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Adverse Childhood Experiences, Mental Health, and Risk Behaviors Among Men in the Solomon Islands

Authors:

Abstract

Compared with many parts of the world, there has been little research in Pacific Island nations into the effects of adverse childhood experiences (ACEs) on adult health. This is a significant gap for local evidence-based child protection. We describe findings from a survey of 400 men aged 18 to 70 years recruited from randomly sampled households in Honiara city, Solomon Islands. Most men reported multiple adversities during childhood (80.7% 3 or more; 46% 5 or more), such as exposure to community and domestic violence, bullying, physical maltreatment, and sexual abuse. Men with multiple ACEs had significantly lower well-being and more psychological distress, recent stressful life events, and health risk behaviors. This study reports the first observation that betel quid chewing increased as a function of multiple ACEs. In comparison with recent East Asian studies, the Solomon Islands data suggest that the collective geographic category of “Asia-Pacific” masks significant intraregional differences in childhood adversities.
Adverse childhood experiences,
mental health and risk behaviours
among men in the Solomon Islands.
Paraniala Silas C Lui (PhD)1*, Michael P Dunne (PhD) 1,2, Philip Baker (PhD)1, Verzilyn
Isom (RN, MN)3
Paraniala Silas C Lui (PhD)1*, Michael P Dunne (PhD) 1,2, Philip Baker (PhD)1, Verzilyn Isom (RN, MN)3
1 School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia.
2Institute for Community Health Research, Hue University, Hue, Vietnam
3School of Nursing & Applied Health Studies, Solomon Islands National University, Honiara, Solomon Islands.
*Corresponding author: paraniala@gmail.com
Abstract
Compared to many parts of the world, there has been little research in Pacific Island nations
into the effects of Adverse Childhood Experiences (ACEs) on adult health. This is a significant
gap for local evidence-based child protection. We describe findings from a survey of 400 men
aged 18-70 years recruited from randomly sampled households in Honiara city, Solomon
Islands. Most men reported multiple adversities during childhood (80.7% three or more; 46%
five or more), such as exposure to community and domestic violence, bullying, physical
maltreatment and sexual abuse. Men with multiple ACEs had significantly lower well-being and
more psychological distress, recent stressful life events and health risk behaviours. This study
reports the first observation that betel quid chewing increased as a function of multiple ACEs. In
comparison to recent East Asian studies, the S.I. data suggest that the collective geographic
category of “Asia-Pacific” masks significant intra-regional differences in childhood adversities.
Key words:
Adverse childhood experiences, mental health, risk behaviour, males, Solomon Islands
Introduction
Adversity during childhood has serious effects on adults physical and mental health and social
well-being, especially when children grow up being exposed to violence, parental neglect,
dangerous neighbourhoods, parent or sibling mental illness, and other complex family and
social problems. Studies have shown dose-response associations between multiple Adverse
Childhood Experiences (ACEs) and health risk behaviours (such as smoking, alcohol misuse, and
illicit drug use), depression, anxiety, physical health problems (such as cancer, cardiovascular
disease and sexually transmitted infections), violence re-victimisation and perpetration later in
adulthood. 1,2 These associations appear to remain significant throughout life.3 For example, a
recent study among men and women in Bhutan aged from 60 to 101 years found that low
quality of life was linked with higher cumulative adverse childhood experiences that occurred
five to eight decades earlier. 4
The basic fact that childhood adversity leads, by various pathways, to later problems is hardly
surprising. However, as more epidemiological data have been gathered around the world, the
magnitude of the impact has been shown to be truly remarkable. A recent systematic review of
Asia Pacific Journal of Public Health
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the 37 best studies internationally that measured the health and risk behaviours of adults
exposed to four or more ACEs (in comparison to no adversity) found consistent, highly elevated
likelihood of severe outcomes such as suicidal behaviour, depression, other mental illness and
problematic alcohol and drug use, with odds ratios ranging from above 3 to more than 7.5 Of the
22 studies that measured smoking among adults, all found significantly higher risk among those
with multiple adversities. Perpetration of violence as an adult was eight times greater among
those with four or more ACEs.5
Compared to research in many western countries, the evidence base on ACEs in the Asia-Pacific
region is relatively sparse. 6,7 This is particularly the case in Pacific Island nations, such as the
Solomon Islands. Most studies classed as being from the Asia-Pacific region have been done in
heavily populated Asian countries or Australia. 8-12
Of the many forms of adversity, childhood physical, sexual and emotional abuse and exposure to
domestic violence are among the most common. No large scale regional survey of a wide range
of ACEs has been done, although systematic reviews have started to chart the breadth of the
problem of child abuse and neglect and the possible health and socioeconomic impacts.13,14 The
United Nations Multi-Country Study on Men and Violence in Asia and the Pacific15 is the most
comprehensive multi-national study of inter-Partner Violence (IPV) and children’s exposure to
IPV in this region. The study included in-depth interviews with representative samples of 3,106
women from sites in four countries (Cambodia, China, Papua New Guinea and Sri Lanka) and
10,178 men from sites in six countries (Bangladesh, Cambodia, China, Indonesia, Papua New
Guinea and Sri Lanka). Adults were asked about a variety of childhood traumas. There was very
wide diversity between cultures in the levels of both childhood exposure to trauma and adults’
experience of IPV perpetration and victimisation. Self-reported rape perpetration by men was
highest in Bougainville PNG and least in Bangladesh.15 Among men, all forms of childhood
trauma were associated with later perpetration of violence against their partners.16 The
evidence clearly points to childhood adversity as a cause, and then an inter-generational
consequence, of children’s exposure to violence in the home.16
There is a need for further research with men and women in Pacific Island nations to deepen
understanding of childhood adversity and its effects on health and well-being. This study is part
of a larger study on men’s sexual health in the Solomon Islands, and is the first from this country
to estimate the prevalence and possible cumulative effects of multiple categories of ACEs upon
key indicators of mental health and risk behaviours. The focus on men only was entirely
pragmatic; the principal researcher (PSL) is a Solomon Islands man and the survey also
included many questions about sexual dysfunction, relationship difficulties and other sensitive
personal issues17. With male only interviewers, it was not culturally appropriate (nor feasible
within a limited budget) for the research team to broaden the scope and ask women to
volunteer. However, the survey approach described here could be adapted in the Solomon
Islands or other Pacific nations for research guided by and conducted with women.
The main objectives of this study were to estimate the prevalence of adverse childhood
experiences and examine the possible impact of early adversity on the health behaviours and
psychological wellbeing of adult males in the Solomon Islands.
Methods
A cross sectional survey regarding the health of men in Honiara, Solomon Islands was
conducted between June and August 2014. Four hundred men aged from 18 to 70 years were
recruited from households in Honiara city and completed face to face interviews. Each
interview lasted between 30 to 40 minutes.
This study employed quasi-randomised quota sampling that was achieved in three stages using
the following procedures:
Asia Pacific Journal of Public Health
Step 1: Simple random selection of 4 wards from the 12 civic wards in Honiara City.
Step 2: Random selection of streets as points in each ward to approach households using
systematic random selection. There are no street names or numbers in many residential areas
in Honiara, so researchers selected the first household in streets in each ward as the starting
point and then approached every third house.
Step 3: At each selected household an attempt was made to recruit males aged 18 and over, until
the quota of 100 interviews per ward was reached. There were no call backs on households
where there was no response or no man was available. Rather, the closest household was
approached. When a household contained multiple eligible men, the man whose birthday was
closest to the survey sampling date was selected.
Data Collection
The interviews were held in places where respondents could not be overheard, including open
public spaces and inside houses. In the Solomon Islands, literacy is quite variable, with fairly
high levels of basic literacy but significant numbers of adult males have insufficient literacy to
read long documents. The face to face interview approach allowed the researchers to explain
the purpose of the study and the need for confidentiality. Interviews were conducted by three
Solomon Islander research assistants (male registered nurses) and the male principal
investigator (a Solomon Islander Public Health researcher). All interviewers were fluent in S. I.
Pidgin and in English, and all interviews were conducted in S.I. Pidgin because it is the national
language.
Study instrument
The survey instrument consisted of questions relating to demographic characteristics (age,
education, place of birth, occupation); self-reported general well-being (The WHO-5 Index of
Wellbeing; 18 psychological distress (the K-10) questionnaire: 19 and a brief checklist of common
chronic diseases. Questions about health risk behaviours included items on current alcohol
consumption, tobacco smoking, illegal drug use and betel quid chewing (betel quid is a
combination of Areca (betel) nut, betel leaves and lime. Chewing this quid is a common cultural
practice in S.I.). The interview also included questions about urinary tract symptoms, sexual
difficulties, sexually transmitted infections (ever) and utilisation of reproductive health services.
Questions about adverse life events included a checklist of recent (past year) stressful life
experiences (SLEs; modified from Holmes, Rahe 20 to be appropriate to Solomon Islands
contexts). The World Health Organization Adverse Childhood Experiences International
Questionnaire (ACE-IQ) was used to estimate the prevalence of adverse experiences during the
first 18 years of life. 12 There were 13 categories in the original ACE-IQ including; physical
abuse, emotional abuse, contact sexual abuse, alcohol and/or drug abuser in home, someone
chronically depressed, mentally ill, institutionalised or suicidal, household member treated
violently, one or no parents, parental separation or divorce, emotional neglect, physical neglect,
bullying, and exposure to community violence ad collective violence
(http://www.who.int/violence_injury_prevention/violence/activities/adverse_childhood_exper
iences/en/). In this study the two original items about emotional neglect were excluded due to
reports of low face validity in pilot testing, and one question about death of a parent during
childhood was excluded because it was deemed to be culturally inappropriate to ask in the
context of Solomon Islands.
The questionnaire was drafted in English and then translated forward and backward into
Solomon Islands Pidgin English using the WHO process for translation. Two bilingual health
professionals independently translated the questionnaire into Pidgin. Inconsistencies were
reconciled through discussion with the bilingual first author. Back translations into English by
4
one independent bilingual health professional was examined for equivalence by the second
author. The interview was pre-tested among 20 adult men before the survey commenced.
Further details of this study can be found in a recent paper by Lui, Dunne, Baker and Isom
(2017).17
Data analysis
Analyses were undertaken using SPSS v22. The total number of ACEs were added to get the
cumulative ACEs score for each participant ranging from 0 to 11. The ACEs score were
combined into four ordinal categories because of the small sample sizes (0-2, 3-4, 5-6 and 7 or
more). Pearson’s chi-square tests were used to analyse associations between categorical
variables. One-way ANOVA was used to analyse the associations between ACEs score and
mental health status.
Ethics approval
The study protocol was approved by Queensland University of Technology Human Research
Ethics Committee (1400000073) and the Solomon Islands National Health Ethics Review (HRC
13/07) Committee before commencement of data collection. All study participants were
informed of the nature, purpose, potential risks and benefits of the study. Privacy was
maintained at all times during and after data collection.
Results
Socio-demographic characteristics of the sample
The research team approached 420 men in randomly selected households. Eight men refused to
participate, while 12 men indicated they were interested but were too busy to be interviewed
during the survey period. All men who commenced the interview completed it. The overall non-
participation rate was 4.8%. Almost half (48.5%) of the 400 interviewed men were aged
between 18 and 29 years. One quarter (24.9%) were unemployed and nearly a third (30.3%)
were students or in job training. Nearly one fifth (18.5%) had completed either no formal
education or only primary school education.
Prevalence of adverse childhood experiences
The percentages of men endorsing at least one item in the 12 categories of ACEs are shown in
Table 1. The most commonly reported types of adversity up to the age of 18 years were:
witnessed community violence (84%), household member treated violently (77%), bullying
(52%), emotional abuse (51.7%) and physical neglect (44.3%). Unwanted sexual experiences
that involved physical contact were reported by one third of the sample (34%). There were a
number of significant associations between ACEs and age group. Younger males (18 29 years)
were more likely to report physical neglect, unwanted sexual contact and experiencing parental
divorce during their childhood. Compared to younger men, the older respondents were more
likely to report growing up in a household with someone who was depressed, suicidal,
chronically mentally ill or had been imprisoned.
Multiple adversity was the norm. Only 19.3% of men reported 0 to 2 adversities during
childhood. More than a third (34.8%) experienced 3 or 4 ACEs, while 26.5% and 19.5% of men
experienced 5 to 6, or 7 or more, ACEs respectively.
Table 1: Prevalence of childhood adversities among men by age group in Honiara, Solomon
Islands.
Asia Pacific Journal of Public Health
Types of ACEs before aged 18
18-29 years
n=194 (%)
30+ years
n=206 (%)
Overall
n =400 (%)
Physical neglect
99 (51.0)
78 (37.9)*
177 (44.3)
Physical abuse
62 (32.0)
61 (29.6)
123 (30.8)
Emotional abuse
103 (53.1)
104 (50.5)
207 (51.7)
Contact sexual abuse
85 (43.8)
51 (24.8)**
136 (34.0)
Alcohol and/or drug abuser in the
household
26 (13.4)
22 (10.7)
48 (12.0)
Incarcerated household member
31 (16.0)
35 (17.0)
66 (16.5)
One parent or divorced
27 (13.9)
9 (4.4)**
36 (9.0)
Someone chronically depressed,
mentally ill, institutionalized or suicidal
13 (6.7)
26 (12.6)*
39 (9.8)
Household member treated violently
147 (75.8)
161 (78.2)
308 (77.0)
Bullying
107 (55.2)
101 (49.0)
208 (52.0)
Community violence
168 (86.6)
168 (81.6)
336 (84.0)
Collective violence
58 (29.9)
52 (25.2)
110 (27.5)
ACE categories
0-2
29 (14.9)
48 (23.3)
77 (19.3)
3-4
69 (35.6)
70 (34.0)
139 (34.8)
5-6
50 (25.8)
56 (27.2)
106 (26.5)
7 or more
46 (23.7)
32 (15.5)
78 (19.5)
Note: p-value<0.05*, p-value<0.001**
Table 2 shows the proportions of males reporting exposure to any single type of ACE in relation
to exposure to all other categories. Overall, it is clear that most ACEs co-occurred, with
considerable overlap for most specific types with exposure to community violence and reports
that a household member was treated violently, or they experienced bullying or childhood
emotional abuse. The general pattern indicated in Table 2 is that these men grew up in an
environment where there was widespread exposure to many forms of violence and other
adversity at home and in the community.
Table 3: Associations between multiple ACEs, current health risk behaviour, psychological
distress, wellbeing and recent stressful life events.
Variables
ACE Score № (%)
n (%)
0-2
3-4
5-6
7 +
𝑝 − 𝑣𝑎𝑙𝑢𝑒𝑠
Risk behaviours
Chewing betel quid
313 (78.3)
50 (64.9)
111 (79.9)
84 (79.2)
68 (87.2)
0.008*
Illicit drug use
39 (9.8)
3 (3.9)
11 (7.9)
12 (11.3)
13 (16.7)
0.088
Current smoker
233 (58.3)
36 (46.8)
81 (58.3)
65 (61.3)
51 (65.4)
0.096
Alcohol use
284 (71.0)
39 (50.6)
40 (71.2)
80 (75.5)
66 (84.6)
0.001*
Multiple sexual
partners
153 (36.8)
22 (28.6)
56 (40.3)
39 (36.8)
36 (46.2)
0.141
Mental health
Wellbeing
68.5(22.0)
62.5 (21.2)
55.6(24.9)*
45.8(26.1) *
0.001**
Distress (K-10)
14.1 (3.9)
15.4 (3.7)
16.8 (4.9)*
20.3 (6.0)*
0.001**
Stressful Life events
2.0 (2.0)
2.7 (2.4)
3.3 (2.3) *
5.2 (2.9) *
0.001**
One-way ANOVA and Tukey post hoc test, * p < 0.05. p-value<0.001**. Higher me ntal health wellbeing score indicates better mental health ,and a higher K-10 indicates
worse mental health.
Associations between multiple adversity, adult health-risk behaviours and mental health
There were significant associations between the number of childhood adversities increased and
current alcohol use and chewing betel nut quid (see Table 3). This is the first known
observation that childhood adversity correlates with betel nut quid use; this is notable, as
chewing betel nut quid in the Solomon Islands is normative among adult males. The
associations between ACE load and tobacco smoking and illicit drug use were approaching
significance.
Mental health was strongly associated with ACEs. Table 3 shows the proportions for the three
mental health indicators in relation to ACE scores. As respondents reported more ACEs, they
had more psychological stress, more recent stressful life events, and lower general wellbeing.
The Tukey post hoc contrasts indicated that the group with seven or more ACEs differed from
all other ACE load levels, while men with 5 or 6 ACEs had poorer mental health than those with
0 to 2 types.
Discussion
This study is the first in the Solomon Islands and one of few in the South Pacific region to report
on childhood adversities experienced by adult males. The data clearly suggest that multiple
adversity is the norm; the great majority of men (91.5%) reported at least one type of ACE,
while 80% had three or more and one in every five men (19.5%) reported seven or more types.
For many men, their high exposure to community and collective violence would be related to
widespread civil conflict in the late 1990s and early 2000’s. The finding that three quarters of
the males witnessed violence in the household when growing up is consistent with evidence
from interviews with Solomon Islands women and indicates prevailing norms for physical and
emotional violence in interpersonal relationships. 21
As noted by many authors, direct comparison of survey findings in this field is hampered by
variation in methods and measures. 11,22,23 The best available comparison for the Solomon
Islands study is the U.N. Multi-country cross sectional study on men and violence in Asia and the
Pacific.15 The focus was on male perpetration of sexual violence, although interviews with men
8
included assessment of some childhood adversities. 15 Our prevalence estimate for childhood
sexual abuse (CSA) of males in the Solomon Islands (34%) was close to that found in nearby
Bougainville (32%) using similar questions15. In both countries, the prevalence of male CSA was
two to three times higher than was found for men in Cambodia, China and Indonesia, and about
50% higher than in Bangladesh. Childhood exposure to violence at home was also common in
Bougainville and the Solomon Islands (56% and 77% respectively), with the Solomon Islands
estimate possibly higher because the question asked about witnessing any household member
being treated violently, whereas the Bougainville question was specific to witnessing abuse of
mothers by partners. The in-home violence exposure estimates for these two countries are at
least twice as high as found in East and South Asian countries.15
Beyond these few direct comparisons to men in Bougainville PNG, there are no directly
comparable studies of multiple childhood adversities among men in South Pacific Island
nations. This is the first in the region to examine associations between multiple ACEs and men’s
mental health and risk behaviours. Here, the findings are quite consistent with global
evidence. The dose-response relationships between multiple ACEs and higher psychological
distress, lower wellbeing, and risk of multiple stressful life events during adult years are similar
to studies in East Asia, the Middle East, North America, Africa and Europe. 9,24-26
A novel finding in this study is the significant association between ACEs and chewing betel quid.
This is interesting, as even this highly normative and long-standing social practice in Pacific
nations is apparently influenced by early life adversity. The finding suggests a further causal
pathway between ACEs and adult severe chronic diseases, similar to the trends in the USA and
other countries regarding alcohol and drug use and tobacco smoking. 27 Habitual betel quid
chewing, with or without concurrent tobacco use, is strongly linked with oral cancers,
periodontal disease, tooth decay and possibly cardiovascular disease.
Further research into childhood adversity and health is needed in the Solomon Islands and
other Pacific nations. Recent syntheses of global and regional evidence on child maltreatment
and other ACEs have started to quantify geographic variation and social and economic
impacts.28,29 Largely that work has captured scant or no evidence from Pacific nations. For
example, a systematic review by Le et al (2016) of multiple forms of victimisation experienced
by children and youth in Low and Lower-Middle income countries located no evidence from
Pacific islands.30 Similarly, the global review of links between multiple ACEs and adult health
problems in 37 studies by Hughes et al (2017) located none from the South Pacific region.5
One potentially important trend that appears when comparing this survey to other studies or
reviews in the East Asia region; 7,12,13,16 is that there are substantial national differences in risk
of several forms of adversity and interpersonal violence between Pacific Islands and proximal
Asian countries. Although further work is necessary to understand causes of this variation, it is
becoming very clear that summative prevalence estimates for the Asia-Pacific region may not be
very useful for describing the situation within individual countries and cultures.
This study has some limitations. The retrospective measurement of ACEs may be subject to
recall bias. While the magnitude of such bias is difficult to estimate, it is notable that the overall
pattern of (mostly) linear dose-response relationships between multiple ACEs, health risk
behaviour and adverse mental health is highly consistent with international evidence5.
The sample was not large and was limited to Honiara. Although this capital city is multicultural
and includes residents from all S.I. provinces, our sample could not be considered to be
representative of social diversity throughout the country. Although we took a simple random
sample of wards in Honiara, the final sample was only quasi-random due to difficulties in
randomisation of recruitment starting points for households in streets and residential clusters
that were un-named or where houses were not numbered. We obtained high participation from
households where men were present, but resource constraints in this study precluded multiple
contact attempts when no potentially eligible residents were at home when the researcher
Asia Pacific Journal of Public Health
visited. Further, inferences from this study are subject to the main limitation of cross-sectional
surveys: Direction of causation between ACEs and health problems cannot be determined.
Conclusion
This study has shown that multiple types of adversity are experienced by boys and adolescent
males in the Solomon Islands. The accumulated experience of adversity was strongly associated
with depression, psychological distress, low well-being and risky health-related practices. The
effects appear to be long lasting because ACEs are associated with health problems in younger
and older men. Further research is needed to extend understanding of determinants of
childhood adversities in the Solomon Islands and the Pacific region. The rapid growth in
epidemiological research into violence and other adversities in the lives of children in Asia
should be matched by further work in the Pacific to ensure that evidence for child protection
policy and programs is relevant to the lives of people in Pacific Island communities.
Conflict of Interest
The authors declare that we have no conflicts of interest relevant to the article.
Acknowledgement
The authors would like to thank the participants of the study and the following health care
workers for their contribution to this work. John Gela, Spencer Gabriel and George Lui at the
Ministry of Health and Medical Services, Honiara, Solomon Islands for assisting in data
collection. We would like to acknowledge financial assistance from the School of Public Health
and Social Work, Queensland University of Technology and an Australian Government
Endeavour postgraduate scholarship.
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... Regarding the relationships between ACE-IQ scores and psychopathological outcomes, several studies observed the association between the former and poor mental health (Almuneef et al., 2019;Cohrdes & Mauz, 2020). Scores in any ACE dimensions were found to be associated with common mental health disorders (El Mhamdi et al., 2020;Small et al., 2021;Subramaniam et al., 2020), psychological distress (Agbaje et al., 2021;Lui et al., 2018). Some studies pointed out the potential specific role of some ACE-IQ dimensions such as emotional abuse, physical neglect (Kumar et al., 2018) and sexual abuse (Almuneef, 2021). ...
... Finally, a relevant number of studies focused on the relationship between ACE-IQ and unhealthy behaviors. As a whole, all found that ACE exposure was a predictive factor of risky health behaviors (e.g., Almuneef et al., 2014;Almuneef, 2021;Lui et al., 2018;Wiehn et al., 2018). In addition, there was specific evidence about sexual risk behaviors (Small et al., 2021;Thang et al., 2017;VanderEnde et al., 2018) and poor adherence to healthy behaviors related to a chronic health condition (Goodman et al., 2017b;Krinner et al., 2020). ...
Article
Background The Adverse Childhood Experiences International Questionnaire (ACE-IQ) collects additional data (e.g., witness community violence/terrorism) than the previous version. Despite ACE-IQ is widely used and validated in several languages, no reviews focus on this measure. Objective The main goals are to: 1) synthesize the ACE-IQ prevalence rates and average means among community samples, both for total ACE and single dimensions (e.g., intrafamily abuse, bullying); 2) discuss these data in light of the characteristics of studies and samples; 3) identify main research lines of the field. Participants and setting The search for studies using the ACE-IQ with community participants was conducted on seven academic databases, including retrieval of grey literature. The screening process led to include 63 documents. Methods A systematic review following the PRISMA guidelines was performed. Results 1) On average, 75% of community respondents experienced ACEs, with a mean of three, primarily emotional abuse and bullying. 2) Males experienced more ACEs, but they were underrepresented, as well as children and adolescents. Most studies were conducted in Asia or Africa, and different geographical areas showed different pathways of prevalence in subdimensions. 3) Most research focused on prevalence and relationships between ACE-IQ scores and respondents' mental and physical health, suicide and parenting, focusing on intrafamily ACEs more than on those outside the household. Conclusions Several issues emerged in terms of lack of reporting prevalence or means, lack of studies in Europe, America and Oceania, and no attention to collective/community/peer violence, plus a lack of consensus toward the dimensions of the ACE-IQ.
... The correlation between ACEs and the physical health of respondents appears to be significantly increased among females who experienced ≥4 types of ACEs. Similar studies in Saudi Arabia comparing nonabused participants to abused individuals during childhood showed a twofold increased risk of developing physical health issues such as hypertension, diabetes mellitus, coronary heart disease, and obesity (AlHowaymel, 2020;AlMuneef et al., 2016;Herzog & Schmal, 2018;Lui et al., 2018). Another large study conducted in the United States found that ACEs were associated with one or more of the following health outcomes: diabetes, heart disease, and functional limitations (Monnat & Chandler, 2015). ...
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Introduction Adverse childhood experiences (ACEs) are widely prevalent and interrelated. They affect multiple domains of health while having a dose–response effect. These effects are biologically plausible, where ACEs are found to be highly associated with physical and mental comorbidities. Objectives The study aimed to measure the magnitude of ACE and its relationship to mental and physical illnesses in the Eastern Region of Saudi Arabia by assessing its prevalence. Materials and Methods This was a retrospective cohort study that took place in the Eastern Region of Saudi Arabia in 2020. Setting It was applied to a population‐based, random adult sample from both genders, different educational levels and socioeconomic statuses. Participants Those who were 19 years old and above and living in the Eastern region were included. Everyone under the age of 19, those not currently living in the Eastern Region, and those who did not complete the questionnaire were excluded. Results The total sample size was 611 respondents, but after applying the exclusion criteria, 507 respondents were included. Most participants were females (65.1%). The mean age of the participants was 29.7 years, with a standard deviation of 11.2 years. Regarding educational level, 69.6% were college/university graduates. Most study respondents (81.8%) were exposed to four or more types of ACEs, with emotional neglect being the most common type (82.2%). Having four or more ACEs increases the risk of having physical illnesses compared to those with only one. Furthermore, female respondents who had four or more ACEs had the highest likelihood of having depressed mood (Adjusted odds ratio [AOR] = 1.04; 95% confidence interval [CI] = 1.0–1.07), stress (AOR = 2.8; 95% CI = 1.11–7.3), and insomnia (AOR = 1.04, 95% CI = 1.01–1.07). Conclusion Our study showed that in the Eastern Region, ACEs are highly prevalent and are associated with an increased risk of mental and physical illness.
... This study also showed the highest prevalence of emotional violence is in Myanmar, while the highest physical and emotional abuse is in Vietnam (Thang et al., 2017). A study on ACE in another Asian Pacific country by Lui et al. (2018) was conducted in Solomon Island. Although the participants of the study were only male, the results were quite surprising. ...
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There has been little research in Indonesia about Adverse Childhood Experiences (ACE). Whereas, research on this topic is urgently needed as the baseline for a national evidence-based child protection policy. Even though the worldwide prevalence of ACE is high, there is no comprehensive study in the Indonesian context in regards to ACE identification and the impact on the survivors’ mental and physical health. Therefore, an ACE screening instrument is urgently needed as the first step for conducting research on this topic. This research aims to examine the validity and reliability of the WHO ACE-IQ or the World Health Organization Adverse Childhood Experience International Questionnaire as an ACE screening instrument in Indonesia. The researcher conducted a cross-sectional survey in 240 participants aged 18-65 years old using an online self-administered questionnaire. The outcome of this research is the Indonesian adapted WHO ACE-IQ is able to provide a reliable, accurate, and valid score of ACE in the Indonesian adult population
... Internal factors include age, sex, hormones, etc., which stimulate the interest in or expression of sexual activities in humans [4,5]. Sexual behaviors also depend on the stage of physical and mental development [6,7]. Several studies have reported that sociocultural factors act as external factors to express or suppress some human-related sexual behaviors [8][9][10]. ...
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Background: Sexual behaviors reflect the degree of exposure to human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV), especially in people in sexually active stages, such as youths. Hill tribe people have their own cultures, beliefs and lifestyles related to their behaviors, including sexual behaviors, which may lead to HIV, HBV, and HCV infections, especially among youths. The study aimed to examine sexual behaviors and assess the seroprevalence of HIV, HBV, and HCV among hill tribe youths. Methods: A cross-sectional study was conducted. The participants were recruited from 60 randomly selected hill tribe villages in Chiang Rai Province, Thailand. A validated questionnaire and 5 mL blood specimens were used to collect data. Data were collected by a self-reporting method. Rapid immunochromatographic tests were used to detect hepatitis B surface antibody (anti-HBs), hepatitis B surface antigen (HBsAg), hepatitis C antibody (anti-HCV), and human immunodeficiency virus antibody-I and- II (anti-HIV-1 and -2). Chi-square and Fisher's exact test were used to detect the associations between variables. Results: A total of 1325 participants were recruited for the analysis. The majority were females (60.5%) and aged 15-17 years (58.9%). A total of 14.5% smoked, 22.4% drank alcohol, 14.2% were tattooed, and 61.4% had their ears pierced. Among the 30.3% who had sexual experience, 42.0% experienced one-night stands, 26.9% had sexual contact with a prostitute within 1 year prior to the study, 18.9% used alcohol prior to having sexual intercourse, and 15.7% had been tested for HIV/AIDS previously. Among males, 11.5% were males who had sex with males (MSM), and 4.6% were bisexual. Among females, 83.0% were females who had sex with males, and 5.0% were females who had sex with females. Different sexes and tribes were found to have significantly different risk behaviors and sexual behaviors, such as overall males having a greater proportion of sexual experience than females, and Lahu, Akha and Hmong had a higher proportion of sexual experience, having sexual experience with one-night stands, and having sexual experience with a prostitute 1 year prior to the study than others. Among the 836 obtained blood samples, none were positive for anti-HIV-I and -II, 6.4% were positive for anti-HBs, 1.9% were positive for HBsAg, and 0.2% were positive for anti-HCV. Conclusion: Hill tribe youths in Thailand are at risk of STIs such as HBV and HCV infections according to their risk behaviors and sexual behaviors, which differ between sexes and tribes. Effective behavioral interventions should be promoted among hill tribe youths to minimize the risk for these diseases in the future.
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Background: Psychological distress is an undersearched cause of poorer health in the Pacific island countries. Aims: The study aimed to investigate the prevalence and associated factors of psychological distress in a population-based survey among 18-69 year-old persons in Solomon Islands. Method: Cross-sectional nationally representative data of 2,533 18-69 year-old persons (38 years were the median age) from the 2015 Solomon Islands STEPS survey were analysed. Results: The results indicate that 18.9% of participants had psychological distress (⩾20 scores), 13.4% had mild (20-24 scores), 4.3% moderate (25-29 scores) and 1.1% severe (30-50 scores) psychological distress. In adjusted logistic regression analysis, being divorced, separated, or widowed (AOR: 2.76, 95% CI: 1.60-4.78), having had a heart attack or stroke (AOR: 3.34, 95% CI: 2.23-4.99), alcohol dependence (AOR: 1.72, 95% CI: 1.04-2.84), and sedentary behaviour (AOR: 1.90, 95% CI: 1.28-2.84), were positively and the consumption of 3-4 servings of fruit and vegetables (AOR: 0.62, 95% CI: 0.42-0.92), were negatively associated with psychological distress (⩾20 scores). In addition, in a sex stratified adjusted logistic regression analysis among men, current smokeless tobacco use (AOR: 4.95, 95% CI: 1.66-14.75), was associated with psychological distress. Furthermore, in the overall unadjusted analysis, stop smoking attempts in the past 12 months and consumption of too much salt was associated with psychological distress. Conclusion: Almost one in five participants were reported psychological distress and several factors were detected which could be targeted in intervention activities.
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Background Despite growing interest in the prevention of lower urinary tract symptoms (LUTS) globally and in the Asia-Pacific region, population-based evidence is limited in the smaller Pacific Island countries such as in the Solomon Islands. This study aimed to investigate the prevalence and describe the risk factors associated with moderate to severe LUTS among Solomon Islander men. Methods A cross-sectional survey was conducted among 400 men aged ⩾18 years living in Honiara, Solomon Islands. LUTS were assessed using the International Prostate Symptom Score (IPSS). The association between moderate to severe LUTS and sociodemographic, health conditions and health-related factors were estimated using logistic regression adjusted for age. Results Overall, 13.8% reported moderate LUTS, and 0.8% reported severe LUTS. Frequent night-time urination was the most commonly reported LUTS. The adjusted odds of moderate to severe LUTS decreased with increasing level of education. The odds increased among men reporting elevated psychological distress, increased stressful events in the past 12 months and depression. Conclusions About one in six Solomon Islander men experience moderate to severe LUTS, having a negative impact on their mental health and general well-being.
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There has been relatively little research into the prevalence of childhood sexual violence (CSV) as well as the risk and protective factors for CSV in low- and middle-income countries including Indonesia. Systematic searches conducted in English and Bahasa Indonesia in this review identified 594 records published between 2006 and 2016 in peer-reviewed journals and other literature including 299 Indonesian records. Fifteen studies, including nine prevalence studies, met the quality appraisal criteria developed for this review. The review found that CSV research is scarce: Only one study included nationally representative prevalence estimates. Varying definitions for CSV, survey methods, and sample characteristics limited the generalizability of the data. The available evidence points to significant risk of sexual violence affecting both girls and boys across many geographical and institutional settings. Married adolescent girls are vulnerable to sexual violence by partners in their homes. Children in schools are vulnerable to CSV by peers and adults. Victims seldom disclose incidents and rarely seek support. In addition, early childhood experiences of trauma were strongly associated with later perpetration of sexual violence and revictimization. Limited information is available about protective factors. This review synthesizes evidence about what is currently known about CSV in Indonesia and identifies the strengths and weaknesses of the existing research. A more robust evidence base regarding CSV is required to better inform policy and justify investment into prevention programs.
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Background: A growing body of research identifies the harmful effects that adverse childhood experiences (ACEs; occurring during childhood or adolescence; eg, child maltreatment or exposure to domestic violence) have on health throughout life. Studies have quantified such effects for individual ACEs. However, ACEs frequently co-occur and no synthesis of findings from studies measuring the effect of multiple ACE types has been done. Methods: In this systematic review and meta-analysis, we searched five electronic databases for cross-sectional, case-control, or cohort studies published up to May 6, 2016, reporting risks of health outcomes, consisting of substance use, sexual health, mental health, weight and physical exercise, violence, and physical health status and conditions, associated with multiple ACEs. We selected articles that presented risk estimates for individuals with at least four ACEs compared with those with none for outcomes with sufficient data for meta-analysis (at least four populations). Included studies also focused on adults aged at least 18 years with a sample size of at least 100. We excluded studies based on high-risk or clinical populations. We extracted data from published reports. We calculated pooled odds ratios (ORs) using a random-effects model. Findings: Of 11 621 references identified by the search, 37 included studies provided risk estimates for 23 outcomes, with a total of 253 719 participants. Individuals with at least four ACEs were at increased risk of all health outcomes compared with individuals with no ACEs. Associations were weak or modest for physical inactivity, overweight or obesity, and diabetes (ORs of less than two); moderate for smoking, heavy alcohol use, poor self-rated health, cancer, heart disease, and respiratory disease (ORs of two to three), strong for sexual risk taking, mental ill health, and problematic alcohol use (ORs of more than three to six), and strongest for problematic drug use and interpersonal and self-directed violence (ORs of more than seven). We identified considerable heterogeneity (I2 of >75%) between estimates for almost half of the outcomes. Interpretation: To have multiple ACEs is a major risk factor for many health conditions. The outcomes most strongly associated with multiple ACEs represent ACE risks for the next generation (eg, violence, mental illness, and substance use). To sustain improvements in public health requires a shift in focus to include prevention of ACEs, resilience building, and ACE-informed service provision. The Sustainable Development Goals provide a global platform to reduce ACEs and their life-course effect on health. Funding: Public Health Wales.
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Background To date there has been little research into men's sexual and reproductive health in Pacific Island countries. The aim of this study was to describe men's sexual difficulties and barriers to their seeking reproductive health care in the Solomon Islands. Methods: The study included qualitative inquiry (17 individual interviews and three focus group discussions with a total of 21 men) and a quantitative quasi-randomised quota sample household survey (n=400). The prevalence of sexual difficulties and potential risk factors, such as chronic diseases, health risk behaviours, depression and psychological distress were measured using standardised questions translated into pidgin. Results: The most commonly self-reported sexual difficulties were premature ejaculation (39.5%), low sexual desire (29.0%), orgasm difficulty (27.3%) and erectile difficulty (4.3%). More than half (56%) of the men experienced at least one sexual difficulty. Relatively few men (7.3%) had ever sought professional health care for reproductive health problems, and 15.4% of men preferred to use kastom (traditional) medicine for sexual problems. Multivariate analysis revealed that comorbid non-communicable diseases (NCDs), low health-related quality of life and dissatisfaction with sexual relationships were independently correlated with sexual difficulties. Contrary to expectations, self-reported psychological distress was inversely associated with these difficulties. In general, the insights gained from in-depth interviews validated the survey findings. Conclusion: This study adds the first data on symptoms of sexual dysfunction among men in the Solomon Islands and is one of few studies from the Pacific region. The findings strongly suggest the need for comprehensive health services that are gender-specific and sensitive to the sexual difficulties of Islander men.
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Background: Although childhood trauma and violence against women are global public health issues, few population-based data from low-income and middle-income countries exist about the links between them. We present data from the UN Multi-country Study on Men and Violence in Asia and the Pacific, exploring the pathways between different forms of childhood trauma and violence against women. Methods: In this multicountry study, we interviewed multistage representative samples of men and women, aged 18–49 years, in Asia and the Pacific, using standardised population-based household surveys. Men were interviewed in six countries, and women in four. Respondents were asked questions about their perpetration or experience of intimate partner violence or non-partner sexual violence, childhood trauma, and harsh parenting (smacking their children as a form of discipline). We used maximum likelihood multivariate logit models to explore associations between childhood trauma and violence against women, and fitted path models to explore associations between experience and perpetration of child maltreatment. Findings: Between Jan 1, 2011, and Dec 1, 2012, 10 178 men and 3106 women completed interviews in this study, with between 815 and 1812 men per site and 477 and 1103 women per site. The proportion of men who experienced any childhood trauma varied between 59% (n=478, 95% CI 54·0–63·3; Indonesia rural site) and 92% (n=791, 89·4–93·8; Bougainville, Papua New Guinea). For women, the results ranged from 44% (n=272, 37·7–50·8; Sri Lanka) to 84% (n=725, 80·7–86·8; Bougainville, Papua New Guinea). For men, all forms of childhood trauma were associated with all forms of intimate partner violence perpetration. For women, all forms of childhood trauma were associated with physical intimate partner violence, and both physical and sexual intimate partner violence. There were significant, often gendered, pathways between men's and women's perpetration and experiences of childhood trauma, physical intimate partner violence, harsh parenting, and other factors. Interpretation: The data point to both a co-occurrence and a cycle of abuse, with childhood trauma leading to violence against women and further child maltreatment, which in turn increases the risk of experience or perpetration of violence during adulthood. Efforts to prevent both forms of violence would benefit from a meaningful integrated approach. Interventions should promote positive parenting, address inequality and the normalisation of violence across the life course, and transform men's power over women and children. Funding: Partners for Prevention. National studies were funded by the UN Population Fund in Bangladesh and China, UN Women in Cambodia and Indonesia, UN Develoment Programme in Papua New Guinea, and CARE in Sri Lanka.
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This study explored associations between quality of life (QOL), spirituality, social integration, chronic diseases, and lifetime adversity among people aged 60 years and older in Bhutan. Adults aged 60 to 101 years (n = 337) completed face-to-face interviews. The main measure included the World Health Organization QOL questionnaire and Adverse Childhood Experiences International Questionnaire. The social relationships domain of QOL had the highest mean. Frequent back pain, memory decline, depression, mobility impairment, insomnia, and lung diseases were commonly reported and negatively related to QOL. Compared with women, men reported fewer physical and mental health problems and better QOL. Multivariate analysis revealed that cumulative health problems, psychological distress, and social connectedness contributed significantly to overall QOL. The measure of spirituality was negatively associated with QOL, which is not conclusive and suggests the need for more research especially when the influence of spiritualism is highly visible in the everyday lives of Bhutanese people. The significance of these findings is discussed in relation to care for elderly people in Bhutan.
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Background: Most of the world's children and adolescents live in low- and lower-middle-income countries (LALMIC), but there is limited evidence about polyvictimization (experiences of multiple forms of victimization) among them. The aims of this article were to systematically review the evidence from LALMIC about the overall prevalence of polyvictimization and to identify the associations between polyvictimization and health and well-being among children and adolescents. Method: A systematic search of the English-language peer-reviewed literature to identify empirical, quantitative studies conducted in LALMIC between 2005 and 2015, assessing at least four forms of victimization among young people aged up to 19 years. Where prevalence of any victimization and of polyvictimization were reported, meta-analyses were performed. Results: A total of 30/8,496 articles were included in the review. Evidence was available from 16/84 LALMIC and methodology and quality varied. Pooled prevalence of experiences of any victimization was 76.8% (95% confidence interval (CI) [64.8%, 88.9%]). Prevalence of polyvictimization ranged from 0.3% to 74.7% with an overall estimate of 38.1% (95% CI [18.3%, 57.8%]). None of the studies examined the associations between polyvictimization and physical or reproductive health or quality of life. Polyvictimization was associated with increased likelihood of mental health problems and involvement in health risk behaviors. Conclusions: Experiences of polyvictimization among children and adolescents in LALMIC are more prevalent than in high- and upper-middle-income countries and contribute to the burden of poor health among children and adolescents. Most LALMIC lack local data, and research is required to address this knowledge gap.
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Background Individuals’ childhood experiences can strongly influence their future health and well-being. Adverse childhood experiences (ACEs) such as abuse and dysfunctional home environments show strong cumulative relationships with physical and mental illness yet less is known about their effects on mental well-being in the general population. Methods A nationally representative household survey of English adults (n = 3,885) measuring current mental well-being (Short Edinburgh-Warwick Mental Well-being Scale SWEMWBS) and life satisfaction and retrospective exposure to nine ACEs. Results Almost half of participants (46.4 %) had suffered at least one ACE and 8.3 % had suffered four or more. Adjusted odds ratios (AORs) for low life satisfaction and low mental well-being increased with the number of ACEs. AORs for low ratings of all individual SWEMWBS components also increased with ACE count, particularly never or rarely feeling close to others. Of individual ACEs, growing up in a household affected by mental illness and suffering sexual abuse had the most relationships with markers of mental well-being. Conclusions Childhood adversity has a strong cumulative relationship with adult mental well-being. Comprehensive mental health strategies should incorporate interventions to prevent ACEs and moderate their impacts from the very earliest stages of life.
Article
Abstract This multilevel meta-analysis examined the effects of geographical and economic factors on worldwide childhood maltreatment estimates measured by the Childhood Trauma Questionnaire (CTQ) short-form. The primary outcome extracted was continuous scores on the CTQ subscales – emotional abuse, physical abuse, sexual abuse, emotional neglect, and physical neglect – and total score. Geographical, economical and methodological variables were extracted for use as covariates in meta-regression models. A literature search identified 288 studies suitable for the CTQ total score analysis (N = 59,692) and 189 studies suitable for maltreatment subtype analysis (N = 44,832). We found that Europe and Asia were associated with lower CTQ estimates while South America presented the highest estimates among continents. Specifically, studies from China, Netherlands and United Kingdom presented the lowest maltreatment estimates. Furthermore, high-income countries presented lower CTQ physical neglect estimates in comparison to low- or middle-income countries, while per-capita gross domestic product of countries was negatively associated with childhood physical neglect estimates. Despite the influence of methodological covariates, these findings indicate that geographical and economic factors could influence variations of childhood maltreatment estimates around the world, particularly when assessed by a structured standardized questionnaire.
Article
Adverse childhood experiences (ACEs) include verbal, physical, or sexual abuse, as well as family dysfunction (e.g., an incarcerated, mentally ill, or substance-abusing family member; domestic violence; or absence of a parent because of divorce or separation). ACEs have been linked to a range of adverse health outcomes in adulthood, including substance abuse, depression, cardiovascular disease, diabetes, cancer, and premature mortality. Furthermore, data collected from a large sample of health maintenance organization members indicated that a history of ACEs is common among adults and ACEs are themselves interrelated. To examine whether a history of ACEs was common in a randomly selected population, CDC analyzed information from 26,229 adults in five states using the 2009 ACE module of the Behavioral Risk Factor Surveillance System (BRFSS). This report describes the results of that analysis, which indicated that, overall, 59.4% of respondents reported having at least one ACE, and 8.7% reported five or more ACEs. The high prevalence of ACEs underscores the need for 1) additional efforts at the state and local level to reduce and prevent child maltreatment and associated family dysfunction and 2) further development and dissemination of trauma-focused services to treat stress-related health outcomes associated with ACEs.