Abstract
Importance: Adverse childhood experiences (ACEs) are well-established risk factors for health problems in the population. However, it is not known whether screening for ACEs can accurately identify individuals who develop later health problems. Objective: To test the predictive accuracy of ACE screening for later health problems.
Design: Two birth cohorts: The Environmental Risk (E-Risk) Longitudinal Twin Study followed participants born in 1994-1995 until age 18 (2012-2014), and the Dunedin Multidisciplinary Health and Development Study followed participants born in 1972-1973 until age 45 (2017-2019).
Setting: Population-based cohorts from the United Kingdom and New Zealand. Participants: 2,232 participants in E-Risk and 1,037 participants in Dunedin.
Exposure: ACEs were measured prospectively in childhood through repeated interviews and observations in both cohorts. ACEs were also measured retrospectively in the Dunedin cohort through interviews at age 38.
Main outcomes and measures: Health outcomes were assessed at age 18 in E-Risk and age 45 in Dunedin. Mental health problems were assessed through clinical interviews using the Diagnostic Interview Schedule. Physical health problems were assessed through interviews, anthropometric measurements, and blood collection.
Results: Of 2,232 E-Risk participants and 1,037 Dunedin participants, 2,009 and 928 were included in the analysis, respectively. In E-Risk, children with higher ACE scores had greater risk of later health problems (Relative Risks=1.14 [95% CI=1.10-1.18] for any mental health problem and 1.09 [95% CI=1.07-1.12] for any physical health problem per each additional ACE). ACE scores were associated with health problems independently of other information typically available to clinicians (i.e., sex, socioeconomic disadvantage, and history of health problems). However, ACE scores had poor accuracy in predicting an individual's risk of later health problems (Area Under the ROC Curve for any mental health problem=0.58 [95% CI=0.56-0.61] and 0.60 [95% CI=0.58-0.63] for any physical health problem vs 0.50 for chance prediction). Findings were consistent in the Dunedin cohort using both prospective and retrospective ACE measures.
Conclusions and Relevance: While ACE scores can forecast average group differences in health, they have poor accuracy in predicting an individual's risk of later health problems. Therefore, targeting interventions based on ACE screening is likely to be ineffective in preventing poor health.