Adverse Childhood Experiences, Support, and the Perception of Ability to Work in Adults with Disability

Overview

Journal PLoS One

Specialties General Medicine
Science

Date 2016 Jul 6

PMID 27379796

Citations 9

Authors

Sophia Miryam Schussler-Fiorenza Rose

Jessica G Eslinger

Lindsey Zimmerman

Jamie Scaccia

Betty S Lai

Catrin Lewis

Eva Alisic

Affiliations

Soon will be listed here.

Abstract

Objective: To examine the impact of adverse childhood experiences (ACEs) and support on self-reported work inability of adults reporting disability.

Participants: Adults (ages 18-64) who participated in the Behavioral Risk Factor Surveillance System in 2009 or 2010 and who reported having a disability (n = 13,009).

Design And Main Outcome Measures: The study used a retrospective cohort design with work inability as the main outcome. ACE categories included abuse (sexual, physical, emotional) and family dysfunction (domestic violence, incarceration, mental illness, substance abuse, divorce). Support included functional (perceived emotional/social support) and structural (living with another adult) support. Logistic regression was used to adjust for potential confounders (age, sex and race) and to evaluate whether there was an independent effect of ACEs on work inability after adding other important predictors (support, education, health) to the model.

Results: ACEs were highly prevalent with almost 75% of the sample reporting at least one ACE category and over 25% having a high ACE burden (4 or more categories). ACEs were strongly associated with functional support. Participants experiencing a high ACE burden had a higher adjusted odds ratio (OR) [95% confidence interval] of 1.9 [1.5-2.4] of work inability (reference: zero ACEs). Good functional support (adjusted OR 0.52 [0.42-0.63]) and structural support (adjusted OR 0.48 [0.41-0.56]) were protective against work inability. After adding education and health to the model, ACEs no longer appeared to have an independent effect. Structural support remained highly protective, but functional support only appeared to be protective in those with good physical health.

Conclusions: ACEs are highly prevalent in working-age US adults with a disability, particularly young adults. ACEs are associated with decreased support, lower educational attainment and worse adult health. Health care providers are encouraged to screen for ACEs. Addressing the effects of ACEs on health and support, in addition to education and retraining, may increase ability to work in those with a disability.

Citing Articles

Prevalence of Adverse Childhood Experience Exposure by Disability Status.

Schussler-Fiorenza Rose S, Rehkopf D, Snyder M, Slavich G JAMA Health Forum. 2025; 6(1):e244881.

PMID: 39792402 PMC: 11724342. DOI: 10.1001/jamahealthforum.2024.4881.

Adverse childhood experiences, diabetes and associated conditions, preventive care practices and health care access: A population-based study.

Schussler-Fiorenza Rose S, Snyder M, Slavich G Prev Med. 2022; 160:107044.

PMID: 35398366 PMC: 9218745. DOI: 10.1016/j.ypmed.2022.107044.

Protocol for a Case Control Study to Evaluate Oral Health as a Biomarker of Child Exposure to Adverse Psychosocial Experiences.

Durbin A, Amaechi B, Abrams S, Mandelis A, Werb S, Roebuck B Int J Environ Res Public Health. 2022; 19(6).

PMID: 35329091 PMC: 8948931. DOI: 10.3390/ijerph19063403.

Differences in functional and structural social support among female and male veterans and civilians.

Campbell S, Gray K, Hoerster K, Fortney J, Simpson T Soc Psychiatry Psychiatr Epidemiol. 2020; 56(3):375-386.

PMID: 32249329 PMC: 8687626. DOI: 10.1007/s00127-020-01862-4.

Positive Childhood Experiences and Adult Mental and Relational Health in a Statewide Sample: Associations Across Adverse Childhood Experiences Levels.

Bethell C, Jones J, Gombojav N, Linkenbach J, Sege R JAMA Pediatr. 2019; 173(11):e193007.

PMID: 31498386 PMC: 6735495. DOI: 10.1001/jamapediatrics.2019.3007.

References

Ford E, Anda R, Edwards V, Perry G, Zhao G, Li C . Adverse childhood experiences and smoking status in five states. Prev Med. 2011; 53(3):188-93. DOI: 10.1016/j.ypmed.2011.06.015. View

Dube S, Williamson D, Thompson T, Felitti V, Anda R . Assessing the reliability of retrospective reports of adverse childhood experiences among adult HMO members attending a primary care clinic. Child Abuse Negl. 2004; 28(7):729-37. DOI: 10.1016/j.chiabu.2003.08.009. View

Cornelius L, van der Klink J, Groothoff J, Brouwer S . Prognostic factors of long term disability due to mental disorders: a systematic review. J Occup Rehabil. 2010; 21(2):259-74. PMC: 3098343. DOI: 10.1007/s10926-010-9261-5. View

Garner A, Shonkoff J . Early childhood adversity, toxic stress, and the role of the pediatrician: translating developmental science into lifelong health. Pediatrics. 2011; 129(1):e224-31. DOI: 10.1542/peds.2011-2662. View

Druss B, Hwang I, Petukhova M, Sampson N, Wang P, Kessler R . Impairment in role functioning in mental and chronic medical disorders in the United States: results from the National Comorbidity Survey Replication. Mol Psychiatry. 2008; 14(7):728-37. PMC: 2700857. DOI: 10.1038/mp.2008.13. View

Vandenbroucke J, von Elm E, Altman D, Gotzsche P, Mulrow C, Pocock S . Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): explanation and elaboration. PLoS Med. 2007; 4(10):e297. PMC: 2020496. DOI: 10.1371/journal.pmed.0040297. View

Hadi F, Lai B, Llabre M . Life outcomes influenced by war-related experiences during the Gulf crisis. Anxiety Stress Coping. 2013; 27(2):156-75. PMC: 3877742. DOI: 10.1080/10615806.2013.832219. View

Moak Z, Agrawal A . The association between perceived interpersonal social support and physical and mental health: results from the National Epidemiological Survey on Alcohol and Related Conditions. J Public Health (Oxf). 2009; 32(2):191-201. PMC: 2875984. DOI: 10.1093/pubmed/fdp093. View

Kessler R, Ormel J, Demler O, Stang P . Comorbid mental disorders account for the role impairment of commonly occurring chronic physical disorders: results from the National Comorbidity Survey. J Occup Environ Med. 2003; 45(12):1257-66. DOI: 10.1097/01.jom.0000100000.70011.bb. View

10.

Green J, McLaughlin K, Berglund P, Gruber M, Sampson N, Zaslavsky A . Childhood adversities and adult psychiatric disorders in the national comorbidity survey replication I: associations with first onset of DSM-IV disorders. Arch Gen Psychiatry. 2010; 67(2):113-23. PMC: 2822662. DOI: 10.1001/archgenpsychiatry.2009.186. View

11.

Kessler R, Davis C, Kendler K . Childhood adversity and adult psychiatric disorder in the US National Comorbidity Survey. Psychol Med. 1997; 27(5):1101-19. DOI: 10.1017/s0033291797005588. View

12.

CASE R, MOSS A, Case N, McDermott M, Eberly S . Living alone after myocardial infarction. Impact on prognosis. JAMA. 1992; 267(4):515-9. View

13.

Smith D, Strauser D . Examining the impact of physical and sexual abuse on the employment of women with disabilities in the United States: an exploratory analysis. Disabil Rehabil. 2008; 30(14):1039-46. DOI: 10.1080/09637480701539542. View

14.

Weinberg C . Interaction and exposure modification: are we asking the right questions?. Am J Epidemiol. 2012; 175(7):602-5. PMC: 3324436. DOI: 10.1093/aje/kwr495. View

15.

Colman R, Widom C . Childhood abuse and neglect and adult intimate relationships: a prospective study. Child Abuse Negl. 2004; 28(11):1133-51. DOI: 10.1016/j.chiabu.2004.02.005. View

16.

Schussler-Fiorenza Rose S, Xie D, Stineman M . Adverse childhood experiences and disability in U.S. adults. PM R. 2014; 6(8):670-80. PMC: 4306581. DOI: 10.1016/j.pmrj.2014.01.013. View

17.

Brouwer S, Reneman M, Bultmann U, van der Klink J, Groothoff J . A prospective study of return to work across health conditions: perceived work attitude, self-efficacy and perceived social support. J Occup Rehabil. 2009; 20(1):104-12. PMC: 2832875. DOI: 10.1007/s10926-009-9214-z. View

18.

Anda R, Fleisher V, Felitti V, Edwards V, Whitfield C, Dube S . Childhood Abuse, Household Dysfunction, and Indicators of Impaired Adult Worker Performance. Perm J. 2015; 8(1):30-8. PMC: 4690705. DOI: 10.7812/TPP/03-089. View

19.

Anda R, Felitti V, Douglas Bremner J, Walker J, Whitfield C, Perry B . The enduring effects of abuse and related adverse experiences in childhood. A convergence of evidence from neurobiology and epidemiology. Eur Arch Psychiatry Clin Neurosci. 2005; 256(3):174-86. PMC: 3232061. DOI: 10.1007/s00406-005-0624-4. View

20.

Felitti V, Jakstis K, Pepper V, Ray A . Obesity: problem, solution, or both?. Perm J. 2010; 14(1):24-30. PMC: 2912711. DOI: 10.7812/TPP/10.996. View