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Safe, Stable, and Nurtured: Protective Factors against Poor Physical and Mental Health Outcomes Following Exposure to Adverse Childhood Experiences (ACEs)

  • Elizabeth Crouch
  • Elizabeth Radcliff
  • Melissa Strompolis
  • Aditi Srivastav
ORIGINAL ARTICLE

Abstract

Protective factors can build resilience and potentially moderate the long-term impact of adverse childhood experiences (ACEs). To better understand the role of protective factors, this study examines the relationship of two protective factors focused on safe, stable and nurturing relationships, ACEs, and self-reported mental and physical health outcomes among a representative adult sample from the South Carolina Behavioral Risk Factor Surveillance System. Protective factors were assessed as potential moderators of ACEs and poor self-reported physical and mental health in multivariate logistic regression analyses. Respondents exposed to four or more ACEs who grew up with an adult who made them feel safe and protected were less likely to report frequent mental distress or poor health. The use of protective factors may be an effective prevention strategy for ACEs and its associated outcomes and may serve as a mechanism to “break the cycle” of childhood trauma.

Keywords

Adverse childhood experiences Resilience Protective factors Physical abuse Sexual abuse Health 

Notes

Compliance with Ethical Standards

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000.

Informed Consent

Informed consent was obtained from all patients for being included in the study.

Conflict of Interest

N/A.

References

  1. Anda, R. F., Felitti, V. J., Bremner, J. D., Walker, J. D., Whitfield, C., Perry, B. D., . . . Giles, W. H. (2006). The enduring effects of abuse and related adverse experiences in childhood. A convergence of evidence from neurobiology and epidemiology. European Archives of Psychiatry and Clinical Neuroscience, 256(3), 174–186.  https://doi.org/10.1007/s00406-005-0624-4.CrossRefPubMedGoogle Scholar
  2. Bethell, C., Gombojav, N., Solloway, M., & Wissow, L. (2016). Adverse childhood experiences, resilience and mindfulness-based approach: Common denominator issues for children with emotional, mental, or behavioral problems. Child and Adolescent Psychiatric Clinics of North America, 25(2), 139–156.CrossRefPubMedPubMedCentralGoogle Scholar
  3. Bonnie, R. J., & Monahan, J. (Eds.). (1997). Mental disorder, work disability, and the law. Chicago: University of Chicago Press.Google Scholar
  4. Brown, D. W., Anda, R. F., Tiemeier, H., Felitti, V. J., Edwards, V. J., Croft, J. B., & Giles, W. H. (2009). Adverse childhood experiences and the risk of premature mortality. American Journal of Preventive Medicine, 37(5), 389–396.  https://doi.org/10.1016/j.amepre.2009.06.021.CrossRefPubMedGoogle Scholar
  5. Brown, D. W., Anda, R. F., Felitti, V. J., Edwards, V. J., Malarcher, A. M., Croft, J. B., & Giles, W. H. (2010). Adverse childhood experiences are associated with the risk of lung cancer: A prospective cohort study. BMC Public Health, 10, 20.  https://doi.org/10.1186/1471-2458-10-20.CrossRefPubMedPubMedCentralGoogle Scholar
  6. Center for the Study of Social Policy. (2017). Strengthening families: The protective factors framework. Retrieved from https://www.cssp.org/reform/strengthening-families/basic-one-pagers/Strengthening-Families-Protective-Factors.pdf.
  7. Chapman, D. P., Whitfield, C. L., Felitti, V. J., Dube, S. R., Edwards, V. J., & Anda, R. F. (2004). Adverse childhood experiences and the risk of depressive disorders in adulthood. Journal of Affective Disorders, 82(2), 217–225.  https://doi.org/10.1016/j.jad.2003.12.013.CrossRefPubMedGoogle Scholar
  8. Chapman, D. P., Liu, Y., Presley-Cantrell, L. R., Edwards, V. J., Wheaton, A. G., Perry, G. S., & Croft, J. B. (2013). Adverse childhood experiences and frequent insufficient sleep in 5 US states, 2009: A retrospective cohort study. BMC Public Health, 13(1), 3.Google Scholar
  9. Child Information Gateway. (2014). Protective factors: approaches in child welfare (Issue Brief). Washington, DC: U.S. Department of Health and Human Services Retrieved from https://www.childwelfare.gov/pubPDFs/protective_factors.pdf.Google Scholar
  10. Chung, E. K., Nurmohamed, L., Mathew, L., Elo, I. T., Coyne, J. C., & Culhane, J. F. (2010). Risky health behaviors among mothers-to-be: The impact of adverse childhood experiences. Academic Pediatrics, 10(4), 245–25.1.  https://doi.org/10.1016/j.acap.2010.04.003.CrossRefPubMedPubMedCentralGoogle Scholar
  11. Cronholm, P. F., Forke, C. M., Wade, R., Bair-Merritt, M. H., Davis, M., Harkins-Schwarz, M., et al. (2015). Adverse childhood experiences: Expanding the concept of adversity. American Journal of Preventive Medicine, 49(3), 354–361.CrossRefPubMedGoogle Scholar
  12. Crouch, E., Strompolis, M., Bennett, K. J., Morse, M., & Radcliff, E. (2017). Assessing the interrelatedness of multiple types of adverse childhood experiences and odds for poor health in South Carolina adults. Child Abuse & Neglect, 65, 204–211.  https://doi.org/10.1016/j.chiabu.2017.02.007.CrossRefGoogle Scholar
  13. Dong, M., Anda, R. F., Felitti, V. J., Dube, S. R., Williamson, D. F., Thompson, T. J., . . . Giles, W. H. (2004). The interrelatedness of multiple forms of childhood abuse, neglect, and household dysfunction. Child Abuse & Neglect, 28(7), 771–784.  https://doi.org/10.1016/j.chiabu.2004.01.008.CrossRefGoogle Scholar
  14. Dube, S. R., Anda, R. F., Felitti, V. J., Edwards, V. J., & Croft, J. B. (2002). Adverse childhood experiences and personal alcohol abuse as an adult. Addictive Behaviors, 27(5), 713–725.  https://doi.org/10.1016/S0306-4603(01)00204-0.CrossRefPubMedGoogle Scholar
  15. Dube, S. R., Felitti, V. J., Dong, M., Chapman, D. P., Giles, W. H., & Anda, R. F. (2003). Childhood abuse, neglect, and household dysfunction and the risk of illicit drug use: The adverse childhood experiences study. Pediatrics, 111(3), 564–572.CrossRefPubMedGoogle Scholar
  16. Dube, S. R., Miller, J. W., Brown, D. W., Giles, W. H., Felitti, V. J., Dong, M., & Anda, R. F. (2006). Adverse childhood experiences and the association with ever using alcohol and initiating alcohol use during adolescence. The Journal of Adolescent Health, 38, 444–4e1.CrossRefPubMedGoogle Scholar
  17. Durlak, J. A. (1998). Common risk and protective factors in successful prevention programs. The American Journal of Orthopsychiatry, 68(4), 512–520.CrossRefPubMedGoogle Scholar
  18. Edwards, V. J., Holden, G. W., Felitti, V. J., & Anda, R. F. (2003). Relationship between multiple forms of childhood maltreatment and adult mental health in community respondents: Results from the adverse childhood experiences study. The American Journal of Psychiatry, 160(8), 1453–1460.CrossRefPubMedGoogle Scholar
  19. Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., . . . Marks, J. S. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) Study. American Journal Preventive Medicine, 14(4), 245–258.CrossRefGoogle Scholar
  20. Fergus, S., & Zimmerman, M. A. (2005). Adolescent resilience: A framework for understanding healthy development in the face of risk. Annual Review of Public Health, 26, 399–419.CrossRefPubMedGoogle Scholar
  21. Ford, E. S., Anda, R. F., Edwards, V. J., Perry, G. S., Zhao, G., Li, C., & Croft, J. B. (2011). Adverse childhood experiences and smoking status in five states. Preventive Medicine, 53(3), 188–193.  https://doi.org/10.1016/j.ypmed.2011.06.015.CrossRefPubMedGoogle Scholar
  22. Gilbert, L. K., Breiding, M. J., Merrick, M. T., Thompson, W. W., Ford, D. C., Dhingra, S. S., & Parks, S. E. (2015). Childhood adversity and adult chronic disease: An update from ten states and the District of Columbia, 2010. American Journal of Preventive Medicine, 48(3), 345–349.  https://doi.org/10.1016/j.amepre.2014.09.006.CrossRefPubMedGoogle Scholar
  23. Green, J. G., McLaughlin, K. A., Berglund, P. A., Gruber, M. J., Sampson, N. A., Zaslavsky, A. M., & Kessler, R. C. (2010). Childhood adversities and adult psychiatric disorders in the national comorbidity survey replication I: Associations with first onset of DSM-IV disorders. Archives of General Psychiatry, 67(2), 113–123.  https://doi.org/10.1001/archgenpsychiatry.2009.186.CrossRefPubMedPubMedCentralGoogle Scholar
  24. Greenberg, M. T. (2006). Promoting resilience in children and youth. Annals of the New York Academy of Sciences, 1094(1), 139–150.  https://doi.org/10.1196/annals.1376.013.CrossRefPubMedGoogle Scholar
  25. Greene, R. R. (2008). Risk and resilience theory: a Social Work perspective. In R. R. Greene (Ed.), Human behavior theory and social work practice (pp. 315–343). New Brunswick: Transaction Publishers.Google Scholar
  26. Hardt, J., & Rutter, M. (2004). Validity of adult retrospective reports of adverse childhood experiences: Review of the evidence. Journal of Child Psychology and Psychiatry, 45(2), 260–273.CrossRefPubMedGoogle Scholar
  27. Harper Browne, C. (2014). The strengthening families approach and protective factors framework. In Branching out and reaching deeper. Washington, DC: Center for the Study of Social Policy.Google Scholar
  28. Health Resources and Service Administration, Maternal Child Health. (2017). Home visiting. Rockville, MD: Health Resources and Services Administration. Retrieved from https://mchb.hrsa.gov/maternal-child-health-initiatives/home-visiting-overview.
  29. Horwitz, A. V., Widom, C. S., McLaughlin, J., & White, H. R. (2001). The impact of childhood abuse and neglect on adult mental health: A prospective study. Journal of Health and Social Behavior, 42(2), 184–201.CrossRefPubMedGoogle Scholar
  30. Larkin, H., & Records, J. (2007). Adverse childhood experiences: Overview, response strategies, and integral theory. Journal of Integral Theory and Practice, 2, 1–25.Google Scholar
  31. Larkin, H., Shields, J. J., & Anda, R. F. (2012). The health and social consequences of adverse childhood experiences (ACE) across the lifespan: An introduction to prevention and intervention in the community. Journal of Prevention & Intervention in the Community, 40, 263–270.CrossRefGoogle Scholar
  32. Larkin, H., Felitti, V. J., & Anda, R. F. (2014). Social work and adverse childhood experiences research: Implications for practice and health policy. Social Work in Public Health, 29(1), 1–16.CrossRefPubMedGoogle Scholar
  33. McElroy, S., & Hevey, D. (2014). Relationship between adverse early experiences, stressors, psychosocial resources and wellbeing. Child Abuse & Neglect, 38(1), 65–75.CrossRefGoogle Scholar
  34. Merrick, M. T., Leeb, R. T., & Lee, R. D. (2013). Examining the role of safe, stable, and nurturing relationships in the intergenerational continuity of child maltreatment--introduction to the special issue. The Journal of Adolescent Health, 53(4 Suppl), S1–S3.  https://doi.org/10.1016/j.jadohealth.2013.06.017.CrossRefPubMedGoogle Scholar
  35. Metzler, M., Merrick, M. T., Klevens, J., Ports, K. A., & Ford, D. C. (2017). Adverse childhood experiences and life opportunities: Shifting the narrative. Child Youth Serv Review, 72, 141–149.  https://doi.org/10.1016/j.childyouth.2016.10.021.CrossRefGoogle Scholar
  36. Moore, K.A. & N. Ramirez, A. (2016) Adverse childhood experience and adolescent well-being: Do protective factors matter? Child Ind Res, 9, 299, 316.Google Scholar
  37. Morse, M., Strompolis, M., Priester, M. A., & Wooten, N. R. (2016). Adverse childhood experiences in South Carolina: A summary of individual demographics and individual ACEs. Retrieved from: https://www.researchgate.net/publication/303328647_Adverse_Childhood_Experiences_in_South_Carolina_A_Summary_of_Demographics_and_Individual_ACEs.
  38. Morse, M., Strompolis, M., Priester, M. A., & Srivastav, A. (2017). Adverse childhood experiences in South Carolina: The interrelatedness of adversity. Research Brief No., 9 Retrieved from https://scchildren.org/public/files/docs/Prevention_Learning_Center/ACES-in-SC-Research-Brief-Interrelatedness.pdf.
  39. National Survey of Children’s Health: NSCH 2011/12. (n.d.). Data query from the Child and Adolescent Health Measurement Initiative, Data Resource Center for Child and Adolescent Health website. Retrieved from www.childhealthdata.org.
  40. Rich-Edwards, J. W., Mason, S., Rexrode, K., Spiegelman, D., Hibert, E., Kawachi, I., . . . Wright, R. J. (2012). Physical and sexual abuse in childhood as predictors of early-onset cardiovascular events in women. Circulation, 126(8), 920–927.  https://doi.org/10.1161/circulationaha.111.076877.CrossRefPubMedPubMedCentralGoogle Scholar
  41. Roxburgh, S., & MacArthur, K. R. (2014). Childhood adversity and adult depression among the incarcerated: Differential exposure and vulnerability by race/ethnicity and gender. Child Abuse & Neglect, 38(8), 1409–1420.  https://doi.org/10.1016/j.chiabu.2014.02.007.CrossRefGoogle Scholar
  42. Roy, A., Janal, M. N., & Roy, M. (2010). Childhood trauma and prevalence of cardiovascular disease in patients with type 1 diabetes. Psychosomatic Medicine, 72(8), 833–838.  https://doi.org/10.1097/PSY.0b013e3181eafc2d.CrossRefPubMedGoogle Scholar
  43. Schofield, T. J., Lee, R. D., & Merrick, M. T. (2013). Safe, stable, nuturing relationships as a moderator of intergenerational continuity of child maltreatment: A meta-analysis. The Journal of Adolescent Health, 53(4), S32–S38.CrossRefPubMedPubMedCentralGoogle Scholar
  44. Shonkoff, J. P., & Garner, A. S. (2012). The lifelong effects of early childhood adversity and toxic stress. Pediatrics, 129(1), e232–e246.  https://doi.org/10.1542/peds.2011-2663.CrossRefPubMedGoogle Scholar
  45. Shonkoff, J. P., Boyce, W. T., & McEwen, B. S. (2009). Neuroscience, molecular biology, and the childhood roots of health disparities: Building a new framework for health promotion and disease prevention. JAMA, 301(21), 2252–2259.CrossRefPubMedGoogle Scholar
  46. Srivastav, A., Fairbrother, G., & Simpson, L. A. (2017). Addressing adverse childhood experiences through the affordable care act: Promising advances and missed opportunities. Academic Pediatrics, 17(7S), S136–S143.  https://doi.org/10.1016/j.acap.2017.04.007.CrossRefPubMedGoogle Scholar
  47. Taloyan, M., Wajngot, A., Johansson, S. E., Tovi, J., & Sundquist, J. (2010). Poor self-rated health in adult patients with type 2 diabetes in the town of Sodertalje: A cross-sectional study. Scandinavian Journal of Primary Health Care, 28(4), 216–220.  https://doi.org/10.3109/00016349.2010.501223.CrossRefPubMedPubMedCentralGoogle Scholar
  48. Thornberry, T. P., Henry, K. L., Smith, C. A., Ireland, T. O., Greenman, S. J., & Lee, R. D. (2013). Breaking the cycle of maltreatment: The role of safe, stable, and nurturing relationships. The Journal of Adolescent Health, 53(4), S25–S31.CrossRefPubMedPubMedCentralGoogle Scholar
  49. US Centers for Disease Control and Prevention. (1998). Self-reported frequent mental distress among adults--United States, 1993–1996. MMWR Morbility and Mortality Weekly Report, 47(16), 326.Google Scholar
  50. US Centers for Disease Control and Prevention. (2014a). Behavior Risk Factor Surveillance System. Retrieved from http://www.cdc.gov/brfss/.
  51. US Centers for Disease Control and Prevention (2014b). Safe, stable, and nurturing relationships may shield children against poor health later in life. Retrieved from. https://www.cdc.gov/violenceprevention/pub/healthy_infants.html.
  52. Waite, R., Davey, M., & Lynch, L. (2013). Self-rated health and association with ACEs. Journal of Behavioral Health, 2(3), 198–205.CrossRefGoogle Scholar
  53. Walker, S. P., Wachs, T. D., Grantham-McGregor, S., Black, M. M., Nelson, C. A., Huffman, S. L., et al. (2011). Inequality in early childhood: Risk and protective factors for early child development. The Lancet, 378(9799), 1325–1338.CrossRefGoogle Scholar
  54. Zimmerman, M. A. (2014). Resiliency theory: A strengths-based approach to research and practice for adolescent health. Health Education & Behavior, 40(4), 381–383.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Elizabeth Crouch
    • 1
  • Elizabeth Radcliff
    • 1
  • Melissa Strompolis
    • 2
  • Aditi Srivastav
    • 2
  1. 1.South Carolina Rural Health Research Center, Arnold School of HealthUniversity of South CarolinaColumbiaUSA
  2. 2.Children’s Trust of South CarolinaColumbiaUSA

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