The Adverse Childhood Experiences (ACEs) studies transformed our understanding of the true burden of trauma. Notable elements of Felitti and colleagues' findings include the influence of adversity on ...many physical as well as psychological problems and the persistence of impacts decades after the traumas occurred. In this article, we make the case that the most revolutionary finding was the discovery of a strong dose-response effect, with marked increases in risk observed for individuals who reported four or more adversities. Over the past two decades, our understanding of the cumulative burden of trauma has expanded further, with recognition that experiences outside the family, including peer victimization, community violence, and racism, also contribute to trauma dose. Recent research has provided evidence for the pervasiveness of trauma, which we now realize affects most people, even by the end of adolescence. Extensive scientific evidence has documented that more than 40 biopsychosocial outcomes, including leading causes of adult morbidity and mortality, are associated with adverse childhood experiences, measured by dose. We summarize the state of science and explain how ACEs built a movement for uncovering mechanisms responsible for these relationships. Perhaps unexpectedly, the pervasiveness of trauma also expands our understanding of resilience, which is likewise more common than previously recognized. Emerging research on positive childhood experiences and poly-strengths suggests that individual, family, and community strengths may also contribute to outcomes in a dose-response relationship. We close with an agenda for research, intervention, and policy to reduce the societal burden of adversity and promote resilience.
Public Significance Statement
The Adverse Childhood Experiences (ACEs) studies and related research have revealed that victimization and trauma are more common than previously known, and that trauma dose, in the form of the number of types of adversities, is strongly associated with more than 40 biopsychosocial outcomes. In turn, the recognition of the pervasiveness of trauma is contributing to a reconceptualization of resilience, which is likewise more common than previously recognized. All individuals, families, and communities need to know how to cope with trauma and overcome adversity, as well as recognize the role we all play in prevention.
Racial discrimination, including microaggressions, contributes to health inequities, yet research on discrimination and microaggressions has focused on single measures without adequate psychometric ...evaluation. To address this gap, we examined the psychometric performance of three discrimination/microaggression measures among American Indian and Alaska Native (AI/AN) college students in a large Southwestern city.
Students (N = 347; 65% female; ages 18-65) completed the revised-Everyday Discrimination Scale, Microaggressions Distress Scale, and Experiences of Discrimination measure. The psychometric performance of these measures was evaluated using item response theory and confirmatory factor analyses. Associations of these measures with age, gender, household income, substance use, and self-rated physical health were examined.
Discrimination and microaggression items varied from infrequently to almost universally endorsed and each measure was unidimensional and moderately correlated with the other two measures. Most items contributed information about the overall severity of discrimination and collectively provided information across a continuum from everyday microaggressions to physical assault. Greater exposure to discrimination on each measure had small but significant associations with more substance use, lower income, and poorer self-rated physical health. The Experiences of Discrimination measure included more severe forms of discrimination, while the revised-Everyday Discrimination Scale and the Microaggressions Distress Scale represented a wider range of severity.
In clinical practice, these measures can index varying levels of discrimination for AI/ANs, particularly for those in higher educational settings. This study also informs the measurement of racial discrimination and microaggressions more broadly.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Extensive research demonstrates that Adverse Childhood Experiences (ACEs) are highly interconnected and have numerous health consequences well into adulthood. Yet, there is a dearth of focused ...research that examines ACEs and health inequities for American Indians (AIs).
To assesses the prevalence of ten types of childhood adversities, explore constellations of exposures, and examine whether there are differential risks of mental health outcomes according to sub-group classification.
Adult AIs with type 2 diabetes from five reservation-based tribal communities in the Great Lakes region of the U.S.
Prevalence was estimated using a modified version of the World Health Organization's ACE-International Questionnaire. To examine heterogeneity in ACEs exposures, latent class analysis was used. Risk of mental health outcomes was calculated by class.
The four most common ACEs reported were residing with someone who abused substances, witnessing household violence, incarceration of a household member, and sexual abuse. Three latent classes were identified: low risk (56.7%), family maladjustment with high probabilities of household violence, incarceration, and substance abuse (27.1%), and complex trauma (16.3%) with moderate to high probabilities of exposure to all ACEs. The most consistent differences in mental health outcomes were between the low risk and complex trauma classes.
Identification of a high number of participants in the low-risk class helps structure a more wholistic image of AI families, as negative stereotypes of AIs are abundant. For the minority of individuals in the complex trauma class, risk for chronic mental health challenges and co-morbidities appears to be high.
American Indian health disparities have reached crisis levels, and there is a need to develop culturally congruent interventions through meaningful tribal involvement and ethical community-oriented ...approaches. Hence, it is imperative that researchers and university administrators better understand how research translation occurs for tribally driven health-equity research projects. Utilizing thematic analysis methods, the authors examined documents from a 12-year community-based participatory research partnership to elucidate factors that ignite momentum and support partnership longevity. The overarching finding was that trust and respect provide a foundation for momentum and longevity and are closely intertwined with other themes identified in analyses. Seven themes were extrapolated and classified into two domains: (1) investments, which are catalyzing factors that advance research, and (2) intermediate processes, which link investments to success. Investment themes include Indigenous scholar involvement, time and effort, establishing rapport, and clear and appropriate communication. Intermediate process themes include generative colearning, active participation, and recognition and celebration. Community-based participatory research principles were reflected in these findings. This study also upholds prior published work on Indigenous research methodologies, promotes the lived experiences of Indigenous people, and contributes to Indigenous theory building and science.
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Dostopno za:
BFBNIB, DOBA, IZUM, KILJ, NMLJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Background
Decades of evidence link adverse childhood experiences (ACEs) to worse health. Despite disproportionate rates of ACEs and health disparities in tribal communities, a gap exists in ...understanding the effects of ACEs on American Indian (AI) health. The purpose of this study is to estimate frequencies of eight categories of ACEs, assess the risk for internalizing symptoms by each ACE category, and determine if moderate and high levels of ACEs exposures have differential, increasing risk associated with internalizing symptoms for a sample of AI adults with T2D.
Methods
Five tribal communities participated in a community-based participatory research study. Data from AI adults with T2D were analyzed (
N
= 192). Frequencies of eight childhood events and situations were assessed, and exposure levels of low (0–1), moderate (2–3), and high levels (4 +) of ACEs were calculated. Odds of screening positive for depression and generalized anxiety disorder (GAD) by each ACE type and moderate and high levels of ACEs were estimated using regression analyses.
Results
Relative to other studies, exposure estimates for each of the eight ACE categories and moderate and high levels of ACEs were high. Sexual and physical abuse, neglect, and household mental illness were positively associated with depressive symptoms, and physical abuse was positively associated with anxiety symptoms. Exposures to moderate and high levels of ACEs were associated with increased odds of screening positive for current depression in a dose-response fashion. A high level of ACEs exposure was also associated with an increased odds of a positive GAD screening.
Conclusions
This research extends limited knowledge about ACEs and health among AIs. More research is needed to understand the health consequences of ACEs for a population exhibiting health inequities. Components of strategies for addressing ACEs, mental health, T2D complications, and comorbidities are proposed for AIs generally and AI adults with T2D specifically.
Indigenous communities lack representation in psychiatric epidemiology despite disproportionate exposure to risk factors. We document the cumulative and 12-month prevalence of psychiatric disorders ...across the early life course among a sample of Indigenous young adults and compare prospective and retrospective reporting of lifetime mental disorders. This community-based participatory research includes data from 735 Indigenous people from 8 reservations/reserves. Personal interviews were conducted between 2002–2010 and 2017–2018 totaling 9 waves; diagnostic assessments of DSM-IV-TR alcohol abuse/dependence, marijuana use/dependence, other substance abuse/dependence, generalized anxiety disorder, major depressive disorder, dysthymic disorder, and attention deficit/hyperactivity disorder occurred at waves 1 (mean age = 11.1 years), 4 (mean age = 14.3 years), 6 (mean age = 16.2 years), 8 (mean age = 18.3 years), and 9 (mean age = 26.3 years). Cumulative lifetime psychiatric disorders reached 77.3% and lifetime comorbidity 56.4% by wave 9. Past-year prevalence and comorbidity at wave 9 were 28.7% and 6.7%, respectively. Substance use disorders (SUDs) were most common with peak past-year prevalence observed when participants were on average 16.3 years old then declining thereafter. Trends in early life course psychiatric disorders in this study with Indigenous participants highlight cultural variations in psychiatric epidemiology including surprisingly low rates of internalizing disorders in the face of risk factors, disproportionately high rates of early-onset and lifetime SUD, and lower rates of past-year SUD in early adulthood compared with prior research.
ObjectivesThe purpose of this study was to determine the frequency of select adverse childhood experiences (ACEs) among a sample of American Indian (AI) adults living with type 2 diabetes (T2D) and ...the associations between ACEs and self-rated physical and mental health. We also examined associations between sociocultural factors and health, including possible buffering processes.DesignSurvey data for this observational study were collected using computer-assisted survey interviewing techniques between 2013 and 2015.SettingParticipants were randomly selected from AI tribal clinic facilities on five reservations in the upper Midwestern USA.ParticipantsInclusion criteria were a diagnosis of T2D, age 18 years or older and self-identified as AI. The sample includes n=192 adults (55.7% female; mean age=46.3 years).Primary measuresWe assessed nine ACEs related to household dysfunction and child maltreatment. Independent variables included social support, diabetes support and two cultural factors: spiritual activities and connectedness. Primary outcomes were self-rated physical and mental health.ResultsAn average of 3.05 ACEs were reported by participants and 81.9% (n=149) said they had experienced at least one ACE. Controlling for gender, age and income, ACEs were negatively associated with self-rated physical and mental health (p<0.05). Connectedness and social support were positively and significantly associated with physical and mental health. Involvement in spiritual activities was positively associated with mental health and diabetes-specific support was positively associated with physical health. Social support and diabetes-specific social support moderated associations between ACEs and physical health.ConclusionsThis research demonstrates inverse associations between ACEs and well-being of adult AI patients with diabetes. The findings further demonstrate the promise of social and cultural integration as a critical component of wellness, a point of relevance for all cultures. Health professionals can use findings from this study to augment their assessment of patients and guide them to health-promoting social support services and resources for cultural involvement.
American Indian and Alaska Native sexual minority (two-spirit) women are vulnerable to substance misuse and mental health challenges due to multiple minority oppressed status and exposure to stress ...and trauma. Yet, these women find pathways toward healing and wellness. We conducted a qualitative data analysis of interviews derived from a national health study and gained an understanding of 11 two-spirit women's resilience and recovery patterns. Emergent from the data, a braided resiliency framework was developed which elucidates multilayered abilities, processes, and resources involved in their resiliency. We recommend that resilience-promoting strategies be incorporated into substance misuse and mental health interventions.
Despite alarming health disparities among American Indians (AIs) and acknowledgement that stressors negatively influence health, conceptualization of the full spectrum of stressors that impact ...Indigenous communities is underdeveloped. To address this gap, we analyze focus group transcripts of AI adults with type 2 diabetes from five tribal communities and classify stressors using an inductive/deductive analytical approach. A Continuum of American Indian Stressor Model was constructed from categorization of nineteen stressor categories within four domains. We further identified poverty, genocide, and colonization as fundamental causes of contemporary stress and health outcomes for AIs and conclude that stressors are generally experienced as chronic, regardless of the duration of the stressor. This work on AI-specific stressors informs future health research on the stress burden in AI communities and identifies target points for intervention and health promotion.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
American Indians experience morbidity and premature mortality at disproportionate and increasing rates compared to other Americans. Type 2 diabetes and behavioral health challenges are major ...contributors to American Indian morbidity and mortality. Moreover, research demonstrates that social stressors, including childhood adversities, impact health and wellness across diverse populations. Yet, little is known about the prevalence of childhood adversities for American Indians with type two diabetes, nor which childhood events and situations generally impact the health of Natives, nor if there are particular combinations of childhood stressors that have differential impacts on Native health. This dissertation situates empirical analyses within an overall health inequities agenda, considers prior research on childhood adversities and health, and recognizes historically unjust traumas and contemporary American Indian-specific social stressors as having continued health effects. Given the rationale and framework described above, childhood stressors are analyzed for a sample of American Indian adults with type 2 diabetes from the Great Lakes region (N= 190). Childhood adversities for this sample are analyzed in three distinct ways. First, I estimate the prevalence of seven conventional childhood adversities and “ACEs scores” and compare these to other study estimates. Findings indicate high exposure rates for singular types of childhood adversities and disproportionate ACEs scores among this sample. Second, I use latent class analysis to explore patterns of co-occurring childhood stressors. Ten types of childhood stressors meaningfully contribute to identification of three distinct profiles of childhood stressors: Class 1: Low Adversity Class; Class 2: Household Violence and Incarceration Class; and Class 3: High Adversity Class. In a final analysis, I examine the association between childhood stressor profiles and depressive symptoms, alcohol misuse, and commercial tobacco use. This analysis shows that depressive symptoms are differentially associated across latent classes. Alcohol misuse and commercial tobacco use are not differentially associated across the latent subgroups. This dissertation expands knowledge about the childhood stressors experienced among American Indians with type 2 diabetes. It suggests that more research is needed to understand the health consequences that may result from childhood adversities for American Indians, particularly those with type 2 diabetes. Multiple practice and policy implications are discussed.
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