Abstract
Childhood adversities affect an individual’s life negatively. The impact of adverse childhood experiences (ACEs) is more profound with the exposure to multiple traumatic experiences. As a global issue, ACEs are widely known for their clustering nature. The current study examines the clustering of ACEs in the Indian setting where no previous studies have been held in this field. From a sample of 559 youth (between 18 and 24 years), selected through multi-stage, stratified sampling from selected colleges in Malappuram, Idukki, and Kollam districts, Kerala, South India, relevant data were collected using the Childhood Experiences of Care and Abuse Questionnaire-2. Descriptive statistics revealed that about 57% of the youth had three or more ACEs. Neglect, antipathy, and psychological abuse were common, whereas physical abuse was the least prevalent one. Risk estimate using crosstab showed that the likelihood of sexual abuse (OR 11.01), neglect (OR 10.87), antipathy (OR 10.81), physical abuse (OR 7.95), and loss (OR 4.83) was greater among youth with three or more ACEs. Further, youth with antipathy was significantly twice more likely to have experienced childhood neglect and vice versa. Physical and sexual abuse also co-occurred (three times), whereas antipathy and psychological abuse were least likely to cluster. Explanations for the current findings detailed with implications, recommendations, and limitations are presented. Findings emphasize the need for epidemiological evaluations of ACEs from multiple perspectives in the Indian setting and also the necessity for preventive efforts at all levels.
Similar content being viewed by others
References
Anda, R. F., Croft, J. B., Felitti, V. J., Nordenberg, D., Giles, W. H., Williamsin, D. F., et al. (1999). Adverse childhood experiences and smoking during adolescence and adulthood. Journal of American Medical Association, 282, 1652–1658.
Anda, R. F., Whitfield, C. L., Felitti, V. J., Chapman, D., Edwards, V. J., Dube, S. R., et al. (2002). Adeverse childhood experiences, alcoholic parents, and later risk of alcoholism and depression. Psychiatric Services, 53(8), 1001–1009.
Austin, A. E., & Herrick, H. W. B. (2014). The effect of adverse childhood experiences on adult health: 2012 North Carolina behavioral risk factor surveillance system survey. SCHS Studies, No. 167. A publication for the state centre for health statistics. www.schs.state.nc.us/schs/pdf/SCHS_Study_169_FIN_20140826.pdf.
Beardslee, W. R., Chien, P. L., & Bell, C. C. (2011). Prevention of mental disorders, substance abuse, and problem behaviors: A developmental perspective. Psychiatric Services, 62(3), 247–254.
Bellis, M. A., Lowey, H., Leckenby, N., Hughes, K., & Harrison, D. (2014). Adverse childhood experiences: Retrospective study to determine their impact on adult health behaviours and health outcomes in a UK population. Journal of Public Health (Oxf), 36, 81–91.
Bifulco, A., Bernazzani, O., Moran, P. M., & Jacobs, C. (2005). Childhood experience of care and abuse questionnaire (CECA.Q) validation in a community series. British Journal of Clinical Psychology, 44, 563–581.
Bifulco, A., Brown, G. W., & Harris, T. O. (1994). Childhood experience of care and abuse (CECA): A retrospective interview measure. Journal of Child Psychology and Psychiatry, 35(8), 1419–1435.
Bifulco, A., & Moran, P. M. (1998). Wednesday’s child: Research into women’s experience of neglect and abuse in childhood, and adult depression. London: Routledge.
Bifulco, A., Moran, P. M., Ball, C., Jacobs, C., Baines, R., Bunn, A., et al. (2002). Childhood adversity, parental vulnerability and disorder: Examining intergenerational transmission of risk. Journal Child Psychology & Psychiatry, 43, 1075–1086.
Bjorkenstam, E., Hjern, A., Mittendorfer-Rutz, E., Vinnerljung, B., Hallqvist, J., & Ljung, R. (2013). Multi-exposure and clustering of adverse childhood experiences, socioeconomic differences and psychotropic medication in young adults. PLoS ONE, 8, e53551.
Butchart, A., & Harvey, Ph A. (2006). Preventing child maltreatment: A guide to taking action and generating evidence. Geneva: WHO.
Cawson, P., Wattam, C., Brooker, S., & Kelly, G. (2000). Child maltreatment in the United Kingdom: A study of the prevalence of child abuse and neglect. London: NSPCC.
Census India, 2011–Provisional Population Totals–India: Census 2011. New Delhi: Census India, Ministry of Home Affairs. http://censusindia.gov.in/2011-prov-results/paper2/data_files/india/Rural_Urban_2011.pdf.
Chapman, D. P., Wheaton, A. G., Anda, R. F., Croft, J. B., Edwards, V. J., Liu, Y., et al. (2011). Adverse childhood experiences and sleep disturbances in adults. Sleep Medicine, 12(8), 773–779.
Chapman, D. P., Whitfield, C. L., Felitti, V. J., Dube, S. R., Edwards, V. J., & Anda, R. F. (2004). Adeverse childhood experiences and risk of depressive disorders in adulthood. Journal of Affective Disorders, 82(2), 217–225.
Chartier, M. J., Walker, J. R., & Naimark, B. (2010). Separate and cumulative effects of adverse childhood experiences in predicting adult health and health care utilization. Child Abuse and Neglect, 34(6), 454–464. doi:10.1016/j.chiabu.2009.09.020.
Clemmons, J. C., DiLillo, D., Martinez, I. G., DeGue, S., & Jeffcott, M. (2003). Co-occurring forms of child maltreatment and adult adjustment reported by Latina college students. Child Abuse and Neglect, 27, 751–767.
Creighton, S., & Russell, N. (1995). Voices from childhood: A survey of childhood experiences and attitudes to childrearing among adults in the United Kingdom. London: NSPCC Policy Practice Research Series.
Damodaran, D. K., Rapheal, J., & Paul, V. K. (2014). Child maltreatment in the Indian context. The International Journal of Humanities and Social Studies, 2(10), 333–339.
Dube, S. R., Anda, R. F., Felitti, V. J., Chapman, D., Williamson, D. F., & Giles, W. H. (2001). Childhood abuse, household dysfunction and the risk of attempted suicide throughout the life span: Findings from adverse childhood experiences study. Journal of American Medical Association, 286, 3089–3096.
Dube, S. R., Felitti, V. J., Dong, M., Giles, W. H., & Anda, R. F. (2003). The impact of adverse childhood experiences on health problems: Evidence from four birth cohorts dating back to 1900. Preventive Medicine, 37, 268–277.
Felitti, V. J. (2002). The relationship of adverse childhood experiences to adult health: Turning gold into lead. Zeitschrift fur Psychosomatische Medizin und Psychotherapie, 48(4), 359–369.
Felitti, V. J., & Anda, R. F. (2010). The relationship of adverse childhood experiences to adult health, well-being, social function, and health care. In R. Lanius, E. Vermetten, & C. Pain (Eds.), The effects of early life trauma on health and disease: The hidden epidemic. Cambridge: Cambridge University Press.
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 of Preventive Medicine, 14(4), 245–258. http://www.scaany.org/documents/felitti_ace_study_article.pdf.
Finkelhor, D., Hotaling, G., Lewis, I. A., & Smith, C. S. (1990). Sexual abuse in a national survey of adult men and women: Prevalence, characteristics, and risk factors. Child Abuse and Neglect, 14, 19–28.
Garbarino, J. (1986). Troubled youth, troubled families: The dynamics of adolescent maltreatment. In D. Cichetti & V. Carlson (Eds.), Child maltreatment: Theory and research on the causes and consequences of child abuse and neglect. Cambridge: Cambridge University Press.
Gorey, K. M., & Leslie, D. R. (1997). The prevalence of child sexual abuse: Integrative review and adjustment for potential response and measurement biases. Child Abuse and Neglect, 21, 391–398.
Kaufman, J. (1991). Depressive disorders in maltreated children. Journal of the American Academy of Child and Adolescent Psychiatry, 30, 257–265.
Kendall-Tackett, K. A. (2001). The long shadow: Adult survivors of childhood abuse. In K. A. Kendall-Tackett (Ed.), The hidden feelings of motherhood: Coping with mothering stress, depression and burnout. Oakland, CA: New Harbinger.
Krug, E. G., Dahlberg, L. L., Mercy, J. A., Zwi, A. B., & Lozano, R. (Eds.). (2002). World report on violence and health. Geneva: World Health Organization.
Malhotra, S., & Gupta, N. (2005a). Sexual abuse in children. In B. Kumar & S. Gupta (Eds.), Sexually transmitted infections (pp. 959–965). New Delhi: Elsevier.
Malhotra, S., & Gupta, N. (2005b). Childhood sexual abuse. In N. Kar & G. C. Kar (Eds.), Comprehensive textbook of sexual medicine (pp. 335–351). New Delhi: Elsevier.
Masuda, A., Yamanaka, T., Hirakawa, T., Koga, Y., Minomo, R., Munemoto, T., et al. (2007). Intra- and extra-familial adverse childhood experiences and a history of childhood psychosomatic disorders among Japanese university students. BioPsychoSocial Medicine. doi:10.1186/1751-0759-1-9.
McCrory, E., De Brito, S., & Viding, E. (2010). Research review: The neurobiology of maltreatment and adversity. Journal of Child Psychology and Psychiatry, 51, 1079–1095.
McEwen, B. S. (1998). Protective and damaging effects of stress mediators. New England Journal of Medicine, 338(3), 171–179.
Ministry of Women and Child Development, Government of India (MoWCD) (2005) India country report on violence against children. Department of Women and Child Development, Ministry of Human Resource Development, New Delhi: Government of India.
Ministry of Women and Child Development, Government of India (MoWCD), (2007). Study on child abuse: India 2007, Ministry of Women and Child Development, New Delhi: Government of India.
Moran, P. M., Bifulco, A., Ball, C., Jacobs, C., & Benaim, K. (2002). Exploring psychological abuse in childhood: I. Developing a new interview scale. Bulletin of the Menninger Clinic, 66(3), 213–240.
Nair, A. B., & Devika, J. (2014). Self-reported sexual abuse among a group of adolescents attending life skills education workshops in Kerala. Academic Medical Journal of India, 2(1), 3–6.
Nye, F. I. (1958). Family relationships and delinquent behavior. New York: Wiley.
Qirjako, G., Burazeri, G., Sethi, D., & Miho, V. (2013). Community survey on prevalence of adverse childhood experiences in Albenia. Copenhagen: WHO Regional Office for Europe.
Reynolds, A. J., Temple, J. A., White, B., Ou, S., & Robertson, D. L. (2011). Age 26 cost-benefit analysis of the child-parent center early education program. Child Development, 82(1), 379–404.
Richmond, J. M., Elliott, A. N., Pierce, T. W., Aspelmeier, J. E., & Alexander, A. A. (2009). Polyvictimization, childhood victimization, and psychological distress in college women. Child Maltreatment, 14, 127–147.
Rothman, E. F., Edwards, E. M., Heeren, T., & Hingson, R. W. (2008). Adverse childhood experiences predict earlier age of drinking onset: Results from a representative US sample of current or former drinkers. Pediatrics, 122(2), e298–e304. doi:10.1542/peds.2007-3412.
Runyan, D., Dunneb, M. P., Zolotorc, A. J., Madridd, B., Jaine, D., Gerbakaf, B., et al. (2009). The development and piloting of the ISPCAN Child abuse screening tool—Parent version (ICAST-P). Child Abuse and Neglect, 33, 826–832.
Sakshi, (1997). http://www.arpan.org.in/csa.html.
Segal, U. A. (1995). Child abuse by the middle class? A study of professionals in India. Child Abuse and Neglect, 19(2), 217–231. doi:10.1016/0145-2134(94)00118-E.
Sethi, D., Bellis, M. A., Hughes, K., Mitis, F., Gilbert, R., & Galea, G. (2013). European report on preventing child maltreatment. Copenhagen: World Health Organization Regional Office for Europe.
Singh, A. P., & Misra, G. (2012a). Adolescent lifestyle in India: Prevalence of risk and promotive factors of health. Psychology and Developing Societies, 24(2), 145–160.
Singh, A. P., & Misra, G. (2012b). Gender differences in lifestyle: Results of a survey among Indian school going adolescents. Social Change, 46(3), 428–443.
Stone, N. (1993). Parental abuse as a precursor to childhood onset of depression and suicidality. Child Psychiatry and Human Development, 24, 13–24.
Sudha, R. (2011). Awareness of the mother regarding child abuse and neglect. The Nursing Journal of India, 102(5), 100–102. http://www.tnai.knowledge.of.mothers/abt.ch.abuse.htm.
The Planning Commission. (2012). Report of the working group on child rights for the 12th five year plan (2012–2017) (p. 8). http://planningcommission.nic.in/aboutus/committee/wrkgrp12/wcd/wgrep_child.pdf.
Tulir. (2006). Prevalence and dynamics of child sex abuse among school going children in Chennai. Website: http://www.tulir.org/images/pdf/Research%20Report1.pdf.
UNICEF. (2009). South Asia in action: Preventing and responding to child trafficking: Analysis of anti-trafficking initiatives in the region. Florence: UNICEF Innocenti Research Centre. http://www.unicef-irc.org/publications/pdf/ii_ct_southasia_analysis.pdf.
WHO. (1999). Report of the consultation on child abuse prevention (document WHO/HSC/PVI/99.1). Geneva.
WHO. (2010). Child maltreatment (Fact sheet, No. 150). WHO Media centre. http://www.who.int/mediacentre/factsheets/fs150/en/index.html.
Zolotor, A., Kotch, J., Dufort, V., Winsor, J., Catellier, D., & Bou-Saada, I. (1999). School performance in a longitudinal cohort of children at risk of maltreatment. Maternal and Child Health Journal, 3(1), 19–27.
Acknowledgement
The investigators acknowledge youth who have instantly came forward to serve as sample for the present study.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
None.
Rights and permissions
About this article
Cite this article
Damodaran, D.K., Paul, V.K. Patterning/Clustering of Adverse Childhood Experiences (ACEs): The Indian Scenario. Psychol Stud 62, 75–84 (2017). https://doi.org/10.1007/s12646-017-0392-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12646-017-0392-z