How do Adverse Childhood Experiences (ACEs) affect health long-term? This study in the Disability & Health Journal examines how ACEs impact outcomes for people with brain injuries.
This plain language summary is part of our series sharing highlights from the Disability and Health Journal.
Why was this study done?
Traumatic brain injuries (TBIs) can lead to long-term secondary health impacts for those who have them. They can affect a person’s physical health and mental well-being. After a TBI, it can be difficult to manage mental health. A person’s recovery is not only impacted by the injury but also by past experiences. A key factor that affects health is related to Adverse Childhood Experiences (ACEs). These can include abuse, neglect, and family problems. Researchers have linked ACEs to poor health later in life.We don’t know much about how they affect recovery after a TBI.
This study looked at how common ACEs are among adults with TBI, and how they affect mental health and quality of life. The researchers examined data from a TBI database in Philadelphia. They looked at home-related ACEs, such as abuse, and community-related ACEs, like exposure to violence. They also investigated how race and neighborhood conditions impact ACE exposure. The goal was to understand how childhood hardships affect recovery from brain injuries. The study results also aimed to show why trauma-informed care is important in TBI treatment.
How was this study done?
This study focused on adults with a confirmed TBI. Participants needed to be at least 18 years old, speak English, and be able to give consent. People with multiple TBIs or other brain conditions weren’t included. The study was created for 85 participants, and 84 completed it.
Researchers recorded details about each participant, such as age, sex, race, and injury data. They used the Philadelphia ACE Survey to assess childhood hardships. This survey examined experiences such as abuse, neglect, and exposure to violence. Participants talked about their lives before they turned 18. These responses helped calculate their ACE score. The study focused on how education and neighborhood conditions shaped ACE exposure. It also explored how these ACEs affected mental health and quality of life after TBI.
What did this study show?
Adults with TBI in this study often faced tough childhoods, both at home and in their communities. Common problems identified included emotional, physical, and substance abuse, and domestic violence. Many also experienced community issues like witnessing violence and racial discrimination. Almost half of the participants had four or more Adverse Childhood Experiences (ACEs). A strong link existed between home and community adversity. Community ACEs were tied to education level. People with less education reported more struggles. Black participants were more likely to report community ACEs than white participants. Living in disadvantaged neighborhoods also related to increased adversity.
The study found that ACEs had lasting effects on mental health and quality of life for TBI survivors. Researchers found that more ACEs linked to poorer mental health and lower well-being. This was true even after considering other factors like age, sex, race, and injury history. Mental health problems appeared to change how ACEs affected quality of life. This shows that facing adversity in childhood can lead to ongoing mental health struggles. These findings show that childhood experiences play a key role in recovering from a TBI.
Data Highlights
Household ACEs:
- 36.5% faced emotional abuse, such as verbal insults from an adult.
- 18.8% feared physical harm from an adult.
- 3.5% felt emotionally neglected (no one made them feel special).
- 36.5% were physically harmed by an adult, with 24.7% experiencing severe abuse.
- 5.9% faced situations where meals were skipped because of lack of money.
- 22.4% experienced sexual abuse or assault.
- 18.8% witnessed domestic violence toward a parent or caregiver.
- 22.4% lived with someone who had depression or mental illness.
- 36.5% lived with someone who had substance use problems.
- 15.3% lived with someone who was incarcerated or had been in prison.
Community ACEs:
- 44.7% witnessed or heard about serious violence in their community.
- 11.8% didn’t feel safe in their neighborhood.
- 24.7% didn’t feel people in their neighborhood could be trusted.
- 30.6% experienced discrimination because of their race or ethnicity.
- 10.6% were bullied by peers.
- 1.2% had been in foster care.
Learn more about this study
Those with traumatic brain injuries (TBI) often face more Adverse Childhood Experiences (ACEs). The study found common ACEs like emotional abuse, physical abuse, and issues with alcohol in the home were prevalent among people with TBI. In terms of community ACEs, participants said they faced more violence than in national studies of TBI. This indicates that community violence might have a major impact on TBIs. The study found that ACEs often occur together. This means people usually face several types of adversity at once.
The study found racial differences in ACEs, with Black participants reporting more community ACEs than white participants. This reflects larger issues, such as racial segregation in housing. This inequity raises stress for Black individuals. People in less wealthy neighborhoods had more community ACEs. This means socioeconomic factors play a role in trauma exposure. These issues can make it even harder for TBI patients to get healthcare, stable housing, and social support.
The study also showed that ACEs were linked to worse mental health and a lower quality of life for people with TBI. Existing mental health issues appear to influence this. Childhood hardships can impact well-being after a brain injury. This highlights the need to think about both the injury and the person’s past when assessing recovery from a TBI.
The study suggests that trauma-informed care (TIC) should be part of TBI rehabilitation. Key elements of Trama-Informed Care are:
- Physical and Emotional Safety: Making sure the patient feels safe both physically and emotionally during care.
- Patient Choice and Autonomy: Supporting the patient in making their own healthcare decisions.
- Collaboration: Working together with the patient to make decisions about their care.
- Trust: Building a strong, trusting relationship between the patient, their doctor, and the healthcare team.
- Empowerment: Helping the patient feel in control of their health and encouraging them to take care of it.
- Minimizing Re-Traumatization: Taking steps to avoid causing any additional harm or trauma to the patient.
- Maximizing Engagement and Benefit: Making sure the patient is fully involved in their treatment and gets the most benefit from it.
- Life Course Approach: Considering the patient’s whole life, including their social, economic, and physical background, when planning their care.
TIC focuses on understanding the patient’s trauma history and working with them in a supportive way. A life course approach examines a person’s whole life and helps people with TBI set realistic goals. This approach also boosts recovery by focusing on an individual’s strengths and challenges. The study shows we need more research on resilience. It should focus on how people successfully overcome early trauma and the effects of TBI.
This research does not fully explain the impact of childhood trauma on recovery after TBI. Future studies should look at how ACEs impact TBI recovery. They could look at how resilience and social factors affect these results also. Trauma-informed care looks at the complete life history of TBI patients. This approach can improve their rehab and recovery.
Strengths and Limitations
Strengths
- This study explores how childhood adversity (ACEs) influences recovery from brain injuries. It’s a subject that has not been widely discussed until now.
- It studies the struggles of both families and communities, creating a more complete picture.
- The study relies on a solid survey to assess childhood hardships. All participants had a confirmed brain injury, which enhances the accuracy of the results.
- The study shows that doctors and therapists should consider a patient’s past trauma to improve recovery.
- The study highlights the need to tackle issues like poverty and discrimination. These factors are important for helping people recover from brain injuries and lead healthier lives overall.
- It suggests focusing on people’s strengths and what helps them overcome challenges.
Limitations
- The study only looked at a small group of people, so the results may not apply to everyone.
- The study was done in one area, so results might differ in other places.
- Because of the small group, the study can’t show how common ACEs are in the general population.
- Future research should engage individuals from a range of backgrounds. This is important, especially for those who lack easy access to healthcare.
- It’s crucial to explore how education and healthcare access influence the link between childhood hardships and brain injuries.
- The study looked at ACEs in people with TBI. However, it didn’t examine how these experiences impacted their lives.