1. Patients who had a history of adverse childhood events were more likely to be prescribed medication to treat psychiatric disorders.
2. A poor relationship with either parent during childhood was also associated with a higher chance of being prescribed psychiatric medication.
Evidence Rating Level: 2 (Good)
Study Rundown: Evidence increasingly supports the hypothesis that many psychiatric disorders are developmental in nature, with adverse childhood events (ACE) conferring greater risk of mental illnesses, including depression, schizophrenia, and anxiety disorders. While many studies have shown specific traumatic events confer greater health risks, the literature is less clear on whether multiple ACEs have a graded effect on the development of psychiatric disease. In this study, researchers recorded the number of ACEs (divorce, long-term financial difficulties, serious family conflict, frequent fear of family member, and family member with alcohol problems) in a Finnish population and followed them for five years in adulthood, recording their use of psychiatric medication (antipsychotics, mood stabilizers, antidepressants, anxiolytics, and hypnotics/sedatives). In almost every case, there was a graded association between the number of ACEs and the likelihood of purchasing psychiatric medications. This correlation remained even when controlling for age, gender, occupational training, work status, recent life events, alcohol use, smoking, and BMI. In addition, a poor relationship with either parent was a separate risk factor for increased likelihood of purchasing a psychiatric medication and combinatorial effects with ACEs were noted.
This study supplements evidence supporting the importance of developmental periods in future risk for psychiatric disorders. However, some aspects of the study design and execution may cause the results to be over or underestimated. The initial response for the baseline measurements was low and more subjects were loss to follow-up. In addition, while tracking psychiatric medication purchases is likely to describe the incidence of psychiatric disease, prescription of certain medications for other disorders, such as SSRIs for neuropathic pain, may make this association less straightforward.
Relevant Reading: CDC’s Adverse Childhood Experiences (ACE) Study
In-Depth [retrospective cohort]: In this Finland based study, 25,898 adult participants were selected randomly from responses to a postal questionnaire (40% response rate) to gather baseline information on ACEs and health information. These patients were then followed up five years later (80% response rate from original cohort) to ensure consistency in results with a κ coefficient from 0.75 to 0.97, indicating good reliability of responses. Over the five year period, 93.8% of respondents gave permission to link their responses with a registry of psychiatric medicine purchases. Psychiatric medications were grouped into antipsychotic, mood stabilizer, antidepressant, anxiolytic, and hypnotics/sedatives categories. While prescription of psychiatric medication had a higher Odds Ratio (OR) associated with ACEs, the OR of 1-2 ACEs and purchasing any psychiatric medication was 1.37 (CI95% 1.27-2.46). There as an increase in the OR of being prescribed psychiatric medication to 2.89 (CI95% 2.48 – 3.36) with 5-6 ACEs. These associations remained unattenuated even when controlling for age, gender, occupational training, work status, recent life events (extreme stresses within last 6 months from time of questionnaire), alcohol use, smoking, and BMI. In addition, a poor relationship with the mother had an OR of 1.84 (CI95% 1.04 – 3.25), which was further increased to 5.06 (CI95% = 3.28 – 7.79) with 5-6 ACEs. Similar results were obtained for poor relationships with the father.
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