Examining the Consequences of Adverse Childhold Experiences Among Veterans

Purpose:Recent literature on service members and veterans explores the link between adverse childhood events (ACEs) and occupational stress on health outcomes. Much of this research points to a direct link between ACEs and mental health outcomes like posttraumatic stress. While research from population based surveys suggests that veterans report more ACEs than their non-veteran counterparts, less is known how different types of ACEs impact health. In this study we used the Behavioral Risk Factor Surveillance System (BRFSS) a population based health survey to examine the link between ACEs and health outcomes. We used a latent class analysis to examine if distinct profiles of ACEs contribute in different ways to posttraumatic stress disorder, poor general health, and mental health related quality of life.

Methods: This study used the BRFSS Veterans Health Supplement and ACEs supplement administered by the state of Tennessee in 2012 (n=607). Latent class anlaysis models were fit using Mplus Version 7. Six indicators of household disruption and three indicators of maltreatment were used. Bivariate analyses determined associations between these two classes and race/ethnicity, gender, and age. Logistic and multiple regressions were then used to determine whether class membership predicted a diagnosis of PTSD, poor general health, and number of mentally unhealthy days in the past month. Race/ethnicity, gender, age, and combat exposure were used as covariates in the models. 

Results: A two class solution was found to be the best fitting model: 27.42% was placed in class 1 which was marked by higher levels of maltreatment including physical, mental, and sexual abuse. The remaining 72.58% of the sample was placed in class 2. This class showed elevated levels of household disruption including parental alcohol abuse and divorce. Veterans in class 1 were 70% less likely to report a diagnosis of PTSD than those in class 2 (p=0.0098). In this model, combat was the strongest indicator of PTSD (AOR=1.60, 95% CI=1.34-8.62). Class membership and combat both had no statistically significant impact on general health after controlling for the effects of age. Veterans in class two reported more mentally unhealthy days after controlling for the effects of combat, sex, race, and age (B=5.10, p=0.02). In this model, female sex was the strongest predictor of the number mentally unhealthy days veterans experienced in the past month (B=7.20, p=0.0030).

Implications: Further exploration of the ACEs of veterans at the population level can provide important information for theory building and future in-depth study. This study found that, contrary to what would generally be hypothesized, more severe ACEs including mental, physical, and sexual abuse are less predictive of negative mental health outcomes (including PTSD) than those that are related to household instability after controlling for combat. This suggests a mechanism resilience among individuals who experience severe abuse as children and who then served in the US military. Interventions should be targeted to detirmine what mechanisms of resilience exist within veterans and how these can be studied to improve our understanding of the influence of trauma on mental health and well-being.