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May 28, 2020

Screening for Adverse Childhood Experiences (ACEs) in Primary Care: A Cautionary Note

Author Affiliations
  • 1University of Rochester School of Medicine and Dentistry, Department of Family Medicine, Rochester, New York
JAMA. 2020;323(23):2379-2380. doi:10.1001/jama.2020.4365

Adverse childhood experiences (ACEs), such as experiencing or witnessing violence or abuse or living with a parent with mental illness or substance use disorder, have been shown to have a powerful influence on subsequent mental and physical health and life expectancy. Exposure to ACEs has been linked to more than 40 negative health conditions, including poor mental health, substance use disorder, adverse health behaviors, chronic physical disease, and shortened life span.1 A meta-analysis of 37 studies that examined 23 health outcomes found that individuals who reported more than 4 ACEs had higher odds of cancer, heart disease, respiratory disease, and poor self-rated health (odds ratios ranging from 2 to 3); mental illness, alcohol use disorder, and risky sexual behavior (odds ratios ranging from 3 to 6); and drug use disorder and interpersonal or self-directed violence (odds ratios greater than 7).2 Early childhood adversity and high levels of “toxic stress” have been found to have widespread and longstanding effects on multiple systems, and have been associated with reduced immunity, high levels of inflammation, shortened telomeres, subsequent poor health outcomes, and premature mortality.3