The World Health Organization (WHO) describe adverse childhood experiences (ACEs) as "some of the most intensive and frequently occurring sources of stress that children may suffer early in life." They include many different types of abuse, ranging from physical abuse to neglect, as well as potentially traumatic situations such as exposure to household mental illness.
According to the Centers for Disease Control and Prevention (CDC), a study of ACEs involving more than 17,000 participants found that approximately two thirds of participants had experienced at least one ACE, with more than one fifth of participants experiencing three or more ACEs.
The ACE Study found that as the number of ACEs increased, so did the risk of several health problems, including the following:
Prior to the new research, led by John Blosnich of the Veterans Affairs Pittsburgh Healthcare System, the prevalence of ACEs among people who currently serve or have served in the US military was unknown. The authors believe that their study, published in JAMA Psychiatry, is the largest US study to examine this prevalence.
'Largest study' to measure ACEs with military service
The authors utilized data from a behavior risk surveillance system alongside telephone interviews from a sample of over 60,000 people. They used this data to examine the prevalence of ACEs in people with a history of military service compared with those who did not, while also considering the differences between the draft era and the all-volunteer era (since 1973).
The researchers found that for many categories of ACE, the prevalence was twice as high in people with military history than people without.
In total, 11 different categories of ACE were examined. These included the following:
- Emotional abuse
- Parental separation or divorce
- Household alcohol abuse
- Exposure to domestic violence
- Being touched sexually.
Within the sample, 12.7% of individuals had a history of military service. Compared with 2% of women, 24% of men reported military service.
Marked differences were found between men who had experienced military service and those who had not in the all-volunteer era, with men with a history of military service having a higher prevalence of ACEs across all 11 categories.
Men with a history of military service during the all-volunteer era were more than twice as likely to have experienced a form of sexual abuse than non-military males. The ACE categories identified were: being touched sexually (11% vs. 4.8%), being forced to touch another sexually (9.6% vs. 4.2%) and being forced to have sex (3.7% vs. 1.6%).
These differences did not extend to the draft era. The only difference among men was with regard to household drug use, where men with military service had a lower prevalence than men without.
In both the draft and all-volunteer eras, women with a history of military service were more likely to have experienced emotional abuse, exposure to domestic violence, household alcohol abuse and physical abuse, compared with women without a history of military service.
Women serving in the all-volunteer era also had a higher prevalence of being touched sexually. Overall among women, slightly fewer differences were found between those with and without a history of military service.
A motivation for enlisting?
This research has several limitations. Both the ACEs and military service were self-reported and thus are subject to the possibility of recall bias or being unable to be verified by official records.
Although the study finds an increased prevalence of ACEs in people with military history, and previous research has found some enlistees citing escaping negative experiences as motivation, the study does not enable the researchers to establish a causal link between military service and ACEs.
The motivation for enlisting is not recorded, and no data was available to the authors to associate ACEs with current or past trauma. This means that in this instance, ACEs can only be regarded as potentially traumatic events.
The authors say it is important to emphasize two points when examining the results of their research. Firstly, they state that most people who survive ACEs can lead healthy lives.
Secondly, they write that there are several positive reasons that lead to people enlisting with the military, such as family tradition, self-improvement and altruism.
According to the authors, acknowledging both ACEs and these more positive motivations "can ensure support and resources are available to service members who are ACE survivors, with the goal of supporting their successful military careers rather than inadvertently increasing stigma toward ACE survivors."
Previously, Medical News Today reported on how a new initiative was analyzing rising suicide rates within the US Army.
Written by James McIntosh