Adverse Childhood Experiences and Behavioral Health Among Older Adults: Findings from the South Carolina Behavioral Risk Factor Surveillance System

Purpose.By 2050 the population of adults over the age of 65 is expected to reach 84 million. One in four older adults experience a behavioral health disorder such as depression and/or substance misuse. Given the link between adverse childhood experiences (ACEs) and substance use and depressive disorders in adults and adolescents, additional research is necessary to examine these relationships in older adults. This study examined the prevalence and association of ACEs and behavioral health among South Carolina (SC) older adults.

Methods. 2014-2015 SC Behavioral Risk Factor Surveillance System (BRFSS) data were analyzed using a sample of SC older adults (>60 years, n=13,042). Weighted prevalence and adjusted odds ratios were used to estimate the association between ACE and behavioral health. ACE variables included: ACE exposure (yes/no), ACE type (abuse, household dysfunction), and ACE cumulative (0, 1, 2, 3, 4+). Behavioral health variables included binge drinking (yes/no), current smoker (yes/no), depressive disorder (yes/no), and mental health distress (frequent/infrequent).

Results.During 2014-2015, 42% of SC older adults reported at least one ACE, 5% reported binge drinking, 11% reported being a current smoker, 19% reported a depressive disorder, and 9% reported frequent mental distress. After adjusting for socio-demographics, logistic regressions revealed that compared to those with no ACE, respondents reporting ACE exposure, ACE type, and ACE cumulative had increased odds for being a binge drinker (OR=2.5), current smoker (OR=1.5), or reporting a depressive disorder (OR=1.6). Those who reported household dysfunction had 1.8 times the odds of binge drinking, 1.6 times the odds of being a current smoker, and 2.3 times the odds of depressive disorder compared to those without household dysfunction. Likewise, the odds of being a binge drinker (OR=2.5), current smoker (OR=1.5), and reporting a depressive disorder (OR=2.6) were greater among persons reporting abuse compared to those who did not report abuse. Respondents reporting 4+ ACEs had increased odds for binge drinking (OR=3.1), being a current smoker (OR=2.6), and depressive disorder (OR=5.7) compared to those with no ACE. After adjusting for socio-demographics, binge drinking, and depressive disorder, those who reported ACE exposure (OR=2.2), abuse (OR=2.5), and household dysfunction (OR=1.9), had increased odds of reporting frequent mental health distress. Those reporting 4+ ACE had 2.7 times the odds of reporting frequent mental health distress, compared to those who experienced no ACE.

Conclusions: SC older adults who experienced ACE had higher prevalence of behavioral health challenges compared to those with no ACE. Results indicate a significant association between ACE exposure, ACE category, and ACE cumulative to binge drinking, current smoking, depressive disorder, and mental health distress. ACE screening of older adults may enhance early identification of high-risk individuals who may benefit from health promotion and wellness programs focused on preventing the onset of behavioral health disorders. In addition, integrated health settings should consider incorporation of trauma-informed practices including patient and provider education to improve access to behavioral health care for older adults. To better inform prevention efforts, future research should focus on individual ACEs and behavioral health among older adults.