Adverse Childhood Experiences in Patients With Neurologic Disease

Abstract

AbstractObjective:To describe the prevalence of high adverse childhood experiences (ACEs) among neurology outpatients and determine their association with healthcare utilization rates, and comorbid medical and psychiatric disease.Methods:This was a cross-sectional study of adults seen for outpatient neurology follow-up at the University of Pennsylvania. Participants completed the ACE questionnaire, and depression/ anxiety screenings. Healthcare utilization metrics (ED visits, hospitalizations, and outpatient calls) were obtained for all participants. High ACE scores were defined as a score ≥ 4. The prevalence of high ACE scores in our cohort was compared to US historical controls. Statistical associations adjusted for age, gender, and race/ethnicity.Results:198 patients enrolled in the study. Neurology patients were more likely to have elevated ACE scores compared to US population estimates (23.7% vs 12.6%, p<0.01). High ACE scores were associated with increased ED utilization (OR=21 CI [5.8-76.0] , p<0.01), hospitalizations (OR=5.2, CI [1.7-15.0], p<0.01), and telephone encounters (OR 3, CI [1.1-8.2], p<0.05). High ACEs were also associated with medical and psychiatric comorbidities (OR 5.8, CI [2.0-17.0], p<0.01 and OR 4.5, CI [2.1-9.6], p< 0.01), as well as high depression and anxiety scores (OR= 6.9, CI [2.8-17.0], p<0.01, and OR=4.3, [CI 1.7-11.0], p<0.01).Conclusion:Patients with neurological conditions are more likely to have high ACEs than the US population which was associated with higher rates of healthcare utilization, increased number of medical and psychiatric comorbidities, and higher anxiety and depression scores. Addressing ACEs may be a way to improve the health outcomes of patients with neurological conditions