ACE Risk Bands and Health Outcomes Among a Group of Adults in Secure Forensic Care

Authors' Affiliations

Kristin Mahan, Department of Psychology, College of Arts and Sciences, East Tennessee State University, Johnson City, TN. Jill Stinson, Department of Psychology, College of Arts and Sciences, East Tennessee State University, Johnson City, TN. Megan Quinn, Department of Biostatistics and Epidemiology, College of Public Health, East Tennessee State University, Johnson City, TN.

Location

Culp Center Rm. 303

Start Date

4-25-2023 1:40 PM

End Date

4-25-2023 2:00 PM

Faculty Sponsor’s Department

Psychology

Name of Project's Faculty Sponsor

Jill Stinson

Classification of First Author

Graduate Student-Doctoral

Competition Type

Competitive

Type

Oral Presentation

Project's Category

Psychology

Abstract or Artist's Statement

Introduction: The Adverse Childhood Experiences (ACE) study demonstrated that childhood maltreatment has a profound impact on adult health, leading to psychopathology, continued victimization, risky behaviors, chronic disease, suicide, and premature death. Persons involved in the forensic mental health system are characterized by a greater degree of cumulative risk – exposed to greater and more prolonged ACEs during critical developmental periods who also face disproportionate exposure to psychosocial and economic deprivation, limited health care access, and other such factors that compound lifetime health concerns. In the current study, we seek to build upon emerging knowledge of ACEs in forensic mental health consumers by examining clusters of persons differentially exposed to ACEs in relation to a range of health and behavioral outcomes. Method: Archival data were used; participants were randomly sampled who had been admitted to the facility and released between 2005 and 2013. Of 250 possible participants identified by the facility’s Quality Management team, data were collected and coded for the resulting 180 persons. Records included admission and discharge summaries, criminal background records and associated pre-sentencing reports, and annual medical, social services, and psychiatric evaluations. Data pertaining to ACEs and characteristics of the early environment, mental and physical health, and criminality and aggression were coded for each participant. For this presentation, we examined outcomes related to adult physical health (e.g., chronic disease conditions, head injuries), mental health (e.g., suicidality, psychiatric admission history, psychiatric diagnoses), and criminogenic behavior (e.g., characteristics of arrest history, onset of aggression) using a series of logistic regression analyses, with differing ACE risk bands as ordinal predictors of our outcome variables. These include persons with an ACE score of 0-1 (40.6%, n = 73), 2-3 (27.2%, n = 49), 4-5 (16.1%, n = 29), and 6+ (16.1%, n = 29). Results & discussion: None of the outcomes for medical history were significantly different across the risk bands, potentially due to high occurrences among the sample, with over 79% reporting a chronic disease. The relationship between risk band and sexual arrest history was significant (p = .045), with those in lower risk bands more likely to be arrested for a sexual offense. This may be due to the additional planning and executive functioning required to engage in these types of crime. There was a significant relationship between risk bands and age at first arrest (p = .032), with the highest risk band arrested at younger ages. There was also a significant relationship for age at first aggression (p < .001) and age at first psychiatric hospitalization (p < .001) with highest risk bands demonstrating aggressive behaviors and being hospitalized at earlier ages. Relationships between self-harm history (p < .001), PTSD diagnosis (p < .001), and BPD diagnosis (p < .001) were significantly related to ACE risk bands. Implications and future directions will be discussed.

This document is currently not available here.

Share

COinS
 
Apr 25th, 1:40 PM Apr 25th, 2:00 PM

ACE Risk Bands and Health Outcomes Among a Group of Adults in Secure Forensic Care

Culp Center Rm. 303

Introduction: The Adverse Childhood Experiences (ACE) study demonstrated that childhood maltreatment has a profound impact on adult health, leading to psychopathology, continued victimization, risky behaviors, chronic disease, suicide, and premature death. Persons involved in the forensic mental health system are characterized by a greater degree of cumulative risk – exposed to greater and more prolonged ACEs during critical developmental periods who also face disproportionate exposure to psychosocial and economic deprivation, limited health care access, and other such factors that compound lifetime health concerns. In the current study, we seek to build upon emerging knowledge of ACEs in forensic mental health consumers by examining clusters of persons differentially exposed to ACEs in relation to a range of health and behavioral outcomes. Method: Archival data were used; participants were randomly sampled who had been admitted to the facility and released between 2005 and 2013. Of 250 possible participants identified by the facility’s Quality Management team, data were collected and coded for the resulting 180 persons. Records included admission and discharge summaries, criminal background records and associated pre-sentencing reports, and annual medical, social services, and psychiatric evaluations. Data pertaining to ACEs and characteristics of the early environment, mental and physical health, and criminality and aggression were coded for each participant. For this presentation, we examined outcomes related to adult physical health (e.g., chronic disease conditions, head injuries), mental health (e.g., suicidality, psychiatric admission history, psychiatric diagnoses), and criminogenic behavior (e.g., characteristics of arrest history, onset of aggression) using a series of logistic regression analyses, with differing ACE risk bands as ordinal predictors of our outcome variables. These include persons with an ACE score of 0-1 (40.6%, n = 73), 2-3 (27.2%, n = 49), 4-5 (16.1%, n = 29), and 6+ (16.1%, n = 29). Results & discussion: None of the outcomes for medical history were significantly different across the risk bands, potentially due to high occurrences among the sample, with over 79% reporting a chronic disease. The relationship between risk band and sexual arrest history was significant (p = .045), with those in lower risk bands more likely to be arrested for a sexual offense. This may be due to the additional planning and executive functioning required to engage in these types of crime. There was a significant relationship between risk bands and age at first arrest (p = .032), with the highest risk band arrested at younger ages. There was also a significant relationship for age at first aggression (p < .001) and age at first psychiatric hospitalization (p < .001) with highest risk bands demonstrating aggressive behaviors and being hospitalized at earlier ages. Relationships between self-harm history (p < .001), PTSD diagnosis (p < .001), and BPD diagnosis (p < .001) were significantly related to ACE risk bands. Implications and future directions will be discussed.