Brain Story Certification: Module 10

Module 10: ACEs, Part A – The Impact of Adverse Childhood Experiences on a Range of Adult Health Outcomes

 

Excerpt from “What Are ACEs?” Vincent Felitti, MD Kaiser Permanente

• Documents of conversion of abusive life experiences into addictions/disease in later life. Abuse is common in society and that abuse impacts the whole life.  Abuse has a strong influence on illness over the life course.
• If you don’t understand the mechanisms you can’t address the underlying issues.
• ACE study examined general population of adverse events. There was a startling outcome of the study.
• Looked at 17,500 people at 50 years of age and their earlier life histories over 10 categories of life experiences. Looking at 16 years after as well.
• Significance of losing a mother on child development.
• ACES are common, threatening, and often denied.
• Aces impact (profoundly) addiction, health risks, disease, and death.
• Leading determinant of health and wellbeing within a society.

Excerpt from “The Progressive Nature of Adverse Childhood Experiences: Building Self-Healing Communities” Robert Anda, MD, MS Centers for Disease Control and Prevention.

• ACES rarely to not take place in isolation (if there is substance abuse, there is likely to be other adversity constructs within the ACES present)
• People do not frame their life around ACES – we do not know how many adverse experiences they have experienced.
• 10-fold increase in the rate of addiction with an ACE>5
• ACES impact who we choose to partner with in relationships.
• Mental health has a link with ACES the higher the score (depression, suicide – 20-fold)
• The more adversity, the more comorbidity.
• 0 ACES score has very slim to none rate of mental health or addiction. Co-morbid diagnoses increase with the ACES score.  Argument for mental health as a spectrum of symptoms as a result of trauma.
• What is predictable is preventable – minimum of 50% population attribution to multiple social problems with ACES. We could address many of the social problems by addressing ACES impact on mental illness and substance use.
• ACES can impact biological mechanisms through behaviours that are harmful to health.
• Heart disease increases may be epigenetic and physiological changes from adverse experiences.
• Individuals with six or more aces died 20 years earlier than those with fewer.

Excerpt from “The Progressive Nature of Adverse Childhood Experiences: Building Self-Healing Communities” Robert Anda, MD, MS Centers for Disease Control and Prevention

• 4 types of addiction outcomes (food, alcohol, nicotine, and IV drugs)
• Unconscious compulsive use of psychoactive materials or agents. It’s hard enough to get enough of something that almost works.
• Over-eating was not the core problem – it as a marker of the core problem. Addiction highly correlates with experiences from the individual’s life experiences in early childhood.
• Subtle examples of addiction are compulsive eating, sex, gambling, or shopping.
• Conventional view is that substances operates on pathways that make it difficult for them to give the substance up.
• Self-medication hypothesis and addictions in relation to adverse experiences in childhood.
• 4-5 ACES categories 13%, 6 or more 17%. The higher the number of categories, the higher the increase of smoking incidence.
• Self-acknowledged alcoholism follows the same trajectory for number of categories and alcohol abuse prevalence.
• We substitute mechanisms for cause. 6> 4600% increase in injection substance use.
• Despite the war on drugs, there has not been a change in substance use. Are we overlooking the cause to address the outcome?
• Methamphetamine was once an ani-depressant.
• The core problem is unaddressed solution to trauma.

Excerpt from “Child Maltreatment & Inflammation” Andrea Danese, MD, PhD King’s College, London

• ACES impact physiological mechanisms – such as cardiovascular disease.
• Inflammation is an innate part of the immune system
  • Body-physical barriers
  • Non-self recognition – is it a part of our body or not.
  • Activation (cytokines, endothelial cells)
  • Response (phagocytes, acute phase proteins)
  • Inflammation is the first response to promote tissue repair and prevent infection.
  • Increase of plasma c-reactive protein relates to myocardial infraction.
  • Dunedin study – representative birth cohort followed up to 32 years of age.
    • Maltreatment includes maternal rejection, harsh discipline, disruptive caregiver changes, physical abuse, sexual abuse.
    • 3/10 experienced 3 factors, 1/10 4 or more.
  • Maltreatment in childhood was correlated with more proteins linked with inflammation later in life.
  • Low birth weight, low SES, and low childhood IQ were also correlated with inflammation.
  • Looking at childhood adversity and stress in adult life. Low SE, major depression, and high perceived stress impact inflammation.
  • Looking at childhood adversity, smoking, physical activity, CV risk, and diet correlation with inflammation.
• Timing matters
• Maltreatment, depression, and inflammation
  • These factors can compound to impact inflammation and do more than when they individually exist on their own.
• Stress in childhood may modify developmental trajectories and have long-term disease risk. Stress later in life does not have as adverse of an impact as it does in childhood.