Adverse childhood experiences and health outcomes in adulthood: factors contributing to resilience

Background: Adverse Childhood Experiences (ACEs) have been consistently linked to an increased risk of adult morbidity and mortality, yet little research has been conducted to identify factors that may protect the health of those exposed to ACEs, thus contributing to resiliency in those exposed to significant ACEs. Objective: Utilizing data from a population-based survey of adult residents of a county in Southwestern Pennsylvania, this study examines the effects that socioeconomic status and social and emotional support may have in protecting adult health following exposure to ACEs. Methods: Data collected in the 2009-2010 Allegheny County Health Survey was used to identify adults who had experienced great childhood adversity (defined as those reporting ACE score of 5 or higher to examine the most severe cases) and divide them based on their health outcomes. ACE score was measured using a six-item instrument adapted from a larger instrument measuring adversity. Socioeconomic status was measured by combining annual household income and educational attainment. Level of social and emotional support was gathered through a series of questions inquiring about availability of types of support. Chi-square and T-test were used to compare demographic make-up of those with significant childhood adversity and those with little to no childhood adversity. Logistic Regression analysis was used to examine the relationship between SES and social and emotional support on health outcomes. Results: Of the 5,442 people interviewed between August 2009 and September 2010, 735 (13.5%) reported ACE score of 5 or more. Several differences were noted in those who reported high ACE scores: they were more likely to be younger, female, African American, and have lower SES. They were also more likely to be unhealthy. However, those reporting high ACEs with medium to high SES tended to have better health outcomes than those reporting high ACEs with low SES (O.R.=1.811, p<.0001). Social and emotional support was also associated with better overall health, especially for those in the high ACE group (O.R.=1.057 p=0.0377). Conclusions: ACEs are associated with poorer health outcomes in adults, and about 13% of Allegheny County residents have experienced 5 ACEs or more. Socioeconomic status may increase resilience due to broadening opportunities and resources for the individuals. Higher levels of perceived social support are associated with better health outcomes for those who have experienced great adversity; perhaps because those with high ACEs have less developed internal resources for coping, therefore the benefits of social support become more pronounced for those who have experienced significant adversity. Identifying factors associated with resilience in individuals who have experienced childhood adversity is relevant to the field of public health in that it would help service providers and other professionals to better understand the relationship between ACEs and health, and direct public health professionals to areas of intervention for those who have experienced ACEs and are thus at heightened risk for negative adult health outcomes