A retired psychiatrist once told me that childhood trauma is the foundation for many of our societal problems. When I first heard of this claim, I didn’t think much of it. But as I build my experience working with the vulnerable population, I can attest that there is a lot of truth to it.
In fact, the upbringing of kids is so important that we should focus a lot more resources on kids than on adults A LOT MORE.
According to a recent study by Copeland et al, they found the cumulative childhood trauma exposure is associated with poor adult outcomes. In this prospective, population-based cohort study of 1420 participants, a community representative sample of participants was assessed with structured child and adolescent psychiatric assessment interviews up to 8 times in childhood for lifetime trauma exposure (as defined by the Diagnostic and Statistical Manual of Mental Disorders). Participants were followed up 4 times during adulthood (age 19, 21, 25, 30) with structured young adult psychiatric assessment interview for psychiatric outcomes, functional outcomes, and evidence of a disrupted transition to adulthood.
Below are some interesting results worth noting:
- By age 16 years, 30.9% of children (n = 451) were exposed to 1 traumatic event.
- 22.5% (n=289) were exposed to 2 such events and 14.8% were exposed to 3 ore more.
- Cumulative childhood trauma exposure to age 16 years was associated with higher rates of adult psychiatric disorders (odds ratio for any disorder 1.2;95% CI, 1.0-1.4) and poorer functional outcomes, including key outcomes that indicate a significantly disrupted transition to adulthood (e.g. higher rates of adult psychiatric and functional outcomes after adjusting for a broad range of childhood risk factors, including psychiatric functioning and family adversities and hardships (adjusted OR for any disorder 1.3; 95% CI 1.0-1.5)
The authors have concluded that cumulative childhood trauma exposure is associated with negative outcomes in health and functioning in adulthood.
The big question is, can we proactively address these concerns?
The results of this study is consistent with findings from the Adverse Childhood Experience study where the authors also looked at the relationship between adverse childhood experiences and self reported disabilities in adult life. The authors also found there is a strong graded relationship between the two factors.
So what exactly is considered an adverse childhood experience? A glimpse at the ACE survey may shed some light:
ACE Questionnaire
Prior to your 18th birthday:
- Did a parent or other adult in the household often or very often… Swear at you, insult you, put you down, or humiliate you? or Act in a way that made you afraid that you might be physically hurt?
No___If Yes, enter 1 __ - Did a parent or other adult in the household often or very often… Push, grab, slap, or throw something at you? or Ever hit you so hard that you had marks or were injured?
No___If Yes, enter 1 __ - Did an adult or person at least 5 years older than you ever… Touch or fondle you or have you touch their body in a sexual way? or Attempt or actually have oral, anal, or vaginal intercourse with you?
No___If Yes, enter 1 __ - Did you often or very often feel that … No one in your family loved you or thought you were important or special? or Your family didn’t look out for each other, feel close to each other, or support each other?
No___If Yes, enter 1 __ - Did you often or very often feel that … You didn’t have enough to eat, had to wear dirty clothes, and had no one to protect you? or Your parents were too drunk or high to take care of you or take you to the doctor if you needed it?
No___If Yes, enter 1 __ - Were your parents ever separated or divorced?
No___If Yes, enter 1 __ - Was your mother or stepmother:
Often or very often pushed, grabbed, slapped, or had something thrown at her? or Sometimes, often, or very often kicked, bitten, hit with a fist, or hit with something hard? or Ever repeatedly hit over at least a few minutes or threatened with a gun or knife?
No___If Yes, enter 1 __ - Did you live with anyone who was a problem drinker or alcoholic, or who used street drugs?
No___If Yes, enter 1 __ - Was a household member depressed or mentally ill, or did a household member attempt suicide? No___If Yes, enter 1 __
- Did a household member go to prison?
No___If Yes, enter 1 __
Now add up your “Yes” answers: _ This is your ACE Score
It turns out that as the ACE score increases, so does the risk of chronic diseases, social and emotional problems later in life.
As a pharmacist, I wonder if there is anything we can do in the community. Can we start to screen individuals and refer them to appropriate resources? When we see patients with potential problems with addiction, can we do something about it? When we witness potential child abuse, we are obliged to report it. But what else can we do in the community?
Can our community pharmacies set up programs to support children and screen for possible abuse?
I recognize I am asking a lot of questions without a lot of answers. But given how pharmacists are positioned in the community who are readily accessible, we should be doing more. The question is how, and what incentives are set up to encourage pharmacists to do something.
Next time when I need to dispense a concoction of psychotropic medications to a patient in the community, or review a chart with endless list of psychiatric diagnoses, maybe I should pause and ask when happened to this person as a kid.
That may help us all to cultivate more empathy and hopefully come up with more creative solutions to help figure out this societal mess.
No I don’t have the answer but that doesn’t mean I shouldn’t try to search for a possible solution. There is such a thing called hope and I hope we haven’t lost sight of it.
Thanks for reading my post. What are your thoughts?
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