Associations of Adverse Childhood Experiences with Past-Year DSM-5 Psychiatric and Substance Use Disorders in Older Adults

Taeho Greg Rhee; Lisa C Barry; George A Kuchel; David C Steffens; Samuel T Wilkinson

doi:10.1111/jgs.16032

Associations of Adverse Childhood Experiences with Past-Year DSM-5 Psychiatric and Substance Use Disorders in Older Adults

J Am Geriatr Soc. 2019 Oct;67(10):2085-2093. doi: 10.1111/jgs.16032. Epub 2019 Jun 17.

Authors

Taeho Greg Rhee^{1

2

3

4}, Lisa C Barry^{5

6}, George A Kuchel⁵, David C Steffens^{5

6}, Samuel T Wilkinson^{2

3}

Affiliations

¹ Department of Community Medicine and Health Care, School of Medicine, University of Connecticut, Farmington, Connecticut.
² Department of Psychiatry, School of Medicine, Yale University, New Haven, Connecticut.
³ Yale Center for Outcomes Research and Evaluation, Yale-New Haven Health, New Haven, Connecticut.
⁴ US Department of Veterans Affairs Connecticut Healthcare System, Mental Illness Research, Education and Clinical Center of New England, West Haven, Connecticut.
⁵ Center on Aging, School of Medicine, University of Connecticut, Farmington, Connecticut.
⁶ Department of Psychiatry, School of Medicine, University of Connecticut, Farmington, Connecticut.

Abstract

Objectives: To examine the prevalence of adverse childhood experiences (ACEs) and the associations of ACEs with psychiatric and substance use disorders among older adults in the United States.

Design: Cross-sectional analysis of the 2012-2013 National Epidemiological Survey on Alcohol and Related Conditions Wave III (NESARC-III).

Setting: Nationally representative drug-related health interview survey in the United States.

Participants: Survey respondents aged 65 or older (n = 5806 unweighted).

Measurements: ACEs, the key independent variable, were assessed using validated measures. Outcome variables consisted of past-year psychiatric disorders (eg, major depressive disorder and generalized anxiety disorder) and substance use disorders (eg, alcohol use disorder) using criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. We estimated the national prevalence of ACEs in older adults and used multivariable-adjusted logistic regression analyses to assess the association between ACEs and the outcomes after adjusting for sociodemographics and clinical comorbidities.

Results: Overall, 35.9% of older adults, representative of 14.8 million older adults nationwide, reported some form of ACEs. The most common types were parental psychopathology (20.3%), other traumatic events (14.0%), and physical/psychological abuse (8.4%). Having experienced any ACEs was associated with higher odds of having a past-year psychiatric disorder (adjusted odds ratio = 2.11; 95% confidence interval = 1.74-2.56). Similar results were found for substance use disorders (P < .01).

Conclusion: ACEs are linked to an increased risk for past-year psychiatric and substance use disorders in older adults. ACEs may have long-term effects on older adults' mental well-being. Although further research is needed, preventing ACEs may lead to large improvements in public mental health that persist well into older age. J Am Geriatr Soc 67:2085-2093, 2019.

Keywords: adverse childhood experiences; mental health; older adults; psychiatric disorder; substance use disorder.

Publication types

Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Adverse Childhood Experiences / statistics & numerical data*
Aged
Aged, 80 and over
Chronic Disease / epidemiology
Cross-Sectional Studies
Diagnostic and Statistical Manual of Mental Disorders
Female
Health Surveys
Humans
Male
Mental Disorders / epidemiology*
Substance-Related Disorders / epidemiology*
Suicide, Attempted / statistics & numerical data
United States / epidemiology

Abstract

Publication types

MeSH terms

Grants and funding