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teaching:childhood-trauma-aces [on April 25, 2020]
teaching:childhood-trauma-aces [on March 3, 2024] (current)
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 ===== Primer ===== ===== Primer =====
-**Adverse Childhood Experiences (ACEs)** are traumatic events that occur during childhood (from age 0 to 17 years), these events range from experiencing abuse and witnessing violence to growing up in a household with substance and mental health problems. +<WRAP group> 
-ACEs are strongly linked to risky health ​behaviors, chronic physical and mental health conditions, low life potential, and +<WRAP half column>​ 
-early mortality. There is a direct correlation between the number of ACEs and the risk for these negative outcomes.+**Adverse Childhood Experiences (ACEs)** are traumatic events that occur during childhood (from age 0 to 17 years), these events range from experiencing abuse and witnessing violence to growing up in a household with substance and mental health problems. ACEs are strongly linked to risky health ​behaviours, chronic physical and mental health conditions, low life potential, and early mortality. There is a direct correlation between the number of ACEs and the risk for these negative outcomes. 
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 +==== History ==== 
 +<alert type="​info"​ icon="​fa fa-book fa-lg fa-fw">​ 
 +See also: **[[https://​www.ncbi.nlm.nih.gov/​pmc/​articles/​PMC6220625/​|Felitti V. J. (2002). The Relation Between Adverse Childhood Experiences and Adult Health: Turning Gold into Lead. The Permanente journal, 6(1), 44–47.]]** 
 +</​alert>​
  
 +The first ACE study was started in 1995 by Kaiser Permanente'​s Department of Preventive Medicine division, after several astute researchers noticed counterintuitive findings in several weight loss programs, where study dropouts were actually successfully losing weight.[([[https://​www.ncbi.nlm.nih.gov/​pmc/​articles/​PMC6220625/​|Felitti V. J. (2002). The Relation Between Adverse Childhood Experiences and Adult Health: Turning Gold into Lead. The Permanente journal, 6(1), 44–47.]])] A link between obesity and abusive childhood experiences was later established by these researchers.
 ==== Outcomes ==== ==== Outcomes ====
-ACEs have been found to have a graded dose-response relationship with more than 40 outcomes.[([[https://​www.cdc.gov/​violenceprevention/​childabuseandneglect/​acestudy/​aboutace.html|Preventing Adverse Childhood Experiences (Aces): Leveraging the best available evidence. National Center for Injury Prevention and Control Centers for Disease Control and Prevention. Houry D.E, Mercy J.A. 2019: ]])]+ACEs have been found to have a graded dose-response relationship with more than 40 outcomes.[([[https://​www.cdc.gov/​violenceprevention/​childabuseandneglect/​acestudy/​aboutace.html|Preventing Adverse Childhood Experiences (Aces): Leveraging the best available evidence. National Center for Injury Prevention and Control Centers for Disease Control and Prevention. Houry D.E, Mercy J.A. 2019: ]])] These outcomes include: smoking, alcohol use disorder, chronic health problems, mental health problems, substance misuse, reduced educational achievement,​ reduced occupational achievement,​ obesity, heart disease, cancer, respiratory disease, diabetes, and suicide. However, ACEs alone do not mean that an individual must experience poor outcomes. Positive experiences or protective factors can protect against many of the negative outcomes even after an ACE has occurred.
  
-ACEs alone does not mean that an individual must experience poor outcomesPositive ​experiences ​or protective factors can protect against many of the negative outcomes even after an ACE has occurred.+==== Depression ==== 
 +There is a strong, dose-response relationship between the number of ACEs and the probability of lifetime and recent [[mood:​1-depression:​home|depressive disorders]].[([[https://​pubmed.ncbi.nlm.nih.gov/​15488250/​|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.]])]
  
 ===== ACEs ===== ===== ACEs =====
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 +===== Pathophysiology =====
 +<alert type="​info"​ icon="​fa fa-book fa-lg fa-fw">​
 +See also:
 +  * **[[https://​pubmed.ncbi.nlm.nih.gov/​32109789/​|Grasso,​ D. J. et al. (2020). Adverse childhood experiences,​ posttraumatic stress, and FKBP5 methylation patterns in postpartum women and their newborn infants. Psychoneuroendocrinology,​ 114, 104604.]]**
 +  * **[[https://​pubmed.ncbi.nlm.nih.gov/​26410355/​|Bierer,​ L. M. et al. (2020). Intergenerational effects of maternal holocaust exposure on FKBP5 Methylation. American Journal of Psychiatry, 177(8), 744-753.]]**
 +</​alert>​
  
 +  * The stress-related gene FKBP5 may be implicated in the intergenerational transmission of trauma-related effects in adult offspring, depending on how methylation is altered.[([[https://​www.ncbi.nlm.nih.gov/​pmc/​articles/​PMC6561294/​|Zannas,​ A. S., Jia, M., Hafner, K., Baumert, J., Wiechmann, T., Pape, J. C., ... & Binder, E. B. (2019). Epigenetic upregulation of FKBP5 by aging and stress contributes to NF-κB–driven inflammation and cardiovascular risk. Proceedings of the National Academy of Sciences, 116(23), 11370-11379.]])][([[https://​pubmed.ncbi.nlm.nih.gov/​33255215/​|Misiak,​ B., Karpiński, P., Szmida, E., Grąźlewski,​ T., Jabłoński,​ M., Cyranka, K., ... & Frydecka, D. (2020). Adverse Childhood Experiences and Methylation of the FKBP5 Gene in Patients with Psychotic Disorders. Journal of Clinical Medicine, 9(12), 3792.]])]
 ===== Prevention ===== ===== Prevention =====
-ACEs and their negative outcomes are preventable. However, this requires major societal and institutional involvement in creating and maintaining safe, stable, nurturing relationships and environments for all children and their families.+  * ACEs and their negative outcomes are preventable. ​ 
 +    * However, this requires major societal and institutional involvement in creating and maintaining safe, stable, nurturing relationships and environments for all children and their families. 
 +  * Positive relationships with parents and with nonparental adults during childhood may reduce the risk of later mental disorders regardless of exposure to ACEs.[([[https://​pubmed.ncbi.nlm.nih.gov/​38150238/​|VanBronkhorst,​ S. B., Abraham, E., Dambreville,​ R., Ramos-Olazagasti,​ M. A., Wall, M., Saunders, D. C., ... & Duarte, C. S. (2023). Sociocultural Risk and Resilience in the Context of Adverse Childhood Experiences. JAMA psychiatry.]])] 
 +  * Participating in team sports during adolescence may lead to better outcomes in those exposed to ACEs.[([[https://​pubmed.ncbi.nlm.nih.gov/​31135890/​|Easterlin,​ M. C., Chung, P. J., Leng, M., & Dudovitz, R. (2019). Association of team sports participation with long-term mental health outcomes among individuals exposed to adverse childhood experiences. JAMA pediatrics, 173(7), 681-688.]])]
  
 <panel type="​info"​ title="​Preventing Adverse Childhood Experiences"​ subtitle="​Adapted from Centers for Disease Control and Prevention (CDC): Preventing Adverse Childhood Experiences (ACEs): Leveraging the Best Available Evidence (2019)"​ no-body="​true"​ footer="">​ <panel type="​info"​ title="​Preventing Adverse Childhood Experiences"​ subtitle="​Adapted from Centers for Disease Control and Prevention (CDC): Preventing Adverse Childhood Experiences (ACEs): Leveraging the Best Available Evidence (2019)"​ no-body="​true"​ footer="">​
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 ===== Resources ====== ===== Resources ======
   * [[https://​www.cdc.gov/​violenceprevention/​childabuseandneglect/​acestudy/​index.html|CDC Adverse Childhood Experiences:​ (ACEs)]]   * [[https://​www.cdc.gov/​violenceprevention/​childabuseandneglect/​acestudy/​index.html|CDC Adverse Childhood Experiences:​ (ACEs)]]
 +  * [[https://​www.bmj.com/​content/​371/​bmj.m3048|Nelson,​ C. A., Scott, R. D., Bhutta, Z. A., Harris, N. B., Danese, A., & Samara, M. (2020). Adversity in childhood is linked to mental and physical health throughout life. bmj, 371.]]
  
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