The Link Between Adverse Childhood Experiences and Chronic Disease

Introduction:

Adverse childhood experiences refer to encountering psychological, emotional, physical, or sexual abuse in childhood, or the child may experience a lack of care and love from the family as a result of household disparities (family members suffering from mental illness or substance abuse). Research studies reveal a strong relationship between adverse childhood experiences and neurological health risks and their negative effects on long-term health. These childhood adverse experiences cause cumulative stress, which can result in cardiac, endocrine, and immune abnormalities. There is an increased incidence of developing chronic diseases such as diabetes, obesity, and mental disorders like anxiety and depression in people who suffered adverse childhood experiences.

How Does Adverse Childhood Experiences Affect the Overall Wellbeing of an Individual?

• The overall well-being of an individual is adversely affected by bitter experiences of childhood, which instills fear, and a series of bad experiences get registered in the memory.

• Such bad experiences may cause neurodevelopmental disturbances, leading a person into an unstable state of mind, failing to balance cognitive abilities and emotions, urging them to harm their lives, or indulging in maladaptive behaviors.

• This approach negatively affects their balance and harmony, making them vulnerable to chronic diseases, which have long-term term effects on health, turning into morbidity and mortality in such cases.

How Does ACE (Adverse Childhood Experiences) Influence the Occurrence of Chronic Diseases?

• Many studies have revealed that individuals who encounter adverse childhood experiences tend to have poor physical and cognitive skills, which in turn predisposes them to indulge in risky behaviors, causing a negative impact on their health.

• Studies suggest that the higher the exposure to bad experiences, the greater the affinity to be involved in maladaptive behaviors, which increases the risk of encountering chronic diseases very early in life.

• Developing chronic diseases affects the quality of life, and it is one of the most common leading causes of death at an early age.

A strong correlation exists between bad childhood experiences and chronic diseases; some of them are mentioned below:

1. People who have encountered a minimum of 4 ACEs tend to develop a sense of physical inactiveness and become obese (having a body mass index above 35).

2. Similarly, a minimum of two to three encounters is associated with excess smoking and alcohol consumption, which in turn puts them at high risk of developing cancer and cardiovascular and respiratory diseases.

3. Having multiple sexual partners, depression, post-traumatic stress disorder (PTSD), and sexually transmitted diseases (STDs) suggest a minimum of three to six adverse childhood experiences.

4. People who indulge in substance abuse and who have attempted suicidal attempts tend to have more than 7 ACE encounters. These people already suffer from underlying mental disorders like post-traumatic stress disorder (PTSD) or depression.

5. It is also found that people who suffer from PTSD are two times more likely to develop cardiovascular diseases like coronary artery calcification when compared to a normal person and, hence, are at increased risk of developing life-threatening complications.

6. The above-mentioned co-relations suggest that the more adverse childhood experiences, the greater the risk of a person being involved in maladaptive behavior, which in turn makes the person vulnerable to chronic diseases and premature death.

What Is the Pathomechanism Behind the Occurrence of Chronic Diseases in People Who Encountered ACEs?

• The adverse physiologic and biomolecular changes or damages occur due to the stress caused by abuse, neglect, or abandonment, resulting in an altered individual development.

• This mechanism is better demonstrated by a study called Biological Embedding of Childhood Adversity Model.

• This study suggests that repeated stress and abuse encountered causes to reach the threshold limit.

• When the threshold limit is reached, it initiates a pro-inflammatory response in the body against the negative or provoking stimuli, causing impaired hormonal inhibition in the body, which in turn impairs self-regulation, cognitive abilities, and emotional stability.

• The inflammatory response is considered to be the key factor contributing to the occurrence of chronic diseases in people who encountered adverse childhood experiences. This can be aggregated by impaired self-regulatory skills.

• The neural, endocrine, immune, and metabolic functions are altered due to repeated negative influences, keeping the patient at high risk of developing chronic diseases.

How Do the Inflammation-Mediated Adverse Childhood Experiences Predispose the Development of Chronic Diseases?

• Cardiovascular diseases are most commonly associated with pathological inflammatory processes.

• Until recent times, it was believed that defective cholesterol storage resulted in the deposition of cholesterol in the walls of the blood vessels of the heart, causing coronary artery disease. However, increased levels of the pro-inflammatory markers in the blood are now considered to be one of the most important risk factors for cardiovascular disease, irrespective of the patient’s cholesterol levels in the blood.

• The elevated levels of biomarkers of inflammation increase the risk of myocardial infarction, peripheral artery disease, and stroke in acute coronary syndrome patients.

• The inflammatory mediators cause the transformation of lipoproteins into fatty substances. On the other hand, coagulation factors accumulate as a part of the inflammatory process and destabilize the plaque, leading to complications like myocardial infarction, peripheral artery disease, and stroke.

• The implication of the inflammatory process in type 1 diabetes (an autoimmune disease caused by inadequate secretion of insulin) is demonstrated by the inflammation of the insulin-producing beta cells of the pancreas, causing its damage, leading to insulitis in such patients.

• Type 2 diabetes occurs as a result of insulin resistance due to secondary factors like obesity, hormonal imbalances, excess cholesterol accumulation, etc.

• Inflammatory mediators, as in the case of patients who suffered ACEs, cause type 2 diabetes, which causes increased inflammation of the pancreatic beta cells, leading to the impairment in their function and inability to secrete insulin, thus leading to type 2 diabetes.

What Are the Steps Taken to Address the Adverse Childhood Experiences by Various Health Sectors?

• The Behavioral Risk Factor Surveillance System (BRFSS) aims to develop preventive and secondary measures to provide the affected children with a non-violent and peaceful environment to reverse the negative influences on their minds.

• Clinicians play an important role in identifying the underlying mental trauma and health risks in such children. Their patient and empathetic approach can make the child feel better, and timely diagnosis and intervention can save the child from further complications.

• Supplementary feeding programs and targeted food distribution programs are implemented to cater to the needs of the children who are deprived of food supply and also the ones dealing with micronutrient deficiency and malnutrition.

• Also, other facilities like disease prevention initiatives, vaccination drives, civil protection rights, and education, which the affected children are deprived of, are provided to create the feeling of being loved and cared for among such children, thereby preventing the children from taking wrong steps and encouraging them to have a better life.

• Tertiary prevention programs focus on those who have already adapted health-harming risks like substance abuse, suicidal attempts, and alcohol consumption by providing rehabilitation to the affected individuals by encouraging them to quit the health-harming behaviors.

• Psychiatrists play an important role in treating patients with mental disorders, depression, post-traumatic stress disorder (PTSD), etc.

• By carrying out specific preventive measures at both state and national levels, the maladaptive behaviors and their implications on developing chronic diseases in such children can be reduced, thereby reducing the healthcare costs and economic burden of the country.

Conclusion:

The increased incidence of chronic diseases, as in cases of people with adverse childhood outcomes, has increased the healthcare costs and burden on the healthcare sectors across the globe. Statistics have documented that around one billion children between the ages of two to 17 years have encountered adverse childhood experiences. Providing a safe childhood environment discourages the development of maladaptive behaviors like indulging in substance abuse and suicidal attempts.