The impact of adverse childhood experiences on health outcomes of indigenous populations over the life course: A systematic review

Abstract

Objective

Adverse childhood experiences (ACEs) are recognised as a strong risk factor affecting health outcomes. This systematic review seeks to synthesize evidence from global studies, investigating the associations of ACEs with the development of various health issues beyond childhood in Indigenous populations.

Study design

Systematic review.

Methods

We systematically searched for research articles published up to February 2024, in databases of peer-reviewed literature. We searched for articles on different types of ACEs recorded and their associated problematic health outcomes in different Indigenous populations across the world. Observational studies and administrative linkage study design were eligible for inclusion. Summary results of individual studies and variations of different ACE measuring tools are presented. We further explored the potential link between ACEs and various health outcomes by constructing an acyclic graph based on available evidence.

Results

We screened 2468 articles, and 56 were included in our review. Although tools for measuring ACEs were diverse, most of the studies used either the CDC-Kaiser study tool or tools by Bernstein et al. which were developed for the mainstream population. No Indigenous-specific tool was found that was used to assess ACEs in Indigenous populations. The studies assessed several types of ACEs, with sexual abuse and physical abuse being the most common. All the studies reported a significant association between ACEs and adverse health outcomes where mental health issues were more examined than physical health issues.

Conclusion

As we found that there was no validated Indigenous-specific tool for the Indigenous population, it is crucial to develop ACE measurement tools tailored to Indigenous populations that can capture trauma events related to their unique history and cultural context. Considering the higher prevalence of several physical health problems, especially cardiovascular and metabolic diseases in this population, more research should be conducted to identify their links with ACEs.