Poor Individual Risk Classification From Adverse Childhood Experiences Screening

TY - JOUR

T1 - Poor Individual Risk Classification From Adverse Childhood Experiences Screening

AU - Meehan, Alan

AU - Baldwin, Jessie R.

AU - Lewis, Stephanie

AU - MacLeod, Jelena

AU - Danese, Andrea

N1 - Funding Information: AJM acknowledges financial support from Yale Child Study Center, Yale School of Medicine. Funding Information: SJL is supported by an MRC Clinical Research Training Fellowship. JRB is supported by a Sir Henry Wellcome Postdoctoral Fellowship (215917/Z/19/Z). AD is funded by the National Institute for Health Research Biomedical Research Centre at South London and Maudsley National Health Service Foundation Trust and King's College London and by a grant (MR/P005918/1) from MRC. This research was funded in part by the Wellcome Trust (215917/Z/19/Z). For the purpose of open access, the authors have applied a CC BY public copyright license to any Author Accepted Manuscript version arising from this submission. Funding Information: AJM acknowledges financial support from Yale Child Study Center, Yale School of Medicine. The views expressed in this paper are those of the authors and not necessarily those of United Kingdom Medical Research Council (MRC), Wellcome Trust, United Kingdom National Health Service, National Institute for Health Research, Yale University, University College London, or King's College London. The funding sources had no role in the design or conduct of the study; collection, management, analysis, or interpretation of the data; preparation, review, or approval of the manuscript; or decision to submit the manuscript for publication. Data supporting this study are freely accessible at https://doi.org/10.1016/S0749-3797(98)00017-8. SJL is supported by an MRC Clinical Research Training Fellowship. JRB is supported by a Sir Henry Wellcome Postdoctoral Fellowship (215917/Z/19/Z). AD is funded by the National Institute for Health Research Biomedical Research Centre at South London and Maudsley National Health Service Foundation Trust and King's College London and by a grant (MR/P005918/1) from MRC. This research was funded in part by the Wellcome Trust (215917/Z/19/Z). For the purpose of open access, the authors have applied a CC BY public copyright license to any Author Accepted Manuscript version arising from this submission. No financial disclosures were reported by the authors of this paper. Publisher Copyright: © 2021 American Journal of Preventive Medicine

PY - 2022/3

Y1 - 2022/3

N2 - Introduction: Adverse childhood experiences confer an increased risk for physical and mental health problems across the population, prompting calls for routine clinical screening based on reported adverse childhood experience exposure. However, recent longitudinal research has questioned whether adverse childhood experiences can accurately identify ill health at an individual level. Methods: Revisiting data collected for the Adverse Childhood Experience Study between 1995 and 1997, this study derived approximate area under the curve estimates to test the ability of the retrospectively reported adverse childhood experience score to discriminate between adults with and without a range of common health risk factors and disease conditions. Furthermore, the classification accuracy of a recommended clinical definition for high-risk exposure (≥4 versus 0–3 adverse childhood experiences) was evaluated on the basis of sensitivity, specificity, positive and negative predictive values, and positive likelihood ratios. Results: Across all health outcomes, the levels of discrimination for the continuous adverse childhood experience score ranged from very poor to fair (area under the curve=0.50–0.76). The binary classification of ≥4 versus 0–3 adverse childhood experiences yielded high specificity (true-negative detection) and negative predictive values (absence of ill health among low-risk adverse childhood experience groups). However, sensitivity (true-positive detection) and positive predictive values (presence of ill health among high-risk adverse childhood experience groups) were low, whereas positive likelihood ratios suggested only minimal-to-moderate increases in health risks among individuals reporting ≥4 adverse childhood experiences versus that among those reporting 0–3. Conclusions: These findings suggest that screening based on the adverse childhood experience score does not accurately identify those individuals at high risk of health problems. This can lead to both allocation of unnecessary interventions and lack of provision of necessary support.

AB - Introduction: Adverse childhood experiences confer an increased risk for physical and mental health problems across the population, prompting calls for routine clinical screening based on reported adverse childhood experience exposure. However, recent longitudinal research has questioned whether adverse childhood experiences can accurately identify ill health at an individual level. Methods: Revisiting data collected for the Adverse Childhood Experience Study between 1995 and 1997, this study derived approximate area under the curve estimates to test the ability of the retrospectively reported adverse childhood experience score to discriminate between adults with and without a range of common health risk factors and disease conditions. Furthermore, the classification accuracy of a recommended clinical definition for high-risk exposure (≥4 versus 0–3 adverse childhood experiences) was evaluated on the basis of sensitivity, specificity, positive and negative predictive values, and positive likelihood ratios. Results: Across all health outcomes, the levels of discrimination for the continuous adverse childhood experience score ranged from very poor to fair (area under the curve=0.50–0.76). The binary classification of ≥4 versus 0–3 adverse childhood experiences yielded high specificity (true-negative detection) and negative predictive values (absence of ill health among low-risk adverse childhood experience groups). However, sensitivity (true-positive detection) and positive predictive values (presence of ill health among high-risk adverse childhood experience groups) were low, whereas positive likelihood ratios suggested only minimal-to-moderate increases in health risks among individuals reporting ≥4 adverse childhood experiences versus that among those reporting 0–3. Conclusions: These findings suggest that screening based on the adverse childhood experience score does not accurately identify those individuals at high risk of health problems. This can lead to both allocation of unnecessary interventions and lack of provision of necessary support.

UR - http://www.scopus.com/inward/record.url?scp=85116755168&partnerID=8YFLogxK

U2 - 10.1016/j.amepre.2021.08.008

DO - 10.1016/j.amepre.2021.08.008

M3 - Article

SN - 0749-3797

VL - 62

SP - 427

EP - 432

JO - American Journal of Preventive Medicine

JF - American Journal of Preventive Medicine

IS - 3

ER -