Adverse Childhood Events Flashcards
The ACEs study - background
Looked at the effects of adverse childhood experiences (trauma) over the lifespan; largest study ever done on this subject. It contained participants who were were receiving physical exams from SoCal (n=17,337, >75 % college educated, 75% white, 54%F)
The ACEs study - methods
Participants completed confidential surveys regarding their childhood experiences and current health status and behaviors. The CDC continued follow up - assessed the medical status of the study participants via updates of morbidity and mortality.
Categories of ACE
Abuse (physical, sexual, emotional), neglect (physical, emotional), household dysfunction (mental illness, incarcerated relative, mother treated violently, substance abuse, divorce)
The ACEs study - Results
ACEs are more common than anticipated or recognized (about 66% reported at least one ACE; more than 20% reported 3+ ACEs). ACEs have powerful correlation to health outcomes later in life. ACEs still have a profound effect 50 years later, although now transformed from psychosocial experience into organic disease, social malfunction, and mental illness.
Behaviors exhibited by participants with ACEs
Lack of physical activity, smoking, alcoholism, drug use, missed work.
Physical and mental health exhibited by participants with ACEs
Severe obesity, diabetes, depression, suicide attempts, STDs, heart disease, cancer, stroke, COPD, broken bones
Mechanisms by which adverse childhood experiences influence health and wellbeing throughout the lifespan
- Disrupted neurodevelopment
- Social, emotional, and cognitive impairment
- Adoption of health-risk behaviors
- Disease, disability, and social problems
- Early death
Theories of stress
Stress has long been linked to disease
Stress-response theory
Stress accompanied most illnesses, and it could be evoked. Stress was observed in patients with diverse health problems and it was considered a “call to arms” of the body’s defense forces in response to excessive demands. The demands could be positive or negative but the effects of stress on the body could also be beneficial or damaging.
Stress can be positive or negative
There is a certain amount of stress that allows for optimal performance but anything more or less than that is not beneficial
Localized Adaptation Syndrome (LAS)
Regional response to stress, localized inflammation, closely coordinated with GAS
Generalized Adaptation Syndrome
Backup for LAS, system level response to stressor that has overwhelmed current adaptive resources; the manner in which the body copes with noxious agents (stress); when homeostasis is overwhelmed, you get 3 stages - alarm, resistance, exhaustion. Negative health effects due to hormone depletion.
Alarm stage of GAS
HPA axis and SNA suppression
Resistance stage of GAS
Decreased alarm reaction; attempts to coexist with stressor
Exhaustion stage of GAS
Increased endocrine activity, continued high cortisol circulation, wear and tear or death
Short term effects for the Allostasis/Allostatic Load Theory
Essential for adaptation, maintenance of homeostasis, and survival allostasis.
Long term effects for the Allostasis/Allostatic Load Theory
Exact at a cost (allostatic load can accelerate disease process), measures as a chemical imbalance in the ANS and CNS, as well as immune system and endocrine activity, daily anxiety, and plasticity changes to the brain
Indicators for Allostatic Load
Systolic and diastolic blood pressures, high density lipoproteins and total cholesterol, glycosylated hemoglobin levels of glucose metabolism over time, overnight urinary noradrenaline and adrenaline excretions
4 types of Allostatic Load
- Repeated elevations of blood pressure over weeks/months accelerates atherosclerosis, increasing the risk of MI. 2. When adaptation to repeated stressors is lacking, there may be prolonges exposure to stress hormones. 3. There may be an inability to shut off allostatic responses after stress is terminated, leading to conditions such as hypertension or decreased bone mineral density. 4. Inadequate responses in some allostatis systems, such as cortisol secretion, may lead to compensatory increased in other systems, such as proinflammatory cytokines
Criticism of GAS
Stress definition and the GAS did not take into account cognition, perception and interpretation of the stimulus. It tried to address this through concepts such as eustress and distress
Walter Cannon’s concept of stress
Behavior and emotions + autonomic and endocrine regulations = homeostasis
Schachter and Singer’s concept of stress
Cognitions and perceptions shape emotions - emotional biasing
Richard Lazarus’s concept of stress
Role of perception in the stress response; primary vs secondary appraisals; psychological stress theory
Psychological Stress Theory
- Threat appraisal
- Perceived ability to cope
- Fear of potential physical harm and helplessness yield the highest stress response
- Brain mechanisms for this process are the same as those that maintain homeostasis in response to physical threats
- Both can lead to physical illness
Transactional Model
Takes into account the person and their environment
Other medical conditions related to stress
Wound healing, surgical recovery, GI disorders, pain, asthma, addiction, trauma and stress related disorders (like PTSD)
Gender stress: women
Women report feelings of stress more often. They also react to a wider range of stressors, including community problems. Women often have 2 jobs, wage earner and (unpaid) homemaker (mother). Women tend to internalize stress, resulting in sleep disturbance, GI distress, and depression
Gender stress: men
Men tend to externalize stress, through anger, blaming, and violence. Men with explosive anger episodes tend to have a sharper rise in BP when stressed and an increased risk of CVA, but suppressing anger can also increase BP
Stress and Race
- Perceived discrimination is a key factor in chronic stress related health disparities.
- AA, Native Hawaiians, and LA have been impacted greatly by hypertension and diabetes due to chronic stress resulting from discrimination.
- Chronic experiences of racial and ethnic discrimination were significantly associated to presence of coronary artery calcification in AA women
SES and Health
SES is one of the most powerful health predictors, including CVD, DM, arthritis, infant mortality, ID, and cancer. (More powerful than smoking, genetics, and exposure to carcinogens). There is a direct linear correlation - the lower the SES, the greater the risk of poor health
Treating stress
Exercise universal precautions by creating systems of care that are trauma-informed.
Trauma informed
Services that are provided for problems other than trauma but require knowledge about violence against humans and the impact of trauma, thereby increasing their effectiveness
The 4 R’s and Key Assumptions of being trauma informed
Realize the widespread impact of trauma. Recognize the signs and symptoms of trauma in patients, families, staff, and others involved with the system. Respond by fully integrating knowledge about trauma into policies, procedures, and practices. Actively resist retraumatization.
Core principles of trauma-informed care
Safety (physical and emotional), trustworthiness, choice, collaboration, empowerment, culture, historical and gender issues, and peer support.
Interventions for Stress
Psychological interventions (hypnosis, disclosure interventions, cognitive styles), expressive writing, spirituality
Nonpharmacological interventions related to perception and coping
Improve time management and sense of humor, pursue personal and vocational activities consistent with life values, explore the meaning and purpose of life, cultivate spiritual and transcendent activities, pursue psychotherapy, increase assertiveness, monitor sensory input, and help others
Arousal reduction and health
Health enhancing activities - exercise, abdominal breathing, massage, contact with nature.
Health degrading activities - tobacco use, substance use, eating disorder
Conclusions
- ACEs are common and they are best understood as a type of chronic stress rooted in childhood.
- The link between ACEs and disease can be explained by stress theories.
- Later models such as the transactional model, incorporates perception, coping, and arousal reduction style into its conceptualization of stress effects
