Adverse childhood experiences and future self-rated health: a prospective cohort study

Background: Negative life events (re) occurring during childhood is often described as adverse childhood experiences (ACEs) and may have long-lasting negative effects on health. Previous studies on the association between ACEs and self-rated health (SRH) have primarily been focusing on chronic diseases in elderly, non-Scandinavian populations using a cross-sectional design. The aim of the study was to examine the associations between ACEs and SRH in early adulthood and to investigate if disadvantageous health-behavioral strategies explain the association between ACEs and SRH.

Methods: A prospective cohort study using data from The West Jutland Cohort Study (N = 2.255). Baseline data on exposure to ACEs were collected from surveys at the age of 15 and 18 and respondents were categorized into having experienced 0, 1-2, 3 or > 4 ACEs. The outcome SRH stems from surveys at the age of 21 and 28 and was dichotomized into moderate and good SRH. The association between ACE-categories and SRH at age 21 and 28 were analyzed separately by logistic regression with a two-step adjustment model, adjusting for potential confounders and disadvantageous health-behavioral strategies.

Results: More than half of the participants reported at least one ACE (56.3%) with "bullying" and "loss of parent, parental separation or divorce" being the most prevalent. Participants who reported > 4 ACEs, compared to those with 0 ACEs, had a 2.6-fold increased odds (95% CI 1.3; 5.1) of having moderate SRH at the age of 21, and a 2.7-fold increased odds (95% CI 1.4; 5.4) of moderate SRH at the age of 28 years, when adjusted for potential confounders. Further, small attenuations of the estimates were seen when adjusting for disadvantageous health-behavioral strategies. A significant exposure response relationship between the ACE-categories and moderate SRH were seen both at age 21 and 28.

Conclusion: The study showed an association between ACEs and moderate SRH in young adulthood, and experiencing multiple ACEs increased the odds of reporting moderate SRH. Information on ACEs could help identifying people with a higher risk of future health problems and accentuates a growing need for early prevention in homes with children who has experienced adverse events.