Childhood trauma considered a “social determinant of health” in neurology

According to the results of a cross-sectional study published in Neurology: Clinical practice.

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

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

The researchers considered an ACE score of four or more to be “high” and compared the prevalence of high scores among the cohort to historical US controls. They used statistical associations to adjust for age, sex, and race / ethnicity.

The results showed higher ACE scores in neurology patients compared to US population estimates at 23.7% and 12.6%, respectively (P <.01). Mendizabal and colleagues noted a correlation between high ACE scores and higher emergency room use (OR = 21; 95% CI, 5.8-76), hospitalizations (OR = 5.2; 95% CI , 1.7-15) and telephone meetings (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 scores for depression and anxiety (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 quickly refer our patients to social work and mental health care, in the hopes of improving their health outcomes and reduce the costly use of health care, ”Mendizabal said.