COVID-19 pandemic coincided with more adult diagnoses related to such trauma, report shows.
The COVID-19 pandemic is frequently blamed for school learning loss and growing rates of anxiety and depression. Now a new study involving state hospital data shows the pandemic also coincided with an increase in childhood trauma.
Admissions data analyzed by the New Jersey Hospital Association showed the percentage of hospital patients who experienced trauma as children — things like extreme poverty, physical or sexual abuse, or a parent’s incarceration — more than doubled between 2016 and 2023, with the rise among women even more extreme. The sharpest increase in trauma-related diagnoses for patients under age 18 followed the outbreak of COVID-19 in early 2020.
The study — which involved data from the roughly 750,000 adults admitted to New Jersey hospitals each year — flagged patients with diagnostic codes associated with ACEs, the shorthand for Adverse Childhood Experiences. The codes might reflect the bruises, broken bones or anxiety associated with child abuse, for example, or the violent outbursts of a youngster whose parents are going through a divorce.
The Hospital Association’s findings also highlighted how someone who faces childhood trauma appears more likely to suffer health problems later in life, something previous studies have also shown.
“It’s great to see NJHA recognizing the prevalence of ACEs as well as their impact on health and well-being across the lifespan. The data collected here does track with our internal understanding of the impact of ACEs in New Jersey,” said Dr. Rebecca Bryan, executive director for the Office of Resilience within the state Department of Children and Families, which oversees child welfare programs. The department created a plan to address these adverse experiences in 2021, said to be the first of its kind in the nation.
The possible reasons
The reason for the increase in ACES-related diagnoses is not clear from the data alone. Sean Hopkins, senior vice president for the association’s Center for Health Analytics, Research and Transformation, which conducted the analysis, said it could reflect an increase in childhood trauma or “better screening” by doctors and nurses.
“As providers continue to improve their screening process, we anticipate that the number of ACEs cases captured annually will continue to climb,” Hopkins said. By 2023, more than 9,000 adults were admitted to New Jersey hospitals who had a childhood trauma-related diagnosis previously recorded in their chart, he said, about 1.2% of all admissions.
Child welfare experts warned that the COVID-19 pandemic itself — with school closures, fears of sickness and death, and the resulting economic fallout — would be traumatic for some children. The impact on children in the foster care system was significant, according to one expert, and the repercussions continue.
Bryan said the rise in childhood adverse experiences is shaped by many factors, including the growing national epidemic of loneliness and the prevalence of things like housing shortages, food insecurity and a lack of childcare. “While COVID-19 certainly contributed to this, the issue is more complex and involves the decline of local engagement in traditional spaces and social outlets [like churches and scouting] and the ubiquity of technology in every aspect of our lives,” she said.
Previous findings suggest more than 40% of children in New Jersey experience at least one adverse incident. A longer-term study released in 2023 suggests these incidents have grown to impact about 67% of kids nationwide, or 62% in New Jersey, the Hospital Association notes.
Those most impacted
ACEs impact all races and economic groups, experts point out, but Black and Hispanic children are more likely to report multiple traumas — including the impact of racism — and often have less access to resources to help them heal. The association’s data shows Hispanic residents reported a higher percentage than other groups from 2016 to 2022. By 2023, white patients had the highest percentage of trauma-related diagnoses.
The Hospital Association’s study also appears to confirm the correlation other research has found between childhood trauma and health challenges as an adult. Once again, the study used diagnostic codes for certain conditions — like stab wounds from a fight, psychiatric episodes or addiction — to compare the health of adults who had experienced childhood trauma with those who did not report such experiences.
New Jersey took bold steps to address the impact of ACEs before the pandemic and by 2020, created the Office of Resilience, a national first.
The data showed that patients with ACES-related diagnoses as kids were more likely to be hospitalized — or treated as an outpatient — for violent incidents or mental health challenges, when compared to those who did not experience these early traumas. Those with past trauma were also more likely to be admitted for treatment for addiction issues, including tobacco use, the data showed.
“Health status is influenced by experiences, environment and other external factors throughout our lifetimes,” Hospital Association President and CEO Cathy Bennett said when the report was released in late August. “By providing insight into the complex and fragile nature of health, this report can help healthcare professionals, public health and other partners support identification, awareness, resilience and healing for those who experience adversity early in life.”
Lesser effects on adults
While the incidence of ACEs diagnoses appears to be on the rise, the impact these traumas have on adult health may be declining, the association’s report found. The greatest change is reflected in substance-use disorder diagnoses, which in 2016 were assigned to nearly 68% of the adults who had childhood trauma-related diagnoses in their charts. By 2023, just over 42% of these patients were diagnosed with a substance-use disorder. Among those without a history of trauma, addiction diagnoses remained steady at close to 18% over the eight years.
New Jersey took bold steps to address the impact of ACEs before the pandemic and by 2020, created the Office of Resilience, a national first. The state tapped national expert Dave Ellis to spearhead this work as part of a unique public-private partnership in which his salary was partly funded by a trio of philanthropic organizations. In 2021, the office released the comprehensive action plan to address childhood trauma impacts, but a shift in outside funding contributed to Ellis’s departure in 2022.
Bryan, who now heads these initiatives for the state, said the Department of Children and Families, continues to work to prevent and heal the impact of ACEs. It is also partnering with others to document and promote positive childhood experiences, which can have a mitigating effect on trauma. It offers tools to help organizations evaluate the extent to which their work is informed by people’s trauma and is building a statewide network of certified “resilience” trainers, among other efforts.
The Hospital Association report is also designed to raise awareness about the impact of childhood traumas among health care practitioners. The group concedes there are limits to the data — like the inability to ascertain the timing and details of the original trauma — and that the results reflect doctors’ willingness and capacity to ask the questions needed to determine if their patient is impacted. A 2020 study cited in the report notes that fewer than one-third of all clinicians said they routinely screened for these conditions.
“We expect that the findings in this study will raise awareness on the importance of properly documenting ACEs among patients through administrative data such as hospital discharges,” the report notes.
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Increased health impacts from childhood trauma seen in NJ | NJ Spotlight News
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