Highlights
- •Over time, youth with 3+ versus 0 adverse childhood experiences (ACEs) reported poorer quality of life.
- •Youth with 3+ versus 0 ACEs reported higher symptoms of PTSD, depression, and anxiety.
- •Functioning differed between youth exposed to different types of ACEs.
- •PTSD symptoms moderated the association between ACEs and anxiety symptoms.
- •ACEs influence the long-term functioning of youth with chronic pain.
Abstract
The aims of this longitudinal study were to 1) identify categories of adverse childhood
experiences (ACEs) (ie, neglect, abuse, household dysfunction in childhood) that increase
risk for internalizing mental health problems, pain-related impairment, and poorer
quality of life and 2) examine the moderating role of posttraumatic stress symptoms
(PTSS) in these associations, in a clinical sample of youth with chronic pain. At
2 timepoints, youth (N = 155; aged 10–18 years) completed measures of exposure to
ACEs, PTSS, depressive and anxiety symptoms, pain intensity, pain interference, and
quality of life. Multivariate analyses of variance, linear mixed modeling, and moderation
analyses were conducted. Results from cross-sectional and longitudinal analyses were
similar; youth with a history of 3+ ACEs reported significantly higher PTSS, depressive
and anxiety symptoms, and poorer quality of life than youth with no ACE history. Results
also revealed differences in functioning between youth exposed to different types
of ACEs (ie, maltreatment only, household dysfunction only, both, none). Finally,
PTSS was found to moderate the association between ACEs and anxiety and depressive
symptoms. Findings underscore the influence that ACEs can have on the long-term functioning
of youth with chronic pain as well as the important role of current PTSS in this association.
Perspective
This study found that the risk of poorer outcomes imposed by ACEs at baseline remains
longitudinally and that posttraumatic stress symptoms (PTSS) moderate the relationship
between ACEs and anxiety and depressive symptoms in youth with chronic pain. These
results underscore the importance of assessing for ACEs and PTSS alongside chronic
pain in youth.
Key words
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Article info
Publication history
Published online: March 30, 2021
Accepted:
March 26,
2021
Received in revised form:
March 16,
2021
Received:
November 11,
2020
Footnotes
Funding Sources: This research was supported by research funding awarded to M. Noel from the Vi Riddell Pediatric Pain Initiative, Alberta Children's Hospital Foundation and Alberta Children's Hospital Research Institute, and the Canadian Institutes of Health Research Strategy for Patient-Oriented Research “Chronic Pain Network.”
Financial Disclosure: The authors have no other financial disclosures in relation to this study.
Conflict of Interest: The authors have no conflict of interest to disclose.
Identification
Copyright
© Published by Elsevier Inc. on behalf of United States Association for the Study of Pain, Inc.
