Childhood trauma seen as ‘social determinant of health’ in neurology

Patients with neurological conditions had an increased risk for adverse childhood experiences compared with the overall U.S. population, according to results of a cross-sectional study published in Neurology: Clinical Practice.

“We know that adverse childhood experiences are associated with negative health outcomes, including cardiovascular and psychiatric health,” Adys Mendizabal, MD, MA, of the department of neurology at the University of California, Los Angeles, told Healio Neurology. “However, little was known about adverse childhood experiences in neurology.”

In addition to investigating high adverse childhood experience (ACE) scores among neurology outpatients, Mendizabal and colleagues also examined the links between childhood trauma and health care utilization rates and comorbid medical and psychiatric conditions. They analyzed data of 198 patients seen for follow-up at the University of Pennsylvania, with data collected via the ACE questionnaire and depression/anxiety screenings. They also collected all participants’ health care utilization metrics, such as ED visits, hospitalizations and outpatient calls.

Researchers considered an ACE score of four or more as “high” and compared the prevalence of high scores among the cohort to U.S. historical controls. They used statistical associations to adjust for age, gender and race/ethnicity.

Results showed higher ACE scores among neurology patients compared with U.S. population estimates at 23.7% and 12.6%, respectively (P < .01). Mendizabal and colleagues noted a correlation between high ACE scores and higher ED utilization (OR = 21; 95% CI, 5.8-76), hospitalizations (OR = 5.2; 95% CI, 1.7-15) and telephone encounters (OR = 3; 95% CI, 1.1-8.2). They also observed a correlation between high ACE scores and medical and psychiatric comorbidities (OR = 5.8; 95% CI, 2-17 and OR = 4.5; 95% CI, 2.1-9.6, respectively) and high depression and anxiety scores (OR = 6.9; 95% CI, 2.8-17 and OR = 4.3; 95% CI, 1.7-11, respectively).

“By recognizing adverse childhood experiences as a social determinant of health in neurology, we can provide early referral to our patients for social work and mental health care, in hopes to improve their health outcomes and reduce costly health care utilization,” Mendizabal said.