Adverse Childhood Experiences: Impact Upon Intimate Partner Violence, Depression, and Suicide Attempt Among Adults in a Sample of Southwest Tribes

BACKGROUND: Adverse Childhood Experiences (ACE) refer to multiple types of abuse suffered during childhood including neglect; violence between parents/caregivers; other kinds of serious household dysfunction such as alcohol/substance abuse; and peer, community, and collective violence. Studies show links between ACE and behavioral health manifestations in adulthood such as Intimate Partner Violence (IPV), depression, and suicide within the general United States (U.S.) population. The association between ACE and these behavioral health outcomes has not been explored in American Indian populations despite the fact American Indians carry longstanding histories of genocide and trauma and experience the highest burden of mental illness, IPV, and suicide in the U.S.

METHODS: Face-to-face Behavioral Risk Factor Surveillance System (BRFSS) interviews were conducted with 663 adults in a sample of southwest tribes from 2008-2010. The instrument included an 8-item ACE module and measures of suicide, IPV victimization, and depression. To measure the cumulative effects of ACE, a four level scale (1, 2, 3, 4+) was used assigning one point for each of the eight possible ACE occurrences. Chi-square and logistic regression analyses were conducted to test associations between ACE and behavioral health outcomes.

RESULTS:  The burden of ACE in this population was considerable, ranging from 7% to 51% for each ACE type. 32% reported no ACE during childhood, and 22%, 16%, 9%, and 21% reported ACE scores of 1, 2, 3, 4+ respectively. Furthermore, 20% of adults experienced IPV, 15% were diagnosed with depression, and 9% attempted suicide. Results showed statistically significant relationships (p<0.05) between ACE during childhood and adult behavioral health outcomes. Consistent with the national literature, adults with high ACE scores (4+) were 3.5-7.2 times more likely to experience depression, suicide, or IVP than adults with low ACE scores.

CONCLUSIONS:  These findings demonstrate that ACE is a serious public health concern for American Indians. Moreover, there is a strong association between ACE and several behavioral health concerns in adulthood. The need for culturally appropriate interventions to prevent ACE exposure and strengthen resiliency among American Indian youth is critical, and may beneficially mitigate behavioral health concerns in adulthood such as suicide, IPV, and depression.  Equal attention must be devoted towards addressing key structural factors such as racism, economic hardship, and inaccessibility to quality behavioral healthcare services, which contribute to such health disparities witnessed among American Indians during childhood and adulthood.