Childhood adversity is linked to how people engage with healthcare services later in life, a new study by Bangor University and Public Health Wales has shown.
Children who experience maltreatment or exposure to domestic violence, for example, often referred to as ACEs or adverse childhood experiences, report lower engagement with healthcare services and discomfort in using hospitals and GP surgeries compared to children who did not experience ACEs.
The findings are published in a new report for the World Health Collaborating Centre (WHO CC) in Wales, which is committed to sharing healthcare expertise, data, and tools to improve health and well-being.
Past research has shown that adverse childhood experiences can be a strong indicator of poor physical and mental health as an adult. Children who are exposed to ACEs are more likely to develop health-harming behaviours such as smoking or substance abuse. In addition, in England and Wales, the financial burden of health issues arising from ACEs has been estimated to total £42.8 billion.
To determine how childhood ACEs affected a person’s interaction and experience of health care later in life, the researchers surveyed 1,696 adults in March 2022 who were residents in England and Wales. Participants were recruited from an online provider panel known as Prolific and undertook an online questionnaire about their exposure to ACEs during childhood and their subsequent use of health services. All participants were over 18 years of age and provided a representative sample across age, sex and ethnicity.
Two-thirds (66.3 per cent) of those surveyed reported exposure to at least one ACE before the age of 18. One in six (17.7 per cent) had experienced exposure to four or more ACE types. Across the nine ACEs measured, individual ACE prevalence ranged from 3.5 per cent for household member incarceration to 37.9 per cent for verbal abuse.
Overall, individuals who had experienced four or more ACE types were over two times more likely to report low comfort in using hospitals and GP and dental surgeries compared to those with no ACEs.
Those with four or more ACEs were 1.5 times more likely to currently take prescription medicines than those with 0 ACEs and 1.5 times more likely to have taken antibiotics. In addition, these participants were 1.6 times more likely to have poor medication adherence than those with no ACEs and 2.4 times more likely to have missed childhood vaccinations.
Participants with the highest number of ACEs also felt that healthcare professionals responded negatively to their health issues. Those with four or more ACEs were 3.6 times more likely to perceive that professionals do not care about their health than those with no ACEs and 3.5 times more likely to think that professionals do not understand their problems. This group were also more likely to report poor childhood experiences with health services than those with no ACEs.
Professor Karen Hughes, research and development manager at Public Health Wales, said: ‘ACEs can increase people’s risks of poor health throughout life and consequently their need to engage with health services. However, ACEs can also affect how people respond to stress and their trust in others, which may influence their perceptions of health services and advice. The development of trauma-informed health care services may help to improve people’s relationships with health professionals and adherence to public health guidance.’
Dr Kat Ford from Bangor University, commenting on the research, added: ‘With around half of the population experiencing at least one ACE in childhood, it’s vitally important that healthcare providers are aware of how ACEs can affect healthcare engagement so that support can be tailored for individuals who have experienced ACEs.’
