Research articleAdverse Childhood Experiences and Prescribed Psychotropic Medications in Adults
Introduction
Prescription drugs are one of the fastest growing healthcare costs in the United States, with total spending for these drugs in 2003 estimated to be $180 billion, or 11% of national health expenditures. This amount was more than four times greater than the amount spent in 1990.1 Antidepressants, anxiolytics, and antipsychotics are among the top-selling prescription drugs, with retail sales of these medications during 2000 totaling $10.4, $3.1, and $2.4 billion, respectively.2 Similarly, the impact of mental illness on disability and quality of life is also being increasingly recognized and quantified as a national public health priority.3
Increased spending on psychotropic medications and the disability and morbidity associated with mental illness highlight: (1) the cost of mental illness to affected individuals, the healthcare system, and society; and (2) the increasing importance of identifying preventable contributors to these disorders.
Childhood abuse and related traumatic stressors are well-established risk factors for developing acute and chronic mental illness. Numerous studies have documented these relationships and have been reviewed elsewhere.4, 5 Data from the Adverse Childhood Experiences (ACE) study,6, 7, 8 have demonstrated that an integer count of the number of categories of abuse, exposure to domestic violence, and other forms of serious household dysfunction (ACE Score)9 experienced during childhood has a strong, graded relationship to a wide variety of health and social problems from adolescence to adulthood6, 7, 8, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25 including depressive disorders,6, 8, 11, 19 suicide attempts,11 anxiety,6 hallucinations,6, 20 panic reactions,6 sleep disturbances,6 and memory disturbances.6, 21
The relationship of child abuse and related traumatic stressors to prescriptions for psychotropic drugs in adulthood has not been described. This analysis used data from the ACE study to prospectively assess the relationship of the ACE Score to prescription rates for four classes of psychotropic medications.
Section snippets
Study Population
The ACE study methods have been described in detail elsewhere.6, 7, 8 Briefly, >50,000 adult members of the Kaiser Health Plan in San Diego, California, are evaluated annually at Kaiser Permanente’s San Diego Health Appraisal Clinic, which includes a standardized health history, psychosocial evaluations, and physical examination. The ACE study was approved by the institutional review boards of Kaiser Permanente and the Office for Protection from Research Risks at the National Institutes of
Characteristics of Study Population
The study population included 8134 women (54%) and 6899 men (46%). The mean age (standard deviation) was 57 (15) years. Seventy-six percent of participants were white, 11% Hispanic, 4% black, 7% Asian, less than 1% Native American, and 2% other; 40% were college graduates, 36% had some college education, and 17% were high school graduates. Only 7% had not graduated from high school. The mean follow-up was 6.1 (SD, 2.4) years.
Prevalence of ACEs and the ACE Score
The prevalence of each of the eight individual ACEs and the ACE Score
Discussion
Prescription rates for antidepressant and anxiolytic drugs increased in a dose–response fashion as the ACE Score increased for young, middle-aged, and older adults. This finding suggests that the cost of prescription psychotropics extends throughout adulthood. Such relationships were also found among younger and middle-aged adults for antipsychotic and lithium-based drugs. The lack of a relationship between the score and antipsychotics in older adults is likely explained by the use of these
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