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Adverse childhood experiences, such as exposure to poverty, violence, discrimination, and prolonged parental absence, can cause toxic stress and can affect children's physical, mental, and behavioral health for the rest of their lives. We examined the association of adverse childhood experiences with depression and anxiety in the understudied population of children 6 to 11 years old. We performed a secondary data analysis of the 2011/2012 National Survey of Children's Health. A sample of 31,060 primary school-aged children was extracted from the nationally representative sample of 95,677 children 0 to 17 years old. Independent variables included sociodemographic items related to the social determinants of health (race/ethnicity, sex, poverty level, family structure) and adverse childhood experience-exposure items (family economic hardship, parental separation/divorce, parental incarceration, parental/family member with mental illness or depression, parental/family member with drug or alcohol problem, and exposure to prejudice or discrimination). Outcome variables were diagnosed depression and anxiety. Descriptive statistics and logistic regression analyses were performed. Findings showed that in this sample, 6% of children were diagnosed with depression and/or anxiety. Findings also showed that economic hardship, poor parental mental/behavioral health, exposure to violence, or racial/ethnic discrimination increased the risk of depression and/or anxiety in 6- to 11-year-old children. Pediatric nurses can help protect children from adverse childhood experience exposure and can help them recover from these events. Pediatric nurses can identify children at risk, provide parental anticipatory guidance, make referrals for mental health services and community-based programs, protect children from traumatic medical events, and provide resilience education/skill-building, which can alleviate the long-term effects of adverse childhood experiences exposure.
Key Words:
Adverse childhood experiences, depression, anxiety, mental health, toxic stress, National Survey of Children's Health.
Popular media, such as CBS' 60 Minutes (Winfrey, 2018) and the PBS News Hour (Harris, 2018), have recently highlighted the importance of addressing the needs of children who have been negatively affected by adverse childhood experiences. According to the American Academy of Pediatrics (AAP), children affected by adverse childhood experiences suffer from " toxic stress," which is defined as "excessive or prolonged activation of the physiologic stress response systems in the absence of the buffering protection afforded by stable, responsive relationships" (Garner & Shonkoff, 2012, p. e225). When children experience prolonged physiologic stress responses, chemical and physical changes...