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OP40 The association between childhood socio-economic position and adverse childhood experiences (ACEs): a systematic review
  1. D Walsh1,
  2. G McCartney2,
  3. M Smith3,
  4. G Armour4
  1. 1GCPH, Glasgow Centre for Population Health, Glasgow, UK
  2. 2Public Health Observatory, NHS Health Scotland, Glasgow, UK
  3. 3Mental Health Services, NHS Greater Glasgow and Clyde, Glasgow, UK
  4. 4Library and Knowledge Services, NHS Health Scotland, Glasgow, UK


Background An increasing amount of evidence has emerged in recent years of the association between different aspects of childhood adversity (termed ACEs – Adverse Childhood Experiences – in a great many studies) and increased risks of negative outcomes in later life. Consequently, ACEs have become a policy priority in many quarters. Despite most ACEs being highly socially patterned, there has been very little discussion in the political discourse regarding the role of childhood socio-economic conditions in understanding and addressing them. The aim, therefore, was to investigate what is known about the association between childhood socio-economic position (SEP) and ACEs, including the extent to which the former explains the latter.

Methods Relevant databases (MEDLINE; psycINFO; ProQuest Public Health Database, Cochrane Library) were searched for all papers satisfying four inclusion criteria: (1) measurement of social position in childhood (prior to ACEs measurement); (2) measurement of multiple aspects of childhood adversity; (3) childhood adversity was the outcome; (4) statistical quantification of the relationship between childhood SEP and childhood adversity. Non-English language papers were excluded.

The initial search terms included ACEs, SEP, and their synonyms. A second search additionally included ‘maltreatment’. Papers were independently screened and critically appraised by two authors. Risk of bias was assessed, and overall study quality calculated using a modified version of the Hamilton Tool. Results were synthesised narratively because of the wide variation in definitions of exposures and outcomes.

Results For the ACEs-based search, 2,779 papers were screened, of which 52 were reviewed in full-text. Of these, only six were eligible for qualitative synthesis. The second search (including maltreatment) increased the numbers to: 4,463 papers screened; 166 full texts; 35 included for synthesis. 18 papers were deemed to be ‘high’ quality, five ‘medium’, the rest ‘low’. Meaningful statistical associations were observed between the exposure (childhood SEP) and the outcome (ACEs/maltreatment) in the vast majority of studies, including all bar one of those deemed to be high quality. Low SEP is therefore clearly a determinant of ACEs/maltreatment: the longitudinal nature of many studies means the association is most likely causal.

Conclusion The relationship between childhood SEP and ACEs is clear, but under-researched. More evidence exists in the maltreatment literature. With UK child poverty levels predicted to increase markedly, any policy approach which ignores the socio-economic context to ACEs is flawed. Policy needs to help those currently affected by childhood adversity; but to prevent further adversity, it must also address the key socio-economic drivers.

  • ‘Adverse childhood experiences’ ‘childhood adversity’ poverty

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