Since its publication in the 1980s, the Adverse Childhood Experiences (ACE) study has resulted in more than 50 follow-up studies suggesting that individuals who experience certain ACEs are more likely than their peers to have various health problems. Many of the researchers examining the impact of ACEs on various problems have taken a simplified approach, summing the number of different ACEs that individuals experience and then examining the associations between this sum and various problems.However, this approach has been limited, according to Courtenay Cavanaugh, an assistant professor of psychology at Rutgers University–Camden.
“This approach assumes that the impacts of different adversities are equal, but different ACEs pose different risks,” says Cavanaugh, a Collingswood resident. “For example, childhood sexual abuse may lead directly to a victim contracting HIV, while childhood emotional abuse does not. Since victims who experience one type of adversity or violence typically experience other forms, it is important to identify the main patterns of abuse – those subgroups with similar histories of victimization – so we can better understand whether different subgroups of survivors have different treatment needs.”
To that end, Cavanaugh and fellow researchers Hanno Petras of the American Institute of Research and Johns Hopkins University, and Silvia Martins of Columbia University, examine the heterogeneity of ACEs in a new study, “Gender-specific profiles of adverse childhood experiences, past year mental and substance use disorders, and their associations among a national sample of adults in the United States,” published recently in the journal Social Psychiatry and Psychiatric Epidemiology.
This is the third study that Cavanaugh and her colleagues have conducted using latent class analysis, an advanced statistical method to examine different subgroups of individuals with similar histories of ACEs and other adversities, and associated mental health problems.
In the first study, the researchers studied whether there were different subgroups of nurses with similar histories of interpersonal violence, and whether those subgroups differed in terms of symptoms of depression and posttraumatic stress. They found four distinct subpopulations of abused women that required different treatment needs.
“For example, we found that depression was associated with subpopulations characterized by histories of childhood abuse or intimate partner violence, whereas posttraumatic stress was only associated with a subpopulation characterized by intimate partner violence victimization,” explains the Rutgers–Camden researcher.In the following study, Cavanaugh and her colleagues expanded their examination of the impact of violence on women’s health by studying whether there were different subgroups of women nationally with similar histories of interpersonal violence victimization, and whether these subgroups differed with 10 associated mental health disorders. The researchers found that women in subgroups characterized by varying degrees of violence against women had greater odds for having a wide range of mental health problems, including those not typically associated with trauma, such as social phobia and manic episodes.
In this latest study, the researchers used a national dataset and latent class analysis to examine profiles of ACEs and profiles of mental and substance use disorders (MSUDs), and used dual latent class regression to examine the associations between the profiles of ACEs and MSUDs. They found four profiles of ACEs, characterized by: low ACEs, high childhood physical abuse, high parental substance abuse, and multiple ACEs for both males and females. The majority – 72-75 percent – of males and females were in the low ACEs profile, while the minority – four to five percent – of males and females were in the multiple ACEs profile.
“It’s interesting to note that the patterns of ACEs were pretty consistent across genders,” says Cavanaugh.
The researchers also found three profiles of MSUDs, characterized by: low MSUDs; a major depressive episode; and multiple MSUDs for women, but low MSUDs except alcohol abuse for men. Profiles characterized by ACEs were generally positively associated with profiles characterized by MSUDs. However, more than one third of members in the profile characterized by multiple ACEs were also in the profile characterized by low MSUDs, which suggests resilience.
According to Cavanaugh, their findings also suggest that, when treating adults with histories of ACEs, there may be a greater need to treat a host of psychopathology among some women than men.
“While the ACE study brought attention to the devastating effects that ACEs have on one’s mental and physical health later on in life,” says Cavanaugh, “our application of latent class analysis is clarifying the mental health needs of subgroups affected by ACEs and other adversities.”