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Review
Relationship between childhood socioeconomic position and adverse childhood experiences (ACEs): a systematic review
  1. David Walsh1,
  2. Gerry McCartney2,
  3. Michael Smith3,
  4. Gillian Armour2,4
  1. 1 Glasgow Centre for Population Health, Glasgow, UK
  2. 2 Public Health Observatory team, NHS Health Scotland, Glasgow, UK
  3. 3 Mental Health and Addictions Services, NHS Greater Glasgow and Clyde, Glasgow, UK
  4. 4 Knowledge Services, NHS Health Scotland, Glasgow, UK
  1. Correspondence to Dr David Walsh, Glasgow Centre for Population Health, Glasgow G40 2QH, UK; david.walsh.2{at}glasgow.ac.uk

Abstract

Background ‘Adverse childhood experiences’ (ACEs) are associated with increased risk of negative outcomes in later life: ACEs have consequently become a policy priority in many countries. Despite ACEs being highly socially patterned, there has been very little discussion in the political discourse regarding the role of childhood socioeconomic position (SEP) in understanding and addressing them. The aim here was to undertake a systematic review of the literature on the relationship between childhood SEP and ACEs.

Methods MEDLINE, PsycINFO, ProQuest and Cochrane Library databases were searched. Inclusion criteria were: (1) measurement of SEP in childhood; (2) measurement of multiple ACEs; (3) ACEs were the outcome; and (4) statistical quantification of the relationship between childhood SEP and ACEs. Search terms included ACEs, SEP and synonyms; a second search additionally included ‘maltreatment’. Overall study quality/risk of bias was calculated using a modified version of the Hamilton Tool.

Results In the ACEs-based search, only 6 out of 2825 screened papers were eligible for qualitative synthesis. The second search (including maltreatment) increased numbers to: 4562 papers screened and 35 included for synthesis. Eighteen papers were deemed ‘high’ quality, five ‘medium’ and the rest ‘low’. Meaningful statistical associations were observed between childhood SEP and ACEs/maltreatment in the vast majority of studies, including all except one of those deemed to be high quality.

Conclusion Lower childhood SEP is associated with a greater risk of ACEs/maltreatment. With UK child poverty levels predicted to increase markedly, any policy approach that ignores the socioeconomic context to ACEs is therefore flawed.

PROSPERO registration number CRD42017064781.

  • lifecourse / Childhood Circumstances
  • socio-economic
  • poverty
  • systematic reviews
  • child health

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

http://dx.doi.org/10.1136/jech-2019-212738

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    Footnotes

    • Twitter @gerrymccartney1

    • Correction notice This article has been corrected since it first publlished online. The postal code for the correspondence address has been corrected.

    • Contributors DW, GM and MS developed the research questions, methods and screened the citations. GA developed and implemented the search strategy. DW and GM critically appraised the included papers. DW drafted the manuscript. All authors critically revised the manuscript and approved the final draft. DW is guarantor for the study.

    • Funding All authors are salaried National Health Service employees.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.