title: Intra- and extra-familial adverse childhood experiences and a history of childhood psychosomatic disorders among Japanese university students.
abstract: BACKGROUND
  Japan has been witnessing a considerable increase in the number of children with psychosomatic disorders. The purpose of this study is to examine the relationship between the risk of psychosomatic disorder in adolescents and intra- and extra-familial adverse childhood experiences (ACEs).
  
  
  METHODS
  A retrospective cohort study of 1592 Japanese university students (52% male, mean age 19.9 years) who completed a survey about intra- and extra-familial ACEs and the incidence of childhood psychosomatic disorders. Intra-familial ACEs included domestic violence, physical violence, emotional abuse, illness in household, parental divorce, no parental affection, and dysfunctional family. Extra-familial ACEs included physical violence or negative recognition by teachers, being bullied in elementary or junior high school, or sexual violence.
  
  
  RESULTS
  The frequency of psychosomatic disorders among the respondents was 14.8%. Among the 7 intra-familial ACEs, emotional abuse (relative risk, RR = 1.9) and illness in household (RR = 1.7) increased the risk of psychosomatic disorders. Estimates of the relative risk for the 5 extra-familial ACEs were statistically significant and ranged from 1.5 for being bullied in elementary school or physical violence from teachers to 2.4. Students who had 3 or more intra-familial ACEs and 2 or more extra-familial ACEs had a 3.0 relative risk for psychosomatic disorder.
  
  
  CONCLUSIONS
  These results suggest that intra- and extra-familial ACEs are associated with the development of psychosomatic disorders. Therefore, sufficient evaluation of ACEs should be performed in adolescent patients with psychosomatic disorder.
authors.affiliation: Masuda Clinic, 1-30 Yamanoguchi, Kagoshima 892-0844, Japan. akimasu55@sky.plala.or.jp
authors.forename: Akinori
authors.initials: A
authors.lastname: Masuda
authors.forename: Takao
authors.initials: T
authors.lastname: Yamanaka
authors.forename: Tadatoshi
authors.initials: T
authors.lastname: Hirakawa
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Koga
authors.forename: Ryosuke
authors.initials: R
authors.lastname: Minomo
authors.forename: Takao
authors.initials: T
authors.lastname: Munemoto
authors.forename: Chuwa
authors.initials: C
authors.lastname: Tei