title: Psychosocial complexity in multimorbidity: the legacy of adverse childhood experiences.
abstract: BACKGROUND
  To effectively meet the health care needs of multimorbid patients, the most important psychosocial factors associated with multimorbidity must be discerned. Our aim was to examine the association between self-reported adverse childhood experiences (ACEs) and multimorbidity and the contribution of other social, behavioural and psychological factors to this relationship.
  
  
  METHODS
  We analysed cross-sectional data from the Mitchelstown study, a population-based cohort recruited from a large primary care centre. ACE was measured by self-report using the Centre for Disease Control ACE questionnaire. Multimorbidity status was categorized as 0, 1 or ≥2 chronic diseases, which were ascertained by self-report of doctor diagnosis. Ordinal logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (95% CIs) for multimorbidity, using ACE as the independent variable with adjustment for social (education, public health cover), behavioural (smoking, exercise, diet, body mass index) and psychological factors (anxiety/depression scores).
  
  
  RESULTS
  Of 2047 participants, 45.3% (n = 927, 95% CI: 43.1-47.4) reported multimorbidity. ACE was reported by 28.4% (n = 248, 95% CI: 25.3-31.3%) of multimorbid participants, 21% (n = 113, 95% CI: 18.0-25.1%) of single chronic disease participants and 16% (n = 83, 95% CI: 13.2-19.7%) of those without chronic disease. The OR for multimorbidity with any history of ACE was 1.6 (95% CI: 1.4-2.0, P < 0.001). Adjusting for social, behavioural and psychological factors only marginally ameliorated this association, OR 1.4 (95% CI: 1.1-1.7, P = 0.002).
  
  
  CONCLUSIONS
  Multimorbidity is independently associated with a history of ACEs. These findings demonstrate the psychosocial complexity associated with multimorbidity and should be used to inform health care provision in this patient cohort.
authors.affiliation: Department of General Practice, csinnott@ucc.ie.
authors.forename: Carol
authors.initials: C
authors.lastname: Sinnott
authors.affiliation: Department of Epidemiology and Public Health and.
authors.forename: Sheena
authors.initials: S
authors.lastname: Mc Hugh
authors.affiliation: School of Mathematical Sciences, University College Cork, Cork, Ireland.
authors.forename: Anthony P
authors.initials: AP
authors.lastname: Fitzgerald
authors.affiliation: Department of General Practice.
authors.forename: Colin P
authors.initials: CP
authors.lastname: Bradley
authors.affiliation: Department of Epidemiology and Public Health and.
authors.forename: Patricia M
authors.initials: PM
authors.lastname: Kearney
mesh_terms: D001007:Anxiety / Q000175:diagnosis; D015992:Body Mass Index; D002648:Child; D002908:Chronic Disease / Q000453:epidemiology / Q000523:psychology*; D015331:Cohort Studies; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003863:Depression / Q000175:diagnosis; D004522:Educational Status; D005260:Female; D015438:Health Behavior; D006304:Health Status; D006306:Health Surveys; D006801:Humans; D007494:Ireland / Q000453:epidemiology; D016015:Logistic Models; D000069451:Long Term Adverse Effects / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011320:Primary Health Care / Q000379:methods / Q000706:statistics & numerical data; D057566:Self Report; D012923:Social Class
keywords: Child abuse; chronic disease/epidemiology; comorbidity; general practice; health services needs and demand; psychological; stress.