Adverse childhood experiences and resilience among adult women: A population-based study
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Evaluation Summary:
This is one of the larger studies investigating the impact of adverse experiences during childhood on adult psychological and psychiatric resilience. Using data from an ongoing cohort study on Icelandic women, Daníelsdóttir and colleagues reported that in the face of accumulated adverse childhood events the prevalence of resilience declines, which supports earlier studies suggesting that resilience is not invincibility. Although the data are limited to women within gender binarism and the operationalization of resilience concept could be improved, the quality of the data, (e.g., sample size), justifies the authors' conclusion that the one way to improve resilience in adulthood lies in facilitating the quality of life in childhood. This paper has the potential to make an important contribution to raising awareness of the adverse childhood experiences and their impact on resiliency, which is of interest to those working on childhood adversity and resilience.
(This preprint has been reviewed by eLife. We include the public reviews from the reviewers here; the authors also receive private feedback with suggested changes to the manuscript. Reviewer #2 agreed to share their name with the authors.)
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Abstract
Adverse childhood experiences (ACEs) have consistently been associated with elevated risk of multiple adverse health outcomes, yet their contribution to coping ability and psychiatric resilience in adulthood is unclear.
Methods:
Cross-sectional data were derived from the ongoing Stress-And-Gene-Analysis cohort, representing 30% of the Icelandic nationwide female population, 18–69 years. Participants in the current study were 26,198 women with data on 13 ACEs measured with the ACE-International Questionnaire. Self-reported coping ability was measured with the Connor-Davidson Resilience Scale and psychiatric resilience was operationalized as absence of psychiatric morbidity. Generalized linear regression assuming normal or Poisson distribution were used to assess the associations of ACEs with coping ability and psychiatric resilience controlling for multiple confounders.
Results:
Number of ACEs was inversely associated with adult resilience in a dose-dependent manner; every 1SD unit increase in ACE scores was associated with both lower levels of coping ability ( β = −0.14; 95% CI-0.15,–0.13) and lower psychiatric resilience ( β = −0.28; 95% CI-0.29,–0.27) in adulthood. Compared to women with 0 ACEs, women with ≥5 ACEs had 36% lower prevalence of high coping ability (PR = 0.64, 95% CI 0.59,0.70) and 58% lower prevalence of high psychiatric resilience (PR = 0.42; 95% CI 0.39,0.45). Specific ACEs including emotional neglect, bullying, sexual abuse and mental illness of household member were consistently associated with reduced adult resilience. We observed only slightly attenuated associations after controlling for adult socioeconomic factors and social support in adulthood.
Conclusions:
Cumulative ACE exposure is associated with lower adult resilience among women, independent of adult socioeconomic factors and social support, indicating that adult resilience may be largely determined in childhood.
Funding:
This work was supported by the European Research Council (Consolidator grant; UAV, grant number 726413), and the Icelandic Center for Research (Grant of excellence; UAV, grant number 163362-051). HBD was supported by a doctoral grant from the University of Iceland Research Fund.
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Evaluation Summary:
This is one of the larger studies investigating the impact of adverse experiences during childhood on adult psychological and psychiatric resilience. Using data from an ongoing cohort study on Icelandic women, Daníelsdóttir and colleagues reported that in the face of accumulated adverse childhood events the prevalence of resilience declines, which supports earlier studies suggesting that resilience is not invincibility. Although the data are limited to women within gender binarism and the operationalization of resilience concept could be improved, the quality of the data, (e.g., sample size), justifies the authors' conclusion that the one way to improve resilience in adulthood lies in facilitating the quality of life in childhood. This paper has the potential to make an important contribution to raising awareness of …
Evaluation Summary:
This is one of the larger studies investigating the impact of adverse experiences during childhood on adult psychological and psychiatric resilience. Using data from an ongoing cohort study on Icelandic women, Daníelsdóttir and colleagues reported that in the face of accumulated adverse childhood events the prevalence of resilience declines, which supports earlier studies suggesting that resilience is not invincibility. Although the data are limited to women within gender binarism and the operationalization of resilience concept could be improved, the quality of the data, (e.g., sample size), justifies the authors' conclusion that the one way to improve resilience in adulthood lies in facilitating the quality of life in childhood. This paper has the potential to make an important contribution to raising awareness of the adverse childhood experiences and their impact on resiliency, which is of interest to those working on childhood adversity and resilience.
(This preprint has been reviewed by eLife. We include the public reviews from the reviewers here; the authors also receive private feedback with suggested changes to the manuscript. Reviewer #2 agreed to share their name with the authors.)
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Reviewer #1 (Public Review):
This important research supports the idea that adverse experiences during childhood can have lasting impact on people through to adulthood. This study has some important strengths, including the relatively large sample size and population-based sample, although is limited in that the data reported here were collected at only one point in time and relied on the memory of participants for collecting data. The research has important implications for health and social policy in protecting the interests of children, particularly those who are vulnerable and at greater risk of adverse experiences during childhood.
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Reviewer #2 (Public Review):
Hilda Björk Daníelsdóttir et al. demonstrated the relationship between adverse childhood experiences (ACEs) and adult resilience, measured as perceived coping ability and psychiatric resilience. While this was already done for specific single types and subsets of ACEs, no study so far could show these associations for the full spectrum of all ACEs.
The large dataset of Icelandic women from the ongoing Stress-And-Gene-Analysis (SAGA) cohort gives the opportunity for an in-depth analysis, controlling for sociodemographic variables like age group, income, civil status and additionally, childhood deprivation, perceived social support, sleep quality, binge drinking and traumatic events. Furthermore, the authors could provide information about correlations (if present) between ACEs as well as between perceived …
Reviewer #2 (Public Review):
Hilda Björk Daníelsdóttir et al. demonstrated the relationship between adverse childhood experiences (ACEs) and adult resilience, measured as perceived coping ability and psychiatric resilience. While this was already done for specific single types and subsets of ACEs, no study so far could show these associations for the full spectrum of all ACEs.
The large dataset of Icelandic women from the ongoing Stress-And-Gene-Analysis (SAGA) cohort gives the opportunity for an in-depth analysis, controlling for sociodemographic variables like age group, income, civil status and additionally, childhood deprivation, perceived social support, sleep quality, binge drinking and traumatic events. Furthermore, the authors could provide information about correlations (if present) between ACEs as well as between perceived coping ability, psychiatric resilience and between perceived coping ability and different tools to obtain the mental health status.
Overall, the paper is well-structured, only descriptive data and associations of the main outcomes are reported as tables within the paper whereas all further results are presented within the supplement. Additionally, the statistical methods like Chi-square tests, rank order correlations and linear models are well known, which additionally is helping to address the paper to a wider audience. The large dataset allowing control for many variables and their possible correlations as well as for correlation between all ACEs, reducing "noisy" effects of small sample sizes.
In the end, the authors succeed identifying the relationship between women without ACEs versus women with one or more ACEs as well as the cumulative effects of ACEs on adult resilience. In addition to the importance of the unique results, the paper it is not too "technical" and well written. Therefore, the paper has the potential to communicate the results outside of the "academic sphere" without too many changes in the main text. In this way, it can make an important contribution to raising awareness of the topic in public.
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Reviewer #3 (Public Review):
Daníelsdóttir and colleagues, using data from an ongoing cohort study of Icelandic women with the objective of studying the associations of ACEs with two measures of adult resiliency: an established questionnaire measure of psychological resilience and a measure based on psychiatric outcomes. One of the key findings of this study was that there was that resilience decreased as ACEs accumulated.
Strengths: The data they used are from nearly 20000 women exposed to at least one traumatic event and complete data on outcomes and exposures. In addition to this large data set, this study had a large number of ACEs. Having a validated measure of psychological resilience is another strength of this study.
Weaknesses: The authors were not very successful in conceptualising resilience. Although Connor-Davidson scale is …
Reviewer #3 (Public Review):
Daníelsdóttir and colleagues, using data from an ongoing cohort study of Icelandic women with the objective of studying the associations of ACEs with two measures of adult resiliency: an established questionnaire measure of psychological resilience and a measure based on psychiatric outcomes. One of the key findings of this study was that there was that resilience decreased as ACEs accumulated.
Strengths: The data they used are from nearly 20000 women exposed to at least one traumatic event and complete data on outcomes and exposures. In addition to this large data set, this study had a large number of ACEs. Having a validated measure of psychological resilience is another strength of this study.
Weaknesses: The authors were not very successful in conceptualising resilience. Although Connor-Davidson scale is well known and can be introduced as such, in this paper there is a new outcome-based measure was introduced, which require laying a strong foundation on the concept of resilience. Not engaging with literature on resilience from the likes of Garmezy, Rutter, Masten, Werner, and others might have contributed to the conceptual weakness. An example might be that the authors refer to Connor- Davidson measure as perceived coping ability while the original authors meant their scale as a measure of psychological resilience in the face of perceived stress.
Although operationalisation of resilience varies, there is a common understanding that resilience is flourishing despite adversity. In this conceptualisation, establishing the role of an exposure as adversity is of paramount importance. In this paper, the psychiatric resilience is operationalised as reduction of psychiatric morbidity in the presence of trauma. However, the role of childhood events as adversities for the psychiatric morbidity cannot be established in this data where everyone has faced at least one trauma, thus leading to the absence of a counterfactual.
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