Adverse Childhood Experiences as Predictors of Perceived Health: Assessing the ACE Pyramid Model Using Multiple-Mediation [scholarlycommons.hcahealthcare.com]

By Phillip Hughes and Tabitha L. Ostrout, HCA Healthcare Journal of Medicine, November 1, 2020

Background: Adverse Childhood Experiences (ACEs) have been shown to contribute to a litany of mental and physical health problems, including several chronic diseases and death, via a model known as the ACE pyramid. Many of the results of ACEs in the ACE pyramid are known contributors to poor perceived health, which has significant health implications. Despite these results, a possible link between ACEs and perceived health has not been examined to date. Based on the temporal order of the ACE pyramid, we believe any relationship between ACEs and perceived health will be mediated by other components of the model.

Results: The analysis included 6,060 respondents. ACEs were associated with an increase of 0.28 additional days of poor perceived health days per ACE through increases in depression and poor sleep.

Conclusions: Adverse childhood experiences may influence perceived health through multiple intermediary factors, including depression and poor sleep quality. We discuss several theoretical and clinical implications, and future directions are proposed that take advantage of the multiply-mediated model.

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