A week or so ago, I attended the 23rd Annual Rosalynn Carter Symposium on Mental Health Policy in Atlanta. It may well be that the Carter Center meeting is the one place each year where the various camps of mental health "players" actually meet face to face: research scientists, service providers and professionals, consumers and family members, as well as state and federal government agency administrators. We all seem to be represented there. Former First Lady Rosalynn Carter is always a gracious host, the conversation interesting and the speakers provocative.
The theme of this year's symposium was the prevention of the onset and progression of mental illness, and I was very interested to see how they would cover this topic. Aside from some dialogue about resiliency, we in the mental health field don't talk much about prevention. I noted that attendance at the meeting was smaller than it usually is, which is a shame, because the prevention issue is a thought-provoking one. If health care research looks at ways to prevent illnesses like cancer, diabetes and substance use disorders, why doesn't it also address ways to prevent mental illnesses like depression and bipolar disorder?
At the symposium, I was most interested by the speaker who discussed the results of a research project that involved interviewing more than 17,000 people across the country-the "Adverse Childhood Experiences (ACE) Study: Bridging the gap between childhood trauma and negative consequences later in life." According to the ACE Study website, the project is
"an ongoing collaboration between the Centers for Disease Control and Prevention [CDC] and Kaiser Permanente. Led by Co-Principal Investigators Robert F. Anda, MD, MS, and Vincent J. Felitti, MD, the ACE Study is perhaps the largest scientific research study of its kind, analyzing the relationship between multiple categories of childhood trauma (ACEs), and health and behavioral outcomes later in life."
The study defines an ACE as exposure to any of the following nine conditions or situations at home prior to age 18:
- Recurrent physical abuse
- Recurrent emotional abuse
- Contact sexual abuse
- Emotional or physical neglect
- One or no parents at home
- Violent treatment of the mother at home
- A household member who abuses alcohol and/or drugs
- A household member who is in prison
- A household member who is chronically depressed, mentally ill, institutionalized or suicidal
If a person was exposed to one of these ACE categories, that qualifies as one "point" in the study. So, a total ACE score of zero (0) would mean that the person reported no exposure to any of the ACEs above. And a score of nine (9) would mean the he or she was exposed to all forms of the childhood trauma listed. The data shows that the higher the ACE score, the higher the incidence of depression. It shows the same correlation between ACE scores and smoking, substance use, heart disease, weight gain and suicide.
At the symposium, I had the chance to chat about the study with the leader of another major mental health organization. His comment was that it's hard to make a case for cause and effect in this kind of retrospective, interview-based study. To explain, he made a comparison — we could probably interview people, he said, and also show higher rates of depression among those who eat a lot of fast food. But, the question is: did eating the fast food actually cause the depression? Probably not. What about the prevalence of depression among people who are right-handed? People who don't eat broccoli? His point was that it's hard to say "this caused that" without using an entirely different method or form of research.
Nonetheless, the issue of prevention and mental illness is interesting, and the CDC is taking note. To find out more from the CDC about the ACE Study, you can visit www.cdc.gov/nccdphp/ace/. At DBSA, we are taking note as well, even though as a consumer organization, we're not currently positioned to do much about prevention. One small thing we can consider doing, though, is to develop more resources that offer parenting support. If those with mental illness have the support they need to be good parents, maybe that's one way to keep ACE scores-and the risk of mental illness-down.
What are your thoughts on the connection between mental illness and the nine ACE categories? What do you think are some steps we can take toward prevention?
Published On: November 14, 2007
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