Childhood adversity is a ‘cause of causes’ of adult illnesses and mental health problems - This public health hazard hides in plain sight

As kids who have had adverse experiences grow up, they are more likely to smoke, to drink excessively and to use nonprescription drugs. They are more likely to engage in risky sexual activities and to become obese. Not all kids with ACEs take on risky activities, of course, but enough to contribute to ACEs’ health consequences.

Growing up in conditions that are consistently frightening or stressful affects the biology of developing bodies, especially the development of the systems that regulate our reactions to threats, from predators to viruses. ACEs are even associated with changes in our chromosomes that are linked to early mortality.

Interpersonal and psychological effects ^{^}

As psychiatrists for adults who experience physical and mental illness in combination, our patients often tell us about the personal impact of ACEs. One man said he did not “have even the slightest shadow of a doubt that a loss of human connection is the most substantial negative impact” of these experiences. The health costs of human disconnection are profound. Indeed, lacking interpersonal support may hasten mortality as much or more than smoking, excessive drinking, inactivity, obesity or untreated high blood pressure.

The psychological effects of ACEs may be more obvious and can include fearful expectations, a conviction that one is unworthy of love or protection, unregulated anger or shame and discombobulating memories of bad events.

It greatly increases the risk of depression, anxiety disorders, post-traumatic stress disorder and addictions. The one in three adults who experienced childhood sexual or physical abuse or witnessed interpersonal violence at home have at least twice the incidence of these disorders compared to others.

And then the dominoes fall: mental illness greatly increases the likelihood, burden and consequences of physical illness. To give just one example, in the months after experiencing a heart attack, those who are depressed are several times more likely to die. So, we see that ACEs don’t only lead to one kind of trouble, but to many.

Social determinants of health ^{^}

Finally, the burden of illness is not distributed fairly. Maintaining health is more challenging for those who are disadvantaged by poverty, lack of education, language barriers, discrimination and living with the continuing systemic harms of colonization and multi-generational trauma.

Childhood trauma has a complex relationship with these social determinants of health. On one hand, ACEs are not unique to marginalized groups and can occur across all strata of society. On the other hand, the risk of experiencing ACEs may be greater in some groups and the consequences of ACEs may multiply as social forces interact.

For example, childhood trauma is strongly associated with behaviours that increase the risk of sexually transmitted infections. About half of the people living with HIV have experienced childhood abuse. HIV is also more common in groups that face discrimination, including men who have sex with men, people who use injectable drugs, Indigenous people and immigrants from countries in which HIV is endemic.

Intersecting components of personal experience and identity attract stigma and discrimination, which in turn influences mental health, self-care and one’s ability to navigate a healthcare system that has multiple barriers and gaps. It is a complex web and ACEs contribute to this complexity.