In 1995 Kaiser Permanente, a Health Maintenance Organization ( HMO), studied the association between adverse childhood experiences and long term health risks, including depression, in 9,508 of its members. This is the largest study of its kind to date. They looked for a possible correlation between ten adverse experiences before age seven and presenting conditions present in the now adult study participants. See below for the significant ACEs reported by the Kaiser Permanente study subjects.
Adverse Childhood Experience (ACE) Questionnaire
While you were growing up, during your first 18 years of life:
- Did a parent or other adult in the household often …
Swear at you, insult you, put you down, or humiliate you? or
Act in a way that made you afraid that you might be physically hurt?
Yes No If yes enter 1 __ - Did a parent or other adult in the household often … Push, grab, slap, or throw something at you? or
Ever hit you so hard that you had marks or were injured?
Yes No If yes enter 1 __ - Did an adult or person at least 5 years older than you ever…
Touch or fondle you or have you touch their body in a sexual way? or
Try to or actually have oral, anal, or vaginal sex with you?
Yes No If yes enter 1 __ - Did you often feel that …
No one in your family loved you or thought you were important or special? or
Your family didn’t look out for each other, feel close to each other, or support each other?
Yes No If yes enter 1 __ - Did you often feel that …
You didn’t have enough to eat, had to wear dirty clothes, and had no one to protect you? or
Your parents were too drunk or high to take care of you or take you to the doctor if you needed it?
Yes No If yes enter 1 __ - Were your parents ever separated or divorced?
Yes No If yes enter 1 __ - Was your mother or stepmother:
Often pushed, grabbed, slapped, or had something thrown at her? or
Sometimes or often kicked, bitten, hit with a fist, or hit with something hard? or
Ever repeatedly hit over at least a few minutes or threatened with a gun or knife?
Yes No If yes enter 1 __ - Did you live with anyone who was a problem drinker or alcoholic or who used street drugs?
Yes No If yes enter 1 __ - Was a household member depressed or mentally ill or did a household member attempt suicide?
Yes No If yes enter 1 __ - Did a household member go to prison?
Yes No If yes enter 1 __Now add up your “Yes” answers: _______ This is your ACE Score
The study showed that the above Adverse Childhood Experiences (ACEs) were common with nearly two-thirds of study subjects reporting at least one ACE, and more than twenty percent reporting three or more ACEs.
The ACE score is calculated by adding the number of ACEs. The total sum is used to assess cumulative stress from childhood. The study found a direct correlation to the number and intensity of ACEs and negative health symptoms (See below) over the course of the adult life with a higher ACES score resulting in more negative health outcomes.
• Alcoholism and alcohol abuse
• Chronic obstructive pulmonary disease
• Depression
• Fetal death
• Health-related quality of life
• Illicit drug use
• Ischemic heart disease
• Liver disease
• Poor work performance
• Financial stress
• The risk for intimate partner violence
• Multiple sexual partners
• Sexually transmitted diseases
• Smoking
• Suicide attempts
• Unintended pregnancies
• Early initiation of smoking
• Early initiation of sexual activity
• Adolescent pregnancy
• The risk of sexual violence
• Poor academic achievement
While this study highlighted the necessity for early treatment in order to avoid these negative health symptoms, it also may leave people who experience recurring depression frustrated because they cannot change their childhood experiences. So does this mean they are stuck with depression for their lifetime? Not necessarily, because with therapy the mind can change the way childhood traumas are perceived, thus internally experienced.
A strong component of childhood trauma that leads to later depression is a child’s inevitable self-blame. He or she has no power over the situation. When their threat system gets triggered they cannot go into the fight or flight mode because they intrinsically know they need their parents to take care of them in order to survive. So they cannot run away or fight. But they can regain power over their lives by blaming themselves. They can try to change themselves because they are helpless to change their parents.
One internal part of them, on a very subconscious level, scorns them with derisive self-statement such as, “You’re bad,” you’re unlovable,” “there is something wrong with you,” “you’re insignificant,” “you’re weak,” you’re unwanted, etc. The purpose of this automatic self-abasement by an internal part or ego state is to motivate the child to behave better so that the parents will care for them. For adults with unremitting depression, a child part continues that self-blame, especially when dealing with difficult people. Because this occurs on a subconscious level, the underlying dynamics continuously adds fuel to the depression fire unbeknownst consciously by the adult self.
Depression therapy in a large part addresses these automatic negative self-thoughts and all the related cognitive distortions. Someone experiencing depression is more likely to have negative assessments about self, others, life, and the future. A depressed person is more likely to personalize a negative event in their lives by attributing the cause of that negative event to themselves somehow, “I’m not worth it.” A depressed person is also more likely to globalize that negative event, “Nothing in my life turns out,” or see it as permanent, “I’m never going to be happy.” This personalization, globalization, and attribution of permanence
The good news is that depression is one of the most effectively treated mental health issue, second only to phobias. The prognosis is good with treatment. Depression therapy should consist of addressing childhood traumas effectively, in a manner that will not retraumatize the client, as well as correcting the automatic negative thinking. Depression coping skills are also a helpful resource to clients. Changing some aspects of lifestyle or relationships that historically trigger depression can be a component of depression treatment as well.
