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      The prevalence of childhood adversity among healthcare workers and its relationship to adult life events, distress and impairment ☆

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          Abstract

          Objective

          We investigated the prevalence of childhood adversity among healthcare workers and if such experiences affect responses to adult life stress.

          Methods

          A secondary analysis was conducted of a 2003 study of 176 hospital-based healthcare workers, which surveyed lifetime traumatic events, recent life events, psychological distress, coping, social support, and days off work due to stress or illness.

          Results

          Sixty eight percent (95% CI 61.1–74.9) of healthcare workers had one or more experience of violence, abuse or neglect, 33% (95% CI 26.1–40.0) before the age of 13. Compared to healthcare workers who did not experience childhood adversity, those who did reported more recent life events (median 11 vs. 5 over the previous 6 months, p < .001) and greater psychological distress (median score 17 vs. 13, p < .001). The relationship between life events and psychological distress was not linear. Most healthcare workers without childhood adversity (73%) reported a low number of life events which were not associated with psychological distress. Most healthcare workers with childhood adversity (81%) reported a higher number of life events, for which the correlation between events and distress was moderately strong (Spearman's rho = .50, p < .001). Childhood adversity was also associated with more missed work days. Each of these outcomes was higher in 22 healthcare workers (13%) who had experienced more than one type of childhood adversity.

          Conclusions

          Childhood adversity is common among healthcare workers and is associated with a greater number of life events, more psychological distress and impairment.

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          Adverse childhood experiences and the risk of depressive disorders in adulthood.

          Daniel P Chapman, Charles L Whitfield, Vincent Felitti … (2004)
          Research examining the association between childhood abuse and depressive disorders has frequently assessed abuse categorically, thus not permitting discernment of the cumulative impact of multiple types of abuse. As previous research has documented that adverse childhood experiences (ACEs) are highly interrelated, we examined the association between the number of such experiences (ACE score) and the risk of depressive disorders. Retrospective cohort study of 9460 adult health maintenance organization members in a primary care clinic in San Diego, CA who completed a survey addressing a variety of health-related concerns, which included standardized assessments of lifetime and recent depressive disorders, childhood abuse and household dysfunction. Lifetime prevalence of depressive disorders was 23%. Childhood emotional abuse increased risk for lifetime depressive disorders, with adjusted odds ratios (ORs) of 2.7 [95% confidence interval (CI), 2.3-3.2] in women and 2.5 (95% CI, 1.9-3.2) in men. We found a strong, dose-response relationship between the ACE score and the probability of lifetime and recent depressive disorders (P<0.0001). This relationship was attenuated slightly when a history of growing up with a mentally ill household member was included in the model, but remained significant (P<0.001). The number of ACEs has a graded relationship to both lifetime and recent depressive disorders. These results suggest that exposure to ACEs is associated with increased risk of depressive disorders up to decades after their occurrence. Early recognition of childhood abuse and appropriate intervention may thus play an important role in the prevention of depressive disorders throughout the life span.
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            Childhood abuse, household dysfunction, and the risk of attempted suicide throughout the life span: findings from the Adverse Childhood Experiences Study.

            S. Dube, R F Anda, V. Felitti … (2001)
            Suicide is a leading cause of death in the United States, but identifying persons at risk is difficult. Thus, the US surgeon general has made suicide prevention a national priority. An expanding body of research suggests that childhood trauma and adverse experiences can lead to a variety of negative health outcomes, including attempted suicide among adolescents and adults. To examine the relationship between the risk of suicide attempts and adverse childhood experiences and the number of such experiences (adverse childhood experiences [ACE] score). A retrospective cohort study of 17 337 adult health maintenance organization members (54% female; mean [SD] age, 57 [15.3] years) who attended a primary care clinic in San Diego, Calif, within a 3-year period (1995-1997) and completed a survey about childhood abuse and household dysfunction, suicide attempts (including age at first attempt), and multiple other health-related issues. Self-reported suicide attempts, compared by number of adverse childhood experiences, including emotional, physical, and sexual abuse; household substance abuse, mental illness, and incarceration; and parental domestic violence, separation, or divorce. The lifetime prevalence of having at least 1 suicide attempt was 3.8%. Adverse childhood experiences in any category increased the risk of attempted suicide 2- to 5-fold. The ACE score had a strong, graded relationship to attempted suicide during childhood/adolescence and adulthood (P<.001). Compared with persons with no such experiences (prevalence of attempted suicide, 1.1%), the adjusted odds ratio of ever attempting suicide among persons with 7 or more experiences (35.2%) was 31.1 (95% confidence interval, 20.6-47.1). Adjustment for illicit drug use, depressed affect, and self-reported alcoholism reduced the strength of the relationship between the ACE score and suicide attempts, suggesting partial mediation of the adverse childhood experience-suicide attempt relationship by these factors. The population-attributable risk fractions for 1 or more experiences were 67%, 64%, and 80% for lifetime, adult, and childhood/adolescent suicide attempts, respectively. A powerful graded relationship exists between adverse childhood experiences and risk of attempted suicide throughout the life span. Alcoholism, depressed affect, and illicit drug use, which are strongly associated with such experiences, appear to partially mediate this relationship. Because estimates of the attributable risk fraction caused by these experiences were large, prevention of these experiences and the treatment of persons affected by them may lead to progress in suicide prevention.
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              Functional status and well-being of patients with chronic conditions. Results from the Medical Outcomes Study.

              A L Stewart, S Greenfield, R D Hays … (1989)
              Enhancing daily functioning and well-being is an increasingly advocated goal in the treatment of patients with chronic conditions. We evaluated the functioning and well-being of 9385 adults at the time of office visits to 362 physicians in three US cities, using brief surveys completed by both patients and physicians. For eight of nine common chronic medical conditions, patients with the condition showed markedly worse physical, role, and social functioning; mental health; health perceptions; and/or bodily pain compared with patients with no chronic conditions. Each condition had a unique profile among the various health components. Hypertension had the least overall impact; heart disease and patient-reported gastrointestinal disorders had the greatest impact. Patients with multiple conditions showed greater decrements in functioning and well-being than those with only one condition. Substantial variations in functioning and well-being within each chronic condition group remain to be explained.
              Article 0 comments Cited 154 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Child Abuse Negl
                Journal ID (iso-abbrev): Child Abuse Negl
                Title: Child Abuse & Neglect
                Publisher: Elsevier Ltd.
                ISSN (Print): 0145-2134
                ISSN (Electronic): 1873-7757
                Publication date PMC-release: 11 February 2010
                Publication date (Print): February 2010
                Publication date (Electronic): 11 February 2010
                Volume: 34
                Issue: 2
                Pages: 114-123
                Affiliations
                [a ]Department of Psychiatry, Mount Sinai Hospital and University of Toronto, Toronto, Ontario, Canada
                [b ]Department of Nursing, Mount Sinai Hospital, Toronto, Ontario, Canada
                [c ]Department of Social Work, Mount Sinai Hospital, Toronto, Ontario, Canada
                Author notes
                [* ]Corresponding author at: Mount Sinai Hospital, 600 University Ave., Toronto, Ontario, Canada, M5G 1X5.
                Article
                Publisher ID: S0145-2134(10)00006-2
                DOI: 10.1016/j.chiabu.2009.04.008
                PMC ID: 7124651
                PubMed ID: 20153051
                SO-VID: d2476d2d-e7a3-42d0-aef1-03ad25fc29a8
                Copyright © Copyright © 2010 Elsevier Ltd. All rights reserved.
                License:

                Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

                History
                Date received : 5 December 2007
                Date revision received : 14 April 2009
                Date accepted : 22 April 2009
                Categories
                Subject: Article

                Keywords: stress,abuse,neglect,healthcare workers
                Data availability:
                Keywords: stress, abuse, neglect, healthcare workers

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