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

Author

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  • Rebekah Lydia Miriam Amos

    (School of Medical and Health Sciences, Bangor University, Wrexham LL13 7YP, UK)

  • Katie Cresswell

    (School of Medical and Health Sciences, Bangor University, Wrexham LL13 7YP, UK)

  • Karen Hughes

    (School of Medical and Health Sciences, Bangor University, Wrexham LL13 7YP, UK
    World Health Organization Collaborating Centre on Investment for Health and Well-Being, Public Health Wales, Wrexham LL13 7YP, UK)

  • Mark A. Bellis

    (School of Medical and Health Sciences, Bangor University, Wrexham LL13 7YP, UK
    World Health Organization Collaborating Centre on Investment for Health and Well-Being, Public Health Wales, Wrexham LL13 7YP, UK
    Faculty of Health, Liverpool John Moores University, Liverpool L2 2ER, UK)

Abstract

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

Suggested Citation

  • Rebekah Lydia Miriam Amos & Katie Cresswell & Karen Hughes & Mark A. Bellis, 2023. "ACEtimation—The Combined Effect of Adverse Childhood Experiences on Violence, Health-Harming Behaviors, and Mental Ill-Health: Findings across England and Wales," IJERPH, MDPI, vol. 20(17), pages 1-13, August.
  • Handle: RePEc:gam:jijerp:v:20:y:2023:i:17:p:6633-:d:1223455
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    References listed on IDEAS

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    1. Negriff, Sonya, 2020. "ACEs are not equal: Examining the relative impact of household dysfunction versus childhood maltreatment on mental health in adolescence," Social Science & Medicine, Elsevier, vol. 245(C).
    2. Tracie O. Afifi & Samantha Salmon & Ashley Stewart-Tufescu & Tamara Taillieu, 2022. "An Examination of Parents’ Adverse Childhood Experiences (ACEs) History and Reported Spanking of Their Child: Informing Child Maltreatment Prevention Efforts," IJERPH, MDPI, vol. 19(17), pages 1-9, August.
    3. Rothman, K.J. & Greenland, S., 2005. "Causation and causal inference in epidemiology," American Journal of Public Health, American Public Health Association, vol. 95(S1), pages 144-150.
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