Population vs Individual Prediction of Poor Health From Results of Adverse Childhood Experiences Screening | Pediatrics | JAMA Pediatrics | JAMA Network
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    1 Comment for this article
    Adversity is not destiny
    Debora Barnes-Josiah, PhD | Nebraska Department of Health and Human Services
    Thank you for this reminder of the importance of those hard-to-quantify factors - resilience and mitigation.
    Views 12,484
    Citations 0
    Original Investigation
    January 25, 2021

    Population vs Individual Prediction of Poor Health From Results of Adverse Childhood Experiences Screening

    Author Affiliations
    • 1Division of Psychology and Language Sciences, Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom
    • 2Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
    • 3Department of Psychology and Neuroscience, Duke University, Durham, North Carolina
    • 4PROMENTA, University of Oslo, Oslo, Norway
    • 5Department of Psychiatry and Behavioral Sciences, Duke University, Durham, North Carolina
    • 6Institute of Psychiatry, King's College London, London, United Kingdom
    • 7Economic and Social Research Council Centre for Society and Mental Health, King’s College London, London, United Kingdom
    • 8Department of Psychological Science, University of California, Irvine, Irvine
    • 9Dunedin Multidisciplinary Health and Development Research Unit, Department of Psychology, University of Otago, Dunedin, New Zealand
    • 10Institute of Psychiatry, Psychology and Neuroscience, Department of Child and Adolescent Psychiatry, King’s College London, London, United Kingdom
    • 11National and Specialist Child and Adolescent Mental Health Services Trauma, Anxiety, and Depression Clinic, South London and Maudsley National Health Service Foundation Trust, London, United Kingdom
    JAMA Pediatr. 2021;175(4):385-393. doi:10.1001/jamapediatrics.2020.5602
    Key Points

    Question  Can screening for adverse childhood experiences (ACEs) accurately predict individual risk for later health problems?

    Findings  In 2 population-based birth cohorts (with a total of 2927 individuals) growing up 20 years and 20 000 km apart, ACE scores were associated with mean group differences in health problems independent of other information available to clinicians. However, ACE scores had low accuracy in predicting health problems at the individual level.

    Meaning  ACE scores can forecast mean group differences in later health problems; however, ACE scores have poor accuracy in identifying individuals at high risk for future health problems.


    Importance  Adverse childhood experiences (ACEs) are well-established risk factors for health problems in a population. However, it is not known whether screening for ACEs can accurately identify individuals who develop later health problems.

    Objective  To test the predictive accuracy of ACE screening for later health problems.

    Design, Setting, and Participants  This study comprised 2 birth cohorts: the Environmental Risk (E-Risk) Longitudinal Twin Study observed 2232 participants born during the period from 1994 to 1995 until they were aged 18 years (2012-2014); the Dunedin Multidisciplinary Health and Development Study observed 1037 participants born during the period from 1972 to 1973 until they were aged 45 years (2017-2019). Statistical analysis was performed from May 28, 2018, to July 29, 2020.

    Exposures  ACEs were measured prospectively in childhood through repeated interviews and observations in both cohorts. ACEs were also measured retrospectively in the Dunedin cohort through interviews at 38 years.

    Main Outcomes and Measures  Health outcomes were assessed at 18 years in E-Risk and at 45 years in the Dunedin cohort. Mental health problems were assessed through clinical interviews using the Diagnostic Interview Schedule. Physical health problems were assessed through interviews, anthropometric measurements, and blood collection.

    Results  Of 2232 E-Risk participants, 2009 (1051 girls [52%]) were included in the analysis. Of 1037 Dunedin cohort participants, 918 (460 boys [50%]) were included in the analysis. In E-Risk, children with higher ACE scores had greater risk of later health problems (any mental health problem: relative risk, 1.14 [95% CI, 1.10-1.18] per each additional ACE; any physical health problem: relative risk, 1.09 [95% CI, 1.07-1.12] per each additional ACE). ACE scores were associated with health problems independent of other information typically available to clinicians (ie, sex, socioeconomic disadvantage, and history of health problems). However, ACE scores had poor accuracy in predicting an individual’s risk of later health problems (any mental health problem: area under the receiver operating characteristic curve, 0.58 [95% CI, 0.56-0.61]; any physical health problem: area under the receiver operating characteristic curve, 0.60 [95% CI, 0.58-0.63]; chance prediction: area under the receiver operating characteristic curve, 0.50). Findings were consistent in the Dunedin cohort using both prospective and retrospective ACE measures.

    Conclusions and Relevance  This study suggests that, although ACE scores can forecast mean group differences in health, they have poor accuracy in predicting an individual’s risk of later health problems. Therefore, targeting interventions based on ACE screening is likely to be ineffective in preventing poor health outcomes.