Childhood trauma linked with worse teen mental health, less access to care
Adolescents with adverse childhood experiences (ACEs) are more likely to live with poor mental health but less likely to have access to mental health care, according to a new study led by the François-Xavier Bagnoud (FXB) Center for Health & Human Rights at Harvard University.
The study was published April 3 in the Journal of Adolescent Health. Rohan Khazanchi, an affiliate of the FXB Center, was corresponding author.
ACEs are traumatic events that occur during childhood, such as physical and emotional abuse, neglect, household dysfunction, and neighborhood violence. While it’s established that ACEs can lead to poor adolescent mental health, little is known about how ACEs might shape health care access and utilization during adolescence—“a critical and unique period for health, education, and social welfare system interventions,” the authors note.
Khazanchi and his co-authors used the 2019 and 2021 results of the National Health Interview Survey to analyze the mental health symptoms and health care access and use among a nationally representative group of more than 5,500 13- to 17-year-olds. Participants reported if they had experienced any of four ACEs: parental incarceration, neighborhood violence, a guardian with serious mental illness, and/or a guardian with an alcohol or drug problem. They also reported on their experiences with anxiety and depression; their ability to access health care, including mental health care; their use of acute care, including visits to urgent care facilities and emergency departments; trouble they’ve encountered with health care costs; and, in 2021, their experiences with COVID-19-related barriers to care.
The study found that one in eight adolescents experienced one of the studied ACEs, and one in 11 experienced two or more. Compared to those who never experienced an ACE, those who did reported more frequent anxiety and depression symptoms, higher acute care use, more trouble paying medical bills, and delayed and forgone mental health care due to cost and/or as a consequence of the COVID-19 pandemic.
According to the researchers, the findings highlight the need to reform U.S. health policy in accordance with how prevalent ACEs are and their influence on mental health outcomes and access to care.
“Adolescents exposed to ACEs experienced mutually reinforcing disadvantages: a worse mental health symptom burden, yet greater barriers to accessing needed medical and mental health care,” they wrote. “ACEs must be reconceptualized as markers of structural—rather than individual—adversity and addressed through structural and policy interventions.”
