What is the intergenerational impact of Adverse Childhood Experiences (ACEs) on health?

Dr. Anna Wilson (left), Catlin Dennis

Study looks at moms with chronic pain and their children

When Catlin Dennis, M.P.H. ’19, was in college, she volunteered in a youth detention facility as a teacher.

There, she became interested in Adverse Childhood Experiences (ACEs), and the impact they have on children into adulthood.

“My students and I shared experiences of adversity, but one of the biggest differences between us was the age at which we’d experienced these events and their frequency,” said Dennis. “Many of the students reported experiences of trauma, neglect and poverty – often chronic in nature – beginning in their childhood. They talked about how these repeated stressors had impacted their life into their teenage years.”

Dennis held onto these conversations as she launched her public health career. How exactly do these stressors impact children throughout their lifespan? Importantly, what can be done to prevent children from having these experiences?

At OHSU, Dennis joined a lab called Advancing Research in Pediatric Pain led by Anna Wilson, Ph.D., associate professor of pediatrics, OHSU School of Medicine. The lab included Amanda Stone, Ph.D., a postdoctoral fellow at the time who was supported by OCTRI’s OSLER [Oregon Students Learn and Experience Research] TL1 program and who is now a research assistant professor at Vanderbilt University Medical Center. The team was also joined by Portland State University student Denae Clohessy, research assistant and Build EXITO intern, who, after graduating from college this spring, is working as a research assistant at Seattle Children’s Research Institute.

ACEs and chronic pain

The team knew that a growing body of research showed that children of parents with chronic pain are at increased risk for developing pain and psychological problems. While certain pain conditions have a strong genetic component, children’s risk of developing chronic pain themselves isn’t just genetic.

“We know very little about the specific psychosocial and environmental mechanisms through which this risk is conferred, though we think there are a number of distinct variables that may be contributing to this such as pain-specific social learning factors, and general environmental factors like family stress,” said Dr. Wilson.

Exposure to ACEs is linked to a number of poor physical and mental health outcomes, including chronic pain. “We know that even in healthy samples, women report exposure to more ACEs than men,” said Dr. Wilson. “And a number of studies have found associations between maternal ACEs and poor physical and emotional health in their biological children.”

So the research team, building off their previous work and fueled by Dennis’s interest in ACEs, developed a study to evaluate the prevalence of ACEs in a sample of mothers with chronic pain. They sought to examine the relationship between maternal ACEs and the mothers’ own physical and emotional functioning, and to examine the association between maternal ACEs and their children’s health outcomes.

The resulting paper is first-authored by Dennis, “Adverse childhood experiences in mothers with chronic pain and intergenerational impact on children,” and is published in The Journal of Pain.

The OHSU School of Medicine has selected it as its Paper of the Month. “Pain researchers talk about this ‘sensation,’ as a bio-psycho-social experience, but our understanding of the social component is negligible compared to the psychological and biological aspects,” said Mary Heinricher, Ph.D., associate dean for research, OHSU School of Medicine. “So it was fascinating for me to see this intergenerational interaction, and a careful dissection of adverse events, chronic pain and depression in mothers with chronic pain and their children.”

The intergenerational link

The team used baseline data from the large, longitudinal Maternal Chronic Pain Study, which is currently being collected by the lab. This study is following 400 mothers with chronic pain and their children ages 8- to 12-years-old over a three-year period.

Results found that, as hypothesized, the sample of mothers with chronic pain reported a higher prevalence of ACEs compared to normative data from a large community sample of women. Higher maternal ACE scores corresponded with lower physical and social functioning for mothers. Higher maternal ACE scores were also significantly correlated with higher child depressive symptoms (self-reported) but contrary to hypotheses, not with child somatic symptoms or functional impairment.

“A path model indicated that maternal depressive symptoms accounted for the association between higher maternal ACE scores and higher child depressive symptoms,” said Dr. Wilson.

In the short run, the team’s findings suggest that intervening on maternal depression for mothers with chronic pain could help mitigate the risk for child depressive symptoms in school-age children.

Working to improve outcomes

“This work also adds to our understanding of maternal chronic pain as a multifaceted risk factor,” said Dr. Wilson. “While not every mother with chronic pain has a high number of ACEs, children who have a mother with chronic pain are also likely to be exposed to intergenerational adversity.”

She added, “In the long run, our findings add to the growing research on ACEs and the importance of preventing childhood adversity in an effort to promote better population health for the current population, but also for future generations as research has shown that parents’ experiences shape children’s lives.”

The Maternal Chronic Pain Study is nearly finished with data collection and the longitudinal data set will be used to better understand the psychosocial mechanisms that affect intergenerational pain transmission and those that lead to resilience in children.

“This information will be used to develop interventions that aim to prevent chronic pain and related poor outcomes in future generations,” said Dr. Wilson.

Catlin Dennis, for her part, is applying her research learnings in a new job: program manager for OHSU’s innovative NICH Program – Novel Interventions in Children’s Healthcare – where she supports the needs of at-risk children with complex medical conditions and their families, working to ensure a better outcome for their health and well-being.

Citation

Dennis, C. H., Clohessy, D. S., Stone, A. L., Darnall, B. D., & Wilson, A. C. (2019). Adverse childhood experiences in mothers with chronic pain and intergenerational impact on children. The Journal of Pain, epub ahead of print.