Lifetime Health Impact of Early Adversity: A Risk and Resource Cohort Analysis
Research on adverse childhood experiences (ACEs) has established consistent findings of elevated ACEs with poorer physical and mental health in later life (Edwards et al., 2003), work that builds on silo-bridging theoretical perspectives (Turner et al., 2006). What is not yet well examined, however, are a) the effects of ACEs when nested within more proximal sociodemographic and resource conditions known to also affect health, or b) the potentially differential levels of impact across adulthood stages (Nurius et al., 2012). The present study advances understanding of early adversity on lifespan health by: 1)examination distinguishing young, middle, and later life stages; 2)comparative impact assessment of specific ACE experiences, and 3)including analysis of resilience resources, which provide guides for intervention targets to mute carry-forward ACE effects.
The Behavioral Risk Factor Surveillance System (BRFSS) is a cross-sectional, population-based, stratified random sample (CDC, 2011); all analyses corrected for the complex sampling. This study combines two waves (N=19,333). Sample was gender-balanced, with a broad adult age range, (M=46.1; SE=0.20); and representative of regional SES and racial/ethnic characteristics. Dependent variables included both poor physical and mental health days reported in the last month. Regression equations were conducted for each outcome separately by age categories: 18-34 (32.2% of sample), 35-49 (27.8%), 50-64 (27.4%), and 65-79 (12.6%). Regressions tested the effects of aggregate ACE exposures (up to 8 aspects of parental dysfunction, witnessed or experienced abuse/violence before age 18), controlling for sociodemographics (income, education, age, sex, race and ethnicity), and the buffering potential of a resilience resource index (social/emotional support, confidence, and optimism). A second set of regressions examined the impact of each ACE item.
All tested models achieved significance and explained later life physical and mental health; each one-unit ACE increase predicted between 0.5-1.0 additional poor health days. The resilience resource index substantially muted these effects for all age groups. Substantial differences in the effects of specific ACE items were observed by age group for both outcomes. In general, the strongest effects on physical health were seen for the 65-79 year olds, whereas those 18-34 were most affected for mental health.
These results demonstrate the unique and persistently erosive effects of early life adversities throughout the lifespan, even controlling for sociodemographic factors that also significantly shape health statuses. Deleterious effects of ACE items—singly and cumulatively—observed decades after their occurrence hold significant implications for an array of social work populations. Prominent ACE effects on physical health for older age groups indicate chronic conditions that are part of stress “wear and tear” effects, whereas mental health impairment strikingly evident among younger groups suggests needs for trauma-related supports in these transitional phases into adulthood. Importantly, intrapersonal and social support resources markedly reduced the contribution of ACEs for both physical and mental health, signaling the potential for resilience far into adulthood. This paper will elaborate implications of these findings for universal and targeted prevention and intervention programs that seek to minimize the detrimental effects of social disadvantages and adverse childhood experiences throughout the lifespan.