Adverse Childhood Experiences and Unmet Health Care Needs due to Cost and the COVID-19 Pandemic: A Nationally Representative Analysis of U.S. Adolescents.

IF 5.5 2区医学 Q1 PEDIATRICS

Journal of Adolescent Health Pub Date : 2025-04-03 DOI:10.1016/j.jadohealth.2025.02.001

Rohan Khazanchi, Ryan C L Brewster, Destiny G Tolliver, Nia J Heard-Garris, Aditi Vasan, Tyler N A Winkelman, Scott E Hadland

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引用次数: 0

Abstract

Purpose: Adverse childhood experience (ACE) exposure and poor mental health are closely intertwined. In 2020, the prevalence of both began precipitously increasing among adolescents. We explored associations of individual and cumulative ACE exposure with cost and COVID-19 pandemic-related unmet health needs to assess ACEs as risk markers for broader structural adversity.

Methods: We conducted a nationally representative analysis of 5,536 adolescents (weighted N = 20,294,070) aged 13-17 years using the 2019 and 2021 National Health Interview Survey. Outcomes included mental health symptoms, preventive care access, cost and COVID-19-related unmet needs, and health care use. We estimated associations with lifetime exposure to 4 ACEs using marginal effects from multivariable logistic regressions.

Results: Millions of adolescents were exposed to parental incarceration (7.8%, N = 1,407,670), neighborhood violence (6.9%, N = 1,567,483), a guardian with serious mental illness (10.3%, N = 2,088,957), and/or a guardian with alcohol or drug problems (11.4%, N = 2,304,953). Overall, 77.7% (N = 15,758,023), 13.2% (N = 2,671,342), and 9.2% (N = 1,864,704) were exposed to 0, 1, and 2+ of these ACEs. In adjusted models, compared with exposure to 0 ACEs, exposure to 1 or 2+ ACEs was positively associated with anxiety and depression symptom frequency, urgent care and emergency department use, trouble paying medical bills, delayed and forgone mental health care due to cost, and delayed and forgone care due to the COVID-19 pandemic.

Discussion: Adolescents exposed to ACEs experienced mutually reinforcing disadvantages: a worse mental health symptom burden, yet greater barriers to accessing needed medical and mental health care. ACEs must be reconceptualized as markers of structural-rather than individual-adversity and addressed through structural and policy interventions.

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目的：童年不良经历（ACE）与不良心理健康密切相关。2020 年，这两种情况在青少年中的发生率开始急剧上升。我们探讨了个人和累积的 ACE 暴露与成本和 COVID-19 大流行病相关的未满足健康需求之间的关联，以评估 ACE 作为更广泛的结构性逆境的风险标记：我们利用 2019 年和 2021 年全国健康访谈调查，对 5,536 名 13-17 岁青少年（加权人数=20,294,070）进行了具有全国代表性的分析。分析结果包括心理健康症状、预防保健、费用和 COVID-19 相关未满足需求以及保健使用情况。我们利用多变量逻辑回归的边际效应估算了终生暴露于 4 种 ACE 的相关性：数百万青少年曾遭受父母监禁（7.8%，N = 1,407,670）、邻里暴力（6.9%，N = 1,567,483）、患有严重精神疾病的监护人（10.3%，N = 2,088,957）和/或有酗酒或吸毒问题的监护人（11.4%，N = 2,304,953）。总体而言，77.7%（样本数=15,758,023）、13.2%（样本数=2,671,342）和 9.2%（样本数=1,864,704）的受影响程度分别为 0、1 和 2+。在调整后的模型中，与暴露于 0 个 ACE 相比，暴露于 1 个或 2 个以上 ACE 与焦虑和抑郁症状频率、紧急护理和急诊使用、医疗账单支付困难、因费用而延迟和放弃心理健康护理以及因 COVID-19 大流行而延迟和放弃护理呈正相关：受 ACE 影响的青少年经历了相互强化的不利因素：心理健康症状负担加重，在获得所需的医疗和心理健康护理方面面临更多障碍。必须重新认识 ACE，将其视为结构性逆境（而非个体逆境）的标志，并通过结构性和政策性干预措施加以解决。

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来源期刊

Journal of Adolescent Health 医学-公共卫生、环境卫生与职业卫生

CiteScore

10.40

自引率

3.90%

发文量

526

审稿时长

46 days

期刊介绍： The Journal of Adolescent Health is a scientific publication dedicated to enhancing the health and well-being of adolescents and young adults. Our Journal covers a broad range of research topics, spanning from the basic biological and behavioral sciences to public health and policy. We welcome a variety of contributions, including original research papers, concise reports, literature reviews, clinical case reports, opinion pieces, and letters to the editor. We encourage professionals from diverse disciplines such as Anthropology, Education, Ethics, Global Health, Health Services Research, Law, Medicine, Mental and Behavioral Health, Nursing, Nutrition, Psychology, Public Health and Policy, Social Work, Sociology, and Youth Development to share their expertise and contribute to our mission of promoting adolescent health. Moreover, we value the voices of young individuals, family and community members, and healthcare professionals, and encourage them to submit poetry, personal narratives, images, and other creative works that provide unique insights into the experiences of adolescents and young adults. By combining scientific peer-reviewed research with creative expressions, our Journal aims to create a comprehensive understanding of the challenges and opportunities in adolescent and young adult health.