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

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This study shows something that I’ve been talking about many times, and specifically when it comes to ACEs and scoring for ACEs. You’ll recall, maybe, when I took a. deep dive into the study and noticed the following:

 

Look at that increase, 4.6 times as many people who had 4 or more ACEs are possibly dealing with than those with zero. A full 50.7% of the people with 4 or more report struggling in this area.

 

Those were the headlines. What wasn’t in the headlines?

 

  • That 50.7% was only based on surveys of 542 people.
    • I’m actually willing to overlook this, because while that number may not be exact, we’ve seen similar increases in other studies, so yes, it’s a small sample size, but we haven’t seen anything that strongly contradicts the results since then. Only confirmation.
  • That 14.2% of people reporting zero ACE scores, still appear to be struggling with depression.
    • This is where we’ve started to go wrong. ACEs appear to be a risk factor for depression, but they are not the end-all be-all of and mental health treatments. Even this study shows that there is a significant percentage of the population who may be dealing with depression that has nothing to do with adverse childhoods.
  • We’ve also overlooked the 49.3% of people with scores of 4 or more, who aren’t depressed. Or, the 81.7% who haven’t attempted suicide, the 71.6% who have not used illicit drugs, or 83.9% who don’t consider themselves alcoholic.
    • Too many people saw those numbers and made an all-too common mistake. They assumed large increased risks = fate. This is, clearly, not true.

When I stop to consider those final two points, I understand why there is criticism. It’s not so much about the study, or subsequent studies, it’s what we do with those numbers. When we advocate for resources, and policy decisions, to assist with ACE prevention and treatment, we cannot forget the people who are struggling for entirely different reasons. We do not need one treatment and option, we need a buffet table full of options. Looking seriously at childhood stress and trauma should be one thing on that buffet. So should a number of other things, to treat a number of different mental health conditions that are not even dealt with in this study. We also need to stop and consider the ramifications of classifying the results as fate. Yes, childhood can set us up for an increased risk statistically. But we need to be careful how we interpret that and treat people. Our ability to get life or health insurance should not be based on this, for example. We shouldn’t be assuming someone with a high score is an addict, or is at risk for obesity.

 

That’s the thing about statistics and percentages. They can help guide us to ways to help more people, and recognize risk factors. But if I point you to one individual, they don’t really tell us much about that person.

Now, here comes a study, linked below, that has done the real scientific research and found:

“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.”

Yes, there are statistics that show that there’s an impact at the societal level from childhood trauma. We should be addressing those issues as a society, things like child poverty, parents in the prison system, abuse, neglect, etc. because we know that as we lessen those impacts on kids, and make resources available for the kids who’s trauma we can’t prevent, we can impact the overall increases in depression, addiction, crime rates, etc. that are a direct result of childhood trauma. But, at an individual level, these things aren’t fate. How one person navigates trauma and is impacted by it, is not going to come down to just the number of traumas they dealt with as a child. When we identify one person with 4 or more ACEs according to the survey, all that really tells us is that it’s basically 50-50 whether or not they are depressed, or there’s a close to 30% chance they’ve used illicit drugs, but a 70% chance they haven’t. One person is not going to neatly fit every category and shouldn’t be treated as if they do.

https://jamanetwork.com/journals/jamapediatrics/fullarticle/2775420

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