Association for Public Policy Analysis & Management

Rationale: Childhood well-being is a global concern, and childhood adversity can have lasting consequences. UNICEF estimates that 275 million children worldwide experience violence at home, yet there are many other forms of significant adversity children may face. While there is a biological understanding of the effect of toxic stress on physiological systems and brain development, the extent to which adverse childhood experiences (ACEs) contribute to poorer health and economic outcomes is not clear. Children who suffer trauma may be disadvantaged in other ways, such as by poverty and thus poorer access to quality healthcare and education.

Objective: To advance knowledge on health and welfare over the life-cycle, the purpose of this systematic review is to identify research on the health, behavioral, and human capital outcomes of adults who experienced childhood adversity.

Method: PubMed and the Publications Database of the National Longitudinal Study of Adolescent to Adult Health were searched through November 2016 for original research in English language assessing physical health, mental health, adverse or risky health behaviors, violent or criminal behavior, or human capital outcomes of adults with ACEs. Collected citations were screened successively at the title, abstract, and full-text levels for inclusion. Studies which calculated only bivariate correlations between ACE exposure and adult outcomes were excluded.

Results: The search yielded 864 unique citations, of which 281 met selection criteria. The majority of studies—179 (64%)—were from the US, 52 (19%) were from Europe, 20 (7%) were from Asia, 14 (5%) were from Canada, 7 (2%) were from Oceania, 3 (1%) were from Latin America, 3 (1%) were from Africa, and the remaining 3 (1%) were international. Many studies assessed adult outcomes across various domains. Among the 281 included studies, 158 assessed mental health outcomes, 70 evaluated adverse or risky health behaviors such as drug use and risky sexual behavior, 54 measured physical health conditions such as chronic conditions and sexually transmitted diseases, 35 reported measures of violent or criminal behavior such as intimate partner violence perpetration or arrests, and 14 evaluated aspects of human capital such as educational attainment, earnings, or cognitive ability. ACEs studied included sexual, physical, and emotional abuse; physical and emotional neglect; parental incarceration; parental drug use; and community or political violence. A large group of included studies measured higher rates of chronic illness, psychological disorders, behavior-related problems for adults with ACEs compared to those who suffered no ACEs or fewer ACEs. In the smaller body of literature on human capital outcomes results are more divisive, as some studies found no significant relationship once childhood poverty was included as a covariate.

Discussion: Further research should identify risk factors for ACEs so that prevention and treatment services can be better targeted to vulnerable populations. By identifying long-term health outcomes caused by ACEs, these services can be designed more appropriately to address the specific ailments caused by childhood trauma. Considering the magnitude of reduced health and earnings, such research might support decisions for resource allocation to childhood support for prevention of ACEs.