Citation

Schüssler-Fiorenza Rose SM, Xie D, Stineman M. PM R 2014; 6(8): 670-680.

Affiliation

Department of Physical Medicine and Rehabilitation and Department of Biostatistics & Epidemiology, Center for Clinical Epidemiology & Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.

Copyright

(Copyright © 2014, American Academy of Physical Medicine and Rehabilitation, Publisher Elsevier Publishing)

DOI

10.1016/j.pmrj.2014.01.013

PMID

24486921

Abstract

OBJECTIVE: To assess relationships between adverse childhood experiences and self-reported disabilities in adult life. DESIGN: Cross-sectional random-digit-dialed state-population-based survey (Behavioral Risk Factor Surveillance System (BRFSS)). SETTING: 14 States and the District of Columbia PARTICIPANTS: Non-institutionalized adults aged ≥ 18 years surveyed in 2009 and/or in 2010 (n = 81,184). METHODS: The BRFSS Adverse Childhood Experience (ACE) Module asks about abuse (physical, sexual, emotional), family dysfunction (exposures to domestic violence, living with mentally ill, substance abusing, or incarcerated family member(s), and/or parental separation/divorce) occurring before age 18. The ACE Score sums affirmed ACE categories (range 0-8). We controlled for demographic characteristics (age, race, education, income, and marital status) and self-reported physical health conditions (stroke, myocardial infarction, diabetes, coronary heart disease, asthma). Five states asked participants about mental health conditions (anxiety and depression). A subset analysis of participants in these states evaluated the effect of adjusting for these conditions. MAIN OUTCOME MEASURES: The primary outcome was disability (self-reported activity limitation and/or assistive device use.) RESULTS: Over half (57%) of participants reported at least one adverse childhood experience category and 23.2% reported disability. The odds ratio (OR [95% confidence interval]) of disability increased in a graded fashion from 1.3 [1.2-1.4] among those experiencing 1 adverse experience to 5.8 [4.6-7.5] among those with 7 to 8 adverse experiences compared to those with no such experiences, adjusting for demographic factors. The relationship between adverse experiences and disability remained strong after adjusting for physical and mental health conditions. CONCLUSIONS: There is a strong graded relationship between childhood exposure to abuse and household dysfunction and self-reported disability in adulthood, even after adjusting for potentially mediating health conditions. Greater clinician, researcher and policymaker awareness of the impact of childhood adversity on disability is crucial to help those affected by childhood adversity lead more functional lives.

Language: en