Early life adversity and life course health: an investigation of adversity clustering and associations with health

Lead Research Organisation: University College London
Department Name: Epidemiology and Public Health

Abstract

Early life adversities, such as child maltreatment, are all too common in the UK. Research to date suggests that such adversities can have long-term effects on health. For instance, adversities experienced in childhood and even during pregnancy may alter the way the body deals with stress throughout life. This can result in an increased risk of diseases such as heart disease, depression and type 2 diabetes. It is therefore important to investigate how early life adversities might be linked to poorer health to better inform the development of interventions.

Previous research into the health effects of early life adversities has been limited in a number of ways. Firstly, many studies have added up the number of adversities a child has experienced to create a score indicating 'total stress'. Unfortunately many children who experience one adversity are also more likely to experience another. The approach of tallying adversities does not help us to understand how adversities might affect health and what we can do about this. We also don't know whether experiencing adversities at certain ages (e.g. during pregnancy) has a greater effect on health than when experienced at other points in early life. There is also little evidence on whether associations between early life adversities and health are different for boys and girls. Also different types of early life adversity are likely to have different associations with health.

The aim of this project is to develop a more valid measure of early life adversity and investigate how it is related to health at different points of life. This new measure will take account of the way in which children who experience one adversity are more likely to experience another. This measure will then be applied to look at associations with health. The research will focus on mental health from childhood onwards, as well as biological markers of stress from childhood and into adulthood.

The research will use three of the UK's world-renowned longitudinal studies: the Millennium Cohort Study (MCS), Avon Longitudinal Study of Parents and Children (ALSPAC), and National Child Development Study (NCDS). These are all large studies with >15,000 participants. Each study has followed the same group of people over time. ALSPAC will be used to assess associations between early life adversities in relation to biological markers of stress from childhood into adolescence. The MCS will be used to assess whether children who experience early life adversities are more likely to have mental health problems across childhood and into adolescence. Finally, the NCDS will be used to test associations between early life adversities and both biological markers of stress in middle-age and mental health across adulthood.

The proposed project will be undertaken at the Department of Epidemiology and Public Health at UCL under the mentorship of Prof. Yvonne Kelly, with support from a network of experts in social statistics, biology and sociology in the International Centre for Life Course Studies in Society and Health. Non-academic partners will be involved from the beginning of the research process. These partners include Barnardo's, the Association of Young People's Health and the Department of Health, who will be able to feed the findings of the research into their work with vulnerable families. Outputs from the project will include at least six academic papers, presentations at six conferences, a briefing note for non-academic audiences, an end of project policy seminar for academics and non-academics, and contributions to blogs and Twitter. The project also has a strong training element to enable the principal investigator to make the transition to independent researcher.

In summary, this project has the potential to advance research in the field of early life adversities and health. It will be the first to provide evidence on how early life adversities increase the risk of poor health.

Planned Impact

This important research project has the potential to benefit a wide range of key stakeholders, including policy makers, public organisations, the general public and the charitable sector.

1. Policymakers
The analyses on the clustering of early life adversities will represent the first step in being able to investigate life course pathways linking adversities to health. This will be done using high quality UK longitudinal data and appropriate analytical methods which have the potential to greatly advance the existing evidence base. This research will equip policymakers with good quality evidence to inform future interventions and policy development in order to prevent later health problems and subsequent costs to society, both financial and non-financial. The Department of Health will be particularly relevant to this project. Dr Ray Earwicker, Lead for Troubled Families, Homelessness and Wider Health Inequalities, will be involved as a non-academic partner from the beginning of the project. His input will be valuable to ensure the research is as policy relevant as possible and he will be able to feed the project outputs to his departmental colleagues.

2. Public organisations
It will also be important to engage with other public organisations, such as Public Health England (PHE), to further disseminate the research. PHE's remit is to reduce health inequalities and improve the nation's health and wellbeing, therefore the research is likely to be highly relevant for their work. The office of the Children's Commissioner would also be interested in this project. Their role is to promote children's rights in England, particularly those of the most vulnerable children. This research will provide further evidence for their work, particularly promoting childhood has a priority policy area.

3. General public
This research will be of significance to the general public, particularly children at risk of, or who have experienced, adversities. In particular, the research will show how early life adversity can have lifelong health impacts. The investigation of clustering of adversities will enable the basis for investigating mechanisms linking adversities to health, therefore providing information and opportunities to target interventions. This has the potential to alleviate the long-term health consequences of early life adversity at the population level.

4. Charitable sector
Charities, particularly those who work with vulnerable families, will benefit from this research. This research will provide good quality evidence to strengthen their missions to support the UK's most at risk families. To ensure that this is done successfully, two such charities (Barnardo's and the Association for Young People's Health) will be involved in this research from the outset in the form of a project advisory group. This will ensure that the research is of practical use to these organisations and they will be able to provide valuable input and feedback to this work throughout. The Association for Young People's Health champions the health and wellbeing of UK adolescents, and promotes evidence-based practice. Barnardo's offers family support and counselling services, and lobbies the government on issues affecting vulnerable families, therefore the findings of this project have the potential to feed into these activities and to the activities of similar organisations.

This exciting interdisciplinary project therefore has a wide range of beneficiaries who will be engaged with throughout the project. The ultimate impact aim of this project is to improve the health of people experiencing early life adversities. The involvement of the stakeholders above is key to ensuring the greatest possible impact of this project in attempting to reach this aim. Further information on how these stakeholders will be reached is included in the Pathways to Impact.

Publications

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Gilbert R (2021) Intergenerational transmission of child maltreatment. in The Lancet. Public health

 
Description We have shown that adverse childhood experiences (ACEs) co-occur. Parental mental health problems were particularly prevalent in the data we have analysed. Parental mental health problems (both mother's and father's) tend to co-occur with other ACEs, particularly family conflict, parental separation/divorce and psychological abuse.

We have also shown that poverty in pregnancy is a strong predictor of adversities in childhood, and particularly for experiencing multiple ACEs.

We have found no evidence of gender differences in the ways in which ACEs cluster but girls are more likely to report sexual abuse and boys more likely to report physical abuse.

ACEs occuring in early childhood (0-8 years) are not associated with C-reactive protein at age 9 or between ages 9-17, but parental separation/divorce and parental mental health problems were associated with higher levels of Interleukin-6 at age 9.

There are differences in the clustering of ACEs depending on whether they are prospectively or retrospectively reported. Retrospectively-reported ACEs are more strongly correlated with one another but this may be due to common method variance.

We have also found that ACEs are strongly related to mental health right across the life course from age 3 through to age 55.

Finally, we found that the timing of experiences was important; focusing on maternal depression, we found that chronic maternal depression was associated with more depressive symptoms in late adolescence for boys. For girls, it was accumulation of experience plus a sensitive period at ages 6-8 years that was important for depression development.
Exploitation Route We hope that researchers will think beyond using ACE scores whereby the number of adversities experienced are added together, instead thinking more about specific ACEs and the ways they co-occur. We also discourage the use of retrospective ACEs questionnaires. This is due to issues of recall, associations with contemporaneous stress, and the potential for common method variance.

We also hope that we have fairly extensively explored latent class analysis as a method for dealing with ACEs clustering. It had mixed success in this project and we actually recommend that looking at individual and cumulative ACEs might be more beneficial.
Sectors Communities and Social Services/Policy

Education

Healthcare

Government

Democracy and Justice

 
Description The JCPP practitioner review on the use of ACE scores in research, policy and practice has had some societal impact. The arguments in the review were included in two major reports by the Early Intervention Foundation cautioning further against the use of ACE scores and the evidence for trauma-informed care. I have also received messages from practitioners who have taken on board the recommendations in the review and made changes to their messages in training and other presentations. There has been a huge amount of interest in the ACAMH blog which I wrote to accompany the publication of the JCPP review. Regarding the empirical research on this award, we have had requests for sharing from DHSC and PHE.
Sector Communities and Social Services/Policy,Government, Democracy and Justice
Impact Types Societal

Policy & public services

 
Description Influence of JCPP practitioner review
Geographic Reach National 
Policy Influence Type Citation in other policy documents
Impact Our JCPP practitioner review was cited in an important report by the Early Intervention Foundation https://www.eif.org.uk/report/adverse-childhood-experiences-what-we-know-what-we-dont-know-and-what-should-happen-next
URL https://www.eif.org.uk/report/adverse-childhood-experiences-what-we-know-what-we-dont-know-and-what-...
 
Description Influence of JCPP review - change in opinion
Geographic Reach National 
Policy Influence Type Influenced training of practitioners or researchers
Impact I have received messages from practitioners who have read the JCPP review to say that they are changing their messages they give in training & other presentations.
 
Description International Centre for Lifecourse Studies in Society and Health (ICLS) Legacy
Amount £102,400 (GBP)
Funding ID ES/W013185/1 
Organisation Economic and Social Research Council 
Sector Public
Country United Kingdom
Start 05/2022 
End 05/2027
 
Description Mental health of parents exposed to interparental violence: effect on mental health/behavioural outcomes of their children and opportunities for intervention
Amount £208,500 (GBP)
Organisation National Institute for Health Research 
Sector Public
Country United Kingdom
Start 09/2021 
End 12/2023
 
Description Motherhood and quality of life: the causal processes of caregiving burden, illness coping, work-life, genetics and social relations
Amount £1,200,000 (GBP)
Organisation Research Council of Norway 
Sector Public
Country Norway
Start 01/2021 
End 12/2023
 
Description Physical punishment and child outcomes in the UK - a mixed methods study
Amount £338,343 (GBP)
Organisation Nuffield Foundation 
Sector Charity/Non Profit
Country United Kingdom
Start 03/2023 
End 06/2025
 
Description The long-term outcomes of young carers
Amount £300,100 (GBP)
Organisation Nuffield Foundation 
Sector Charity/Non Profit
Country United Kingdom
Start 06/2023 
End 03/2026
 
Description UCL Global Engagement award
Amount £2,000 (GBP)
Organisation University College London 
Sector Academic/University
Country United Kingdom
Start 07/2019 
End 07/2020
 
Description ALSPAC external collaborations - 2. INSERM, Toulouse 
Organisation Paul Sabatier University (University of Toulouse III)
Country France 
Sector Academic/University 
PI Contribution Substantive expertise
Collaborator Contribution Substantive expertise
Impact Two forthcoming publications
Start Year 2018
 
Description ALSPAC papers - external collaborators 1. Bristol 
Organisation University of Bristol
Department School of Social and Community Medicine
Country United Kingdom 
Sector Academic/University 
PI Contribution Substantive expertise, analysis of longitudinal data
Collaborator Contribution Provision of expertise on using ALSPAC dataset for ACEs research
Impact Two forthcoming publications
Start Year 2018
 
Description Australian National University & Murdoch Children's Research Institute collaboration 
Organisation Australian National University (ANU)
Country Australia 
Sector Academic/University 
PI Contribution We have been working on harmonised analyses of the Avon Longitudinal Study of Parents and Children, and the Longitudinal Study of Australian Children. We are contributing research analysis time to clean and analyse the ALSPAC data from our side.
Collaborator Contribution Our collaborators are leading on the work. They are also contributing research analysis time to clean and analyse the LSAC data.
Impact There are no outputs as yet but we are currently working on two empirical papers. This collaboration involves epidemiologists, social scientists, and paediatricians.
Start Year 2020
 
Description Australian National University & Murdoch Children's Research Institute collaboration 
Organisation Murdoch Children's Research Institute
Country Australia 
Sector Academic/University 
PI Contribution We have been working on harmonised analyses of the Avon Longitudinal Study of Parents and Children, and the Longitudinal Study of Australian Children. We are contributing research analysis time to clean and analyse the ALSPAC data from our side.
Collaborator Contribution Our collaborators are leading on the work. They are also contributing research analysis time to clean and analyse the LSAC data.
Impact There are no outputs as yet but we are currently working on two empirical papers. This collaboration involves epidemiologists, social scientists, and paediatricians.
Start Year 2020
 
Description NCDS papers - external collaboration 1. KCL 
Organisation King's College London
Department MRC Social Genetic and Developmental Psychiatry Centre (SDGP)
Country United Kingdom 
Sector Academic/University 
PI Contribution Expertise of using NCDS data and substantive expertise
Collaborator Contribution Substantive expertise
Impact Publication forthcoming
Start Year 2018
 
Description NCDS papers - external collaboration 2. ICH 
Organisation University College London
Department Institute of Child Health
Country United Kingdom 
Sector Academic/University 
PI Contribution Substantive expertise
Collaborator Contribution Knowledge of retrospective ACEs data on the NCDS
Impact Forthcoming publication
Start Year 2018
 
Description Practitioner review collaboration - Glasgow 
Organisation University of Glasgow
Department Institute of Health and Wellbeing
Country United Kingdom 
Sector Academic/University 
PI Contribution Expertise in ACEs quantitative research
Collaborator Contribution Clinical expertise, working with children who have experienced maltreatment, substantive expertise
Impact Practitioner review for the Journal of Child Psychology and Psychiatry. Collaboration between epidemiology and psychiatry.
Start Year 2018
 
Description Blog posts for ACAMH and Discover Society 
Form Of Engagement Activity Engagement focused website, blog or social media channel
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Policymakers/politicians
Results and Impact I wrote two blog posts - one for Association for Child and Adolescent Mental Health (ACAMH) and Discover Society. The ACAMH blog was the most read blog post on their website in 2019 despite only being published at the end of 2019.
Year(s) Of Engagement Activity 2019
URL https://www.acamh.org/blog/ace-the-way-we-measure-the-bad-things-that-happen-to-children/
 
Description End of award policy webinar 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Policymakers/politicians
Results and Impact Webinar for policy and pracitioner audience sharing study findings, Q&A, and response from Early Intervention Foundation
Year(s) Of Engagement Activity 2021
 
Description Input to NHS Bury Early Help Competency Framework and Workforce Audit 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Professional Practitioners
Results and Impact I provided input on ACEs for the NHS Bury Early Help Competency Framework and Workforce Audit
Year(s) Of Engagement Activity 2018
 
Description Invitation as discussant on ACEs screening symposium 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Other audiences
Results and Impact Invited to be a discussant for a symposium on ACEs screening for the Society for Research in Child Development in the US
Year(s) Of Engagement Activity 2021
 
Description Invitation to participate in Association for Child and Adolescent Mental Health's special interest group on ACEs 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Organised a webinar on where next for ACEs research for ~400 attendees
Year(s) Of Engagement Activity 2021,2022
URL https://www.acamh.org/event/aces-future-of-research/
 
Description Invited to give seminar for inaugural UCL Children and Young People's Mental Health group 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Other audiences
Results and Impact Invited to give the inaugural seminar on findings from this project for the UCL Child and Young People's Mental Health group
Year(s) Of Engagement Activity 2021
 
Description Non-academic advisory group 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Policymakers/politicians
Results and Impact Convened six-monthly meetings with policymakers and third sector organisations to share findings of the research from this award. Members were from Department of Health and Social Care, Association of Young People's Health, Barnardo's, National Children's Bureau and a social worker for children and families.
Outputs were shared widely amongst contacts in these organisations and beyond (e.g. Public Health England)
Year(s) Of Engagement Activity 2018,2019,2020
 
Description Submission of evidence to Parliamentary Science and Technology Select Committee Inquiry 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Policymakers/politicians
Results and Impact I submitted evidence to this inquiry on the bacground to this project.
Year(s) Of Engagement Activity 2017
URL http://data.parliament.uk/writtenevidence/committeeevidence.svc/evidencedocument/science-and-technol...