however, the Together for Mental Health – a
Strategy for Mental Health and Well-being in
Wales [15] sets out the policy framework for tackling
low mental well-being which is committed to person-
centred holistic care, engaging in all aspects of a
person’s life. This includes:
the promotion of mental well-being and, where
possible, preventing mental health problems
developing as a main theme;
joint-working across sectors to address the range
of factors in people’s lives which can affect mental
health and well-being.
Also, the Together for Children and Young People
programme is a multi-agency service improvement
programme which was established to consider ways
to reshape, remodel and refocus the emotional and
mental health services provided for children and young
people in Wales, in line with principles of prudent
healthcare.
The strategy acknowledges that tackling problems
such as poverty and drug and alcohol misuse are
important, as well as making sure people have strong
communities, healthy schools, good workplaces and
strong relationships. In Wales, early years and anti-
poverty programmes such as Communities First and
Flying Start aim, amongst other things, to increase
people’s life skills and understanding of good mental
health. Such early life interventions have been shown
to help reduce child abuse, depression and substance
use, and indicate improved outcomes for both parents
and children [16-18]. United in Improving Health in
Wales [19] also provides a platform for exploitation
of assets from not just within the health system,
but also resources from within other sectors such as
schools, workplaces, housing, police and fire services.
Understanding the impact of ACEs is a crucial element
of accomplishing the goals of United in Improving
Health in Wales which has adopted improving
outcomes in the early years as a priority.
More broadly, the Well-being of Future Generations
(Wales) Act (2015) [14] aims to ensure that the health
and well-being of future generations in Wales is
secured. This ground-breaking piece of legislation
provides an opportunity for the reduction of ACEs
across Wales by achieving its goals of placing the
needs of new and subsequent generations at the
centre of all public policy in order to build a healthier,
happier, more equal and sustainable Wales. The goal
of ‘a happier Wales’ includes the creation of a society
where an individuals’ physical and mental well-being
are maximised.
Results from the Welsh ACE survey identify both the potential harms to mental well-
being of experiencing childhood adversity, and the substantial gains possible if targeted
action is taken to prevent ACEs.
As well as tackling ACEs in Wales to prevent poor
mental well-being, the promotion of mental well-
being has become a global priority. In 2013, the World
Health Organization developed the Mental Health
Action Plan 2013-2020 [20]. The Plan highlights the
key goal of promoting mental well-being throughout
the life course by:
strengthening effective leadership for mental
health;
providing comprehensive and integrated mental
health and social care services in community-based
settings;
implementing strategies for promotion and
prevention in mental health;
strengthening information systems, evidence and
research for mental health.
Research has also been carried out to examine links
between Mental Health and ACEs through the
World Mental Health Survey. This highlights, at an
international level, the relationships between childhood
adversities and mental disorders [11]. Moreover, the
recently developed Sustainable Development Goals
include measures to improve both physical and mental
health on a global basis as well as targets specifically
focusing on reducing the abuse of children [21].
International support
Public Health Wales
10
Research
This report has provided the platform for identifying
the scale and impact of ACEs in Wales on
mental well-being. Further research using
the Secure Anonymised Information Linkage
(SAIL) databank in Wales is currently being
undertaken to examine the association
between ACEs, healthcare utilisation and
educational outcomes during childhood.
This cohort study will allow individuals to
be followed over time and improve our
understanding of how exposure to ACEs
at different points in childhood may impact
mental health and well-being, educational
attainment and health service use across the
life course. New research initiatives such as
‘HealthWise Wales’6 should create even greater
opportunities to understand and address ACEs in
the future.
Conclusion
This report is primarily aimed at describing the
association between ACEs and mental well-being in
the adult population in Wales. The Welsh ACE survey
identified that the prevalence of low mental well-being
in adults is strongly related to the number of ACEs
individuals reported experiencing as children. This
relationship remained the same even after accounting
for socio-demographic factors. Further, exposure to
ACEs was not only a significant factor in predicting
overall mental well being but also strongly related
to each individual element in the mental well-being
(SWEMWBS) scale. ACEs could be responsible for
almost a third (27%) of adults reporting a low mental
well-being score within this research. In other words,
eradicating ACEs in Wales could potentially reduce the
number of individuals who report low mental well-
being by just over 100,000.
Mental well-being has become a priority on both
international and national fronts. Wales is well
positioned to prevent ACEs from occurring, by
ensuring families are well equipped to deal with the
stresses of everyday life, especially during pregnancy
and early parenthood. None of this can be achieved
without working collaboratively across health,
education, social services and criminal justice services.
Strategies in Wales such as Together for Mental
Health and policies such as the Well-being of Future
Generations (Wales) Act 2015 provide the platform
for such activity and collaborative initiatives such as
United in Improving Health provide the opportunity for
the coordination of assets and resources to collectively
work to prevent ACEs in the future.
6 Healthwise Wales is a Health and Care Research Wales initiative for a Welsh National Population cohort study, which will engage with the
population of Wales and encourage them to become actively involved in research to improve health and well-being, and provide a platform for
research, policy and service development and evaluation. For more information, see http://www.healthwisewales.gov.wales/
Adverse Childhood Experiences and their association with Mental Well-being in the Welsh adult population
11
0 TextReferences
1 Felitti VJ, Anda RF, Nordenberg D et al. 1998. ‘Relationship of child-
hood abuse and household dysfunction to many of the leading
causes of death in adults: the Adverse Childhood Experiences (ACE)
Study.’ American Journal of Preventive Medicine 14:245–258.
2 Anda RF, Felitti VJ and Bremner JD. 2006. ‘The enduring effects
of abuse and related adverse experiences in childhood. A conver-
gence of evidence from neurobiology and epidemiology’ European
Archives of Psychiatry and Clinical Neuroscience 256(3):174-186
3 Bellis MA, Hughes K, Leckenby N, Perkins C and Lowey H. 2014a.
‘National Household Survey of adverse childhood experiences and
their relationship with resilience to health-harming behaviours in
England’. BMC Medicine 12:72.
4 Bellis, MA, Ashton, K, Hughes, K et al. 2016. Adverse Childhood
Experiences and their impact on health harming behaviors in the
Welsh Adult population. Cardiff: Public Health Wales / Liverpool:
Centre for Public Health, Liverpool John Moores University. http://
www2.nphs.wales.nhs.uk:8080/PRIDDocs.nsf/7c21215d6d0c613e80256f-
490030c05a/d488a3852491bc1d80257f370038919e/$FILE/ACE%20Re-
port%20FINAL%20(E).pdf (accessed 15 February 2016)
5 Petchel P and Pizzagalli DA. 2011. Effects of early life stress on
cognitive and affective function: an integrated review of human
literature. Psychopharmacology 214:55-70
6 Bellis MA, Hughes K, Jones A et al. 2013. Childhood happiness and
violence: a retrospective study of their impacts on adult well-being.
BMJ Open 3(9):e003427.
7 Schilling EA, Aseltine Jr RH and Gore S. 2007. Adverse childhood
experiences and mental health in young adults. BMC Public Health
7:30.
8 Afifi TO, Mether A, Boman J et al. Childhood adversity and per-
sonality disorders: results from a nationally representative popula-
tion-based study. J Psychiatr Res 45:814-22.
9 Scott KM, Von Korff M, Angermeyer MC et al. 2011. The asso-
ciation of childhood adversities and early onset mental disorders
with adult onset chronic physical conditions. Arch Gen Psychiatry
68(8):838-844
10 Schilling EA, Aseltine RH and Gore S. 2007. The impact of
cumulative childhood adversity on young adult mental health:
Measures: models and interpretations. Social Science and Medicine
66(5):1140-1151
11 Kessler RC, McLaughln KA, Green JG, Gruber MJ, Sampson NA,
Zaslavsky AM, et al. Childhood adversities and adult psychopa-
thology in the WHO World Mental Health Surveys. B J Psych 2010;
197:378-385.
12 Hughes K, Lowey H, Quigg Z and Bellis MA. 2016. Relationships
between adverse childhood experiences and adult mental well-be-
ing: results from an English national household survey. BMC Public
Health 16:222. Published online 2016 Mar 3. doi: 10.1186/s12889-
016-2906-3.
13 Public Health Wales and Welsh Government. 2016. Measuring the
health and well-being of a nation. Public health outcomes frame-
work for Wales. http://gov.wales/docs/phhs/publications/160329frame-
worken.pdf (accessed 31 March 2016).
14 Welsh Government. 2015. Well-being of Future Generations
(Wales) Act. http://gov.wales/topics/people-and-communities/people/fu-
ture-generations-bill/?lang=en (accessed 17 February 2016).
15 Welsh Government. 2012. Together for Mental Health – A Strategy
for Mental Health and Well-being in Wales. http://gov.wales/topics/
health/nhswales/healthservice/mental-health-services/strategy/?lang=en
(accessed 17 February 2016).
16 Olds DL. 2006. The nurse-family partnership: An evidence-based
preventive intervention. Infant Mental Health Journal 27(1).
17 De Graaf I et al. 2008. Effectiveness of the Triple P Positive Parent-
ing Program on Behavioural Problems in Children: A Meta-Analysis.
Behav Modif 32(5):714-35.
18 Webster-Stratton C, Reid MJ and Stoolmiller M. 2008. Preventing
conduct problems and improving school readiness: evaluation of
the Incredible Years Teacher and Child Training Programs in high-
risk schools. Journal of Child Psychology and Psychiatry 49(5):471-
488.
19 United in Improving Health. 2015. http://www.wales.nhs.uk/
sitesplus/888/news/37242/
20 World Health Organisation. 2013. Mental Health Action Plan
2013-2020. http://www.who.int/mental_health/publications/action_plan/en/
(accessed 16 February 2016).
21 United Nations. 2015. Transforming our World: The 2030 agenda
for sustainable development. https://sustainabledevelopment.un.org/
post2015/transformingourworld/publication (accessed 31 March 2016).
Public Health Wales
12
Appendix 1 Data Tables
Table i: Bivariate relationship between participant demographics and mental well-beinga
Mental well-being (over the last 2 weeks)
SWEMWBS
< 20
I’ve been feeling
optimistic about
the future
(never/rarely)
I’ve been
feeling useful
(never/rarely)
I’ve been
feeling relaxed
(never/rarely)
I’ve been
dealing with
problems well
(never/rarely)
I’ve been
thinking clearly
(never/rarely)
I’ve been
feeling close to
other people
(never/rarely)
I’ve been able to
make up my mind
about things
(never/rarely)
Prevalence %19.42 8.9 8.8 11.39 7.11 4.94 7.27 3.31
n (total sample size) 1843 1843 1843 1843 1843 1843 1843 1843
Age Years,
%18-29 18.85 9.42 9.60 10.30 9.42 5.24 6.81 3.49
30-39 20.48 4.82 8.84 15.66 7.63 5.22 5.62 1.61
40-49 20.49 9.48 7.65 12.23 7.65 5.50 6.73 3.06
50-59 18.24 10.03 7.29 11.25 4.56 4.56 9.73 3.34
60-69 19.73 9.31 9.86 9.59 4.93 4.11 7.40 4.39
x20.854 6.041 2.444 6.59 10.757 1.008 4.281 3.697
p 0.931 0.196 0.655 0.159 0.029 0.909 0.369 0.449
Sex, % Male 19.81 8.41 7.45 13.63 6.50 5.01 9.07 2.45
Female 19.03 9.4 10.18 9.07 7.74 4.87 5.54 4.20
x20.180 0.556 4.257 9.489 1.085 0.019 8.527 4.428
p 0.672 0.456 0.039 0.002 0.298 0.891 0.003 0.035
Deprivation
Quintile, % 1 (least deprived) 14.64 5.46 7.94 5.21 5.46 2.98 4.96 3.23
2 22.22 9.69 8.26 15.10 6.27 2.85 5.98 3.99
3 20.49 8.47 8.74 12.02 8.74 6.56 8.74 3.28
4 19.26 9.92 8.50 13.88 7.08 6.80 8.50 3.12
5 (most deprived) 21.08 11.35 10.54 11.62 8.11 5.68 8.38 2.97
x2 trend 8.57 9.429 1.937 22.359 4.078 11.641 6.687 0.688
p 0.073 0.051 0.747 <0.001 0.396 0.020 0.153 0.953
Ethnicity, % Whiteb19.70 8.88 8.89 11.62 7.18 4.5 7.35 3.42
Otherc10.77 7.69 4.62 3.08 4.62 4.62 3.08 1.54
x23.533 5.54 2.484 4.663 1.897 1.813 1.871 0.894
p 0.171 0.063 0.289 0.097 0.387 0.404 0.392 0.639
Abbreviations: SWEMWBS Short Warwick-Edinburgh Mental Well-being Scale
a Bivariate relationships should be treated with caution as, for instance, demographic (e.g. Age, sex, ethnicity) differences between deprivation quintiles are not accounted for at this stage.
b Including White British, White Irish, White Gypsy or Irish Traveller, White Other
c Including Indian, Pakistani, Bangladeshi, Chinese, Other Asian and Other Ethnicities
Adverse Childhood Experiences and their association with Mental Well-being in the Welsh adult population
13
Table ii: Bivariate association between mental well-being and ACE Count
Outcome All ACE Count, % X2
trend P
% N 0 1 2-3 4+
Mental well-being (over the last 2 weeks)
SWEMWBS < 20 19.42 1843 14.23 15.88 23.27 41.12 84.178 <0.001
I’ve been feeling optimistic about the future (never/rarely) 8.9 1843 5.27 8.82 11.84 20.55 58.279 <0.001
I’ve been feeling useful (never/rarely) 8.8 1843 4.68 6.76 15.10 21.74 83.764 <0.001
I’ve been feeling relaxed (never/rarely) 11.39 1843 7.06 12.06 20.41 18.97 48.026 <0.001
I’ve been dealing with problems well (never/rarely) 7.11 1843 4.78 3.82 7.76 20.16 56.354 <0.001
I’ve been thinking clearly (never/rarely) 4.94 1843 3.28 4.41 6.53 10.67 23.467 <0.001
I’ve been feeling close to other people (never/rarely) 7.27 1843 5.57 5.59 9.39 14.23 21.984 <0.001
I’ve been able to make up my mind about things (never/rarely) 3.31 1843 2.49 2.06 2.45 9.09 17.581 <0.001
Abbreviation: ACE adverse childhood experience; SWEMWBS Short Warwick-Edinburgh Mental Well-being Scale
Public Health Wales
14
Table iii: Adjusted Odds Ratios (AOR) for mental well-being in ACE count groups
Outcome n ACE Count (reference category 0 ACEs) Demographic factors
P 1 P 2 to 3 P 4+ P Ethnicity Age Sex WIMD
AOR (95% CI) AOR (95% CI) AOR (95% CI)
Mental well-being
(over the last 2 weeks)
SWEMWBS < 20 1843 <0.001 1.104 (0.781-1.562) 0.574 1.863 (1.310-2.651) <0.001 4.674 (3.389-6.446) <0.001 0.071 0.737 0.484 0.033
I’ve been feeling
optimistic about the
future (never/rarely) 1843 <0.001 1.889 (1.176-3.035) 0.009 2.508 (1.535-4.097) <0.001 5.808 (3.760-8.971) <0.001 0.853 0.014 0.595 0.043
I’ve been feeling
useful (never/rarely) 1843 <0.001 1.530 (0.909-2.574) 0.109 3.803 (2.384-6.068) <0.001 6.062 (3.913-9.391) <0.001 0.236 0.284 0.068 0.839
I’ve been feeling
relaxed (never/rarely) 1843 <0.001 1.737 (1.147-2.630) 0.009 3.455 (2.299-5.191) <0.001 3.439 (2.264-5.224) <0.001 0.072 0.755 0.002 <0.001
I’ve been dealing with
problems well (never/
rarely) 1843 <0.001 0.804 (0.427-1.513) 0.498 1.752 (1.001-3.066) 0.050 5.180 (3.332-8.054) <0.001 0.299 0.202 0.493 0.203
I’ve been thinking
clearly (never/rarely) 1843 <0.001 1.482 (0.785-2.796) 0.225 2.183 (1.165-4.089) 0.015 4.192 (2.403-7.312) <0.001 0.917 0.989 0.754 0.009
I’ve been feeling close
to other people
(never/rarely) 1843 <0.001 1.091 (0.634-1.879) 0.753 1.829 (1.083-3.089) 0.024 3.435 (2.153-5.481) <0.001 0.224 0.086 0.006 0.083
I’ve been able to make
up my mind about
things (never/rarely) 1843 <0.001 0.851 (0.363-1.996) 0.711 1.048 (0.423-2.597) 0.920 4.516 (2.457-8.300) <0.001 0.319 0.195 0.069 0.914
Abbreviation: ACE adverse childhood experience; SWEMWBS Short Warwick-Edinburgh Mental Well-being Scale; WIMD Welsh Index of Multiple Deprivation
Adverse Childhood Experiences and their association with Mental Well-being in the Welsh adult population
15
Table iv: Modelled impact of preventing ACEs at sample and national population levels on mental well-being
Outcome
Sample Adjusted to national population
Current
prevalence
Estimates with 0
ACEs
%
change
Number
saved Current prevalence
Estimates with 0
ACEs
%
change
Number
saved
% n % n % n % n
Mental well-being (over the last 2
weeks)
SWEMWBS < 20 19.42 358 14.23 143 - 26.73 344 19.64 400802 14.34 292527 - 27.02 108275
I’ve been feeling optimistic about
the future (never/rarely) 8.90 164 5.27 53 - 40.79 159 7.54 153887 4.28 87289 - 43.28 66598
I’ve been feeling useful (never/
rarely) 8.80 162 4.68 47 - 46.82 157 8.63 176199 4.53 92470 - 47.52 83729
I’ve been feeling relaxed (never/
rarely) 11.39 210 7.06 71 - 38.02 203 11.92 243326 7.42 151418 - 37.77 91908
I’ve been dealing with problems
well (never/rarely) 7.11 131 4.78 48 - 32.77 126 6.86 140081 4.71 96036 - 31.44 44045
I’ve been thinking clearly (never/
rarely) 4.94 91 3.28 33 - 33.60 88 4.8 97954 3.16 64436 - 34.22 33518
I’ve been feeling close to other peo-
ple (never/rarely) 7.27 134 5.57 56 - 23.38 128 7.18 146413 5.4 110186 - 24.74 36227
I’ve been able to make up my mind
about things (never/rarely) 3.31 61 2.49 25 - 24.77 59 3.28 66838 2.42 49403 - 26.09 17435
Abbreviaon: ACE adverse childhood experience; SWEMWBS Short Warwick-Edinburgh Mental Well-being Scale
Public Health Wales
16
About us
Public Health Wales exists to protect and improve health and wellbeing and
reduce health inequalities for people in Wales.
We are part of the NHS and report to the Minister for Health and Social
Services in the Welsh Government.
Our vision is for a healthier, happier and fairer Wales. We work locally,
nationally and, with partners, across communities in the following areas:
Health protection – providing information
and advice and taking action to protect people
from communicable disease and environmental
hazards.
Microbiology – providing a network of
microbiology services which support the
diagnosis and management of infectious
diseases.
Screening – providing screening programmes
which assist the early detection, prevention and
treatment of disease.
NHS quality improvement and patient
safety – providing the NHS with information,
advice and support to improve patient
outcomes.
Primary, community and integrated
care – strengthening its public health impact
through policy, commissioning, planning and
service delivery.
Safeguarding – providing expertise and
strategic advice to help safeguard children and
vulnerable adults.
Health intelligence – providing public
health data analysis, evidence finding and
knowledge management.
Policy, research and international
development – influencing policy,
supporting research and contributing to
international health development.
Health improvement – working across
agencies and providing population services to
improve health and reduce health inequalities.
Further information
Web: www.publichealthwales.org
Email: generalenquiries@wales.nhs.uk
Twitter: @PublichealthW
Facebook: www.facebook.com/#!/PublicHealthWales
Public Health Wales
Hadyn Ellis Building
Maindy Road
Cathays
Cardiff CF24 4HQ
Tel: 02921 841 933
Centre for Public Health
Liverpool John Moores University
Henry Cotton Campus
Level 2, 15-21 Webster Street
Liverpool L3 2ET
Tel: 0151 231 4542
... 90 The Welsh ACE studies have shown that children who suffer ACEs are at increased risk of adopting health-harming behaviours and developing mental and physical illness throughout life. [91][92][93] Elsewhere, studies have found associations between ACEs and the development of problem gambling in adulthood. 94 ...
... It may be useful to incorporate gambling harms into frameworks for adverse childhood experiences (ACEs) and assess these harms in ACE population surveys. [91][92][93]181 Finally, under Prosperity for All: the national strategy 182,183 , it may be helpful to consider gambling harms as an outcome under the Healthy and Active aim, related to those of alcohol and smoking. Broader polices (e.g. ...
... Wales has demonstrated a commitment to understanding ACEs and developing effective nationwide responses via a series of ACE-based studies (Bellis et al., 2015;Ashton et al., 2016;Hughes et al., 2018). For example, Hughes et al. (2018) examined sources of resilience and their moderating relationships with harms from ACEs and identified how having a consistent trustworthy and supportive adult figure can mitigate negative outcomes. ...
Article
Research has demonstrated conclusively that the experience of adversities in childhood increases the risks for poor outcomes in the domains of physical and mental health and economic and social circumstances across the life course. This has produced a wave of interest in the effects of Adverse Childhood Experiences internationally, with developments in policy across the UK nations reflective of this. The translation of such research and policy development has witnessed the growing dominance of the 'toxic stress model' as underpinning the early signalling of troubles in children. Such signals are further conceptualised as the presence of 'trauma'. It is upon these conceptual pillars that therapeutically orientated services are being built. In this article , we describe these developments, offering as they do, challenges to short-term interventions as well as providing opportunities for social workers to appropriate the developing knowledge base so as to inform more effective ways of working.
Article
The Offender Personality Disorder Pathway programme is a jointly commissioned initiative between NHS England and Her Majesty’s Prison & Probation Service (HMPPS), the aim of which is to provide a pathway of psychologically informed services for offenders who are likely to be diagnosed with personality disorder. This paper aims to describe the underpinning evidence behind the principles and expectations of services that make up the OPD pathway programme. Evidence of personality disorder treatments from mental health settings, as well as the evidence base from the criminal justice system and the Ministry of Justice’s ‘What Works?’ literature, is considered and draws together the evidence underlying critical elements of the programme. Research shows that there is no one treatment shown to be successful for the treatment of personality disorder. As such, a holistic approach is taken, with key components including trauma-informed approaches, a focus on relationship building, early identification and sentence planning, and the importance of workforce development and relationships.
ResearchGate has not been able to resolve any references for this publication.