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Adverse Childhood Experiences and their association with chronic disease and health service use in the Welsh adult population

Adverse childhood experiences (ACEs) are stressful events occurring in childhood such as being a victim of neglect and child abuse (physical, sexual and/or emotional) or growing up in a household in which there are adults experiencing alcohol and drug use problems, mental health conditions, domestic violence or criminal behaviour resulting in incarceration.Evidence from Wales and internationally has demonstrated a strong and cumulative association between exposure to adversity during childhood, and the adoption of health-harming behaviours and poor mental health across the life course. Early life trauma from ACEs does not only expose children to immediate harm (for example, injury resulting from physical abuse) but has also been associated with changes in childhood neurological, immunological and hormonal development  which have detrimental effects on health across the life course. Prolonged exposure to childhood stressors can result in children becoming ‘locked’ into a higher state of alert to threat; physiologically adapted to short-term survival as they become permanently prepared to respond to further trauma. Such adaptation also increases tissue inflammation and long-term wear and tear on the body]. In addition, ACEs in childhood can compromise how children learn to regulate their emotions, control their impulses or manage their behaviour]. Reduced self-control and difficulty with social interactions increase individuals’ vulnerability to engaging in health-harming behaviours, such as alcohol, tobacco and drug use, which are often adopted as coping mechanisms. The uptake of such behaviours, as well as the physiological changes resulting directly from chronic childhood trauma, increase the risk of individuals developing noncommunicable diseases (NCDs) such as cancer and heart disease earlier in life, and can ultimately result in premature mortality.

Children who are exposed to adversity are also more likely to have problems developing secure attachments with others, which can threaten their self-image or sense of self worth. Consequently, experiencing ACEs can have a long-term impact on mental health, increasing the risk of depression, anxiety and psychosis, and having a negative impact on general mental well-being]. Lower mental well-being is itself associated with health-harming behaviours and increased risk of poor health and NCDs. In addition, individuals exposed to ACEs are likely to have low self-control which can lead to increased levels of violence perpetration and victimisation in later life].

International and national evidence also suggests there are associations between exposure to ACEs and health care use including visits to doctors, surgeries, hospitalisations and higher annual healthcare costs in adulthood. Increased use of health care services amongst those who have experienced adversity in childhood may be a direct result of poor physical health, but also a consequence of poor mental health  or perceived health needs. Individuals who have been exposed to ACEs have been shown to hold more negative perceptions of their own general health, suggesting they may perceive a greater need for health care intervention irrespective of actual ill health.