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Fam Pract. 2015 Jun;32(3):269-75. doi: 10.1093/fampra/cmv016. Epub 2015 Apr 21.

Psychosocial complexity in multimorbidity: the legacy of adverse childhood experiences.

Author information

  • 1Department of General Practice, csinnott@ucc.ie.
  • 2Department of Epidemiology and Public Health and.
  • 3School of Mathematical Sciences, University College Cork, Cork, Ireland.
  • 4Department of General Practice.

Abstract

BACKGROUND:

To effectively meet the health care needs of multimorbid patients, the most important psychosocial factors associated with multimorbidity must be discerned. Our aim was to examine the association between self-reported adverse childhood experiences (ACEs) and multimorbidity and the contribution of other social, behavioural and psychological factors to this relationship.

METHODS:

We analysed cross-sectional data from the Mitchelstown study, a population-based cohort recruited from a large primary care centre. ACE was measured by self-report using the Centre for Disease Control ACE questionnaire. Multimorbidity status was categorized as 0, 1 or ≥2 chronic diseases, which were ascertained by self-report of doctor diagnosis. Ordinal logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (95% CIs) for multimorbidity, using ACE as the independent variable with adjustment for social (education, public health cover), behavioural (smoking, exercise, diet, body mass index) and psychological factors (anxiety/depression scores).

RESULTS:

Of 2047 participants, 45.3% (n = 927, 95% CI: 43.1-47.4) reported multimorbidity. ACE was reported by 28.4% (n = 248, 95% CI: 25.3-31.3%) of multimorbid participants, 21% (n = 113, 95% CI: 18.0-25.1%) of single chronic disease participants and 16% (n = 83, 95% CI: 13.2-19.7%) of those without chronic disease. The OR for multimorbidity with any history of ACE was 1.6 (95% CI: 1.4-2.0, P < 0.001). Adjusting for social, behavioural and psychological factors only marginally ameliorated this association, OR 1.4 (95% CI: 1.1-1.7, P = 0.002).

CONCLUSIONS:

Multimorbidity is independently associated with a history of ACEs. These findings demonstrate the psychosocial complexity associated with multimorbidity and should be used to inform health care provision in this patient cohort.

KEYWORDS:

Child abuse; chronic disease/epidemiology; comorbidity; general practice; health services needs and demand; psychological; stress.

PMID:
25900675
DOI:
10.1093/fampra/cmv016
[PubMed - indexed for MEDLINE]
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