New research finds a link between childhood trauma and a reduced engagement with healthcare services later in life.
Our health, wellbeing and behaviour are shaped by our childhood experiences.
Exposure to trauma or intense stress, referred to as “adverse childhood experiences” (Aces) by experts, is linked to a multitude of negative outcomes later in life. These include an increased risk of developing physical and mental health problems, engaging in risky behaviour, experiencing violence and lower educational attainment.
My colleagues and I wanted to understand the effect that childhood trauma may have on our relationships with healthcare professionals. We also wanted to gauge the level of comfort people had when visiting health settings. Our new research shows that Aces can be linked to distrust in health services and lower levels of comfort in hospitals and clinics.
The types of Aces that academic studies measure can vary. They typically include experiencing physical, emotional or sexual abuse, parental separation or divorce, growing up in a home where there is domestic violence or abuse, mental illness, drug or alcohol misuse, or where a household member has been in prison.
Unfortunately, Aces are relatively common. Research conducted in the UK has found that around half of people report they have experienced at least one Ace, while around one in ten report four or more Aces. And studies in more vulnerable populations find a much higher level of Aces, with more than half of male prisoners in one UK study reporting four or more Aces.
Aces are thought to influence neurological and emotional development, affecting emotion regulation and stress tolerance. Research also suggests a correlation between Aces and difficulties with delayed gratification, which is the ability to wait for a larger reward rather than taking a smaller one immediately. Additionally, Aces may be linked to lower levels of actions that benefit others, such as cooperation or helping people in need.
A growing body of international research reveals a concerning link between exposure to multiple Aces and a multitude of negative life outcomes. These include a greater likelihood of developing chronic illnesses like cancer and cardiovascular disease, as well as mental health issues such as depression, anxiety, self-harm and suicide.
Aces have also been linked to an increased use of healthcare services such as visiting accident and emergency departments, having an overnight stay in hospital or frequent GP use.
Research is starting to show that the experience of Aces can be linked to a low uptake of preventative healthcare, such as vaccination. For example, Ace exposure is associated with hesitancy to have the COVID-19 vaccine. It is also associated with perceiving public services as less supportive and having less trust in medical professionals and public services.
But until now, very little research had explored whether Aces may be linked to how people engage with health services or how comfortable they feel in health settings.
We conducted an online survey with 1,696 adults in England and Wales. We found that, in comparison to people who had not experienced any childhood trauma, people who had experienced four or more Aces were more likely to think that health professionals do not care about their health or understand their problems. Compared to people who reported no Aces, people with four or more Aces were also more than twice as likely to report low levels of comfort when using hospitals, GP clinics and dental surgeries.
Consistent with studies elsewhere, we found that exposure to Aces were associated with increased medication use, including being prescribed antibiotics. But we also found that Aces were associated with not taking medication as instructed.
In Wales and England alone, Aces are estimated to cost £42 billion. This cost is associated with various health problems, including illnesses like cancer, and risk factors like smoking.
So, unravelling the factors that could enhance healthcare engagement is crucial. This knowledge may allow us to better understand people’s needs and tailor health services accordingly.
By fostering stronger relationships between patients and healthcare workers, and enhancing patient comfort, we could potentially see a significant increase in service uptake and ultimately, improved healthcare delivery.
Public Health Wales NHS Trust funded this research and Kat Ford's post at Bangor University.
