title: Adverse Childhood Experiences, Support, and the Perception of Ability to Work in Adults with Disability.
abstract: OBJECTIVE
  To examine the impact of adverse childhood experiences (ACEs) and support on self-reported work inability of adults reporting disability.
  
  
  METHODS
  Adults (ages 18-64) who participated in the Behavioral Risk Factor Surveillance System in 2009 or 2010 and who reported having a disability (n = 13,009).
  
  
  METHODS
  The study used a retrospective cohort design with work inability as the main outcome. ACE categories included abuse (sexual, physical, emotional) and family dysfunction (domestic violence, incarceration, mental illness, substance abuse, divorce). Support included functional (perceived emotional/social support) and structural (living with another adult) support. Logistic regression was used to adjust for potential confounders (age, sex and race) and to evaluate whether there was an independent effect of ACEs on work inability after adding other important predictors (support, education, health) to the model.
  
  
  RESULTS
  ACEs were highly prevalent with almost 75% of the sample reporting at least one ACE category and over 25% having a high ACE burden (4 or more categories). ACEs were strongly associated with functional support. Participants experiencing a high ACE burden had a higher adjusted odds ratio (OR) [95% confidence interval] of 1.9 [1.5-2.4] of work inability (reference: zero ACEs). Good functional support (adjusted OR 0.52 [0.42-0.63]) and structural support (adjusted OR 0.48 [0.41-0.56]) were protective against work inability. After adding education and health to the model, ACEs no longer appeared to have an independent effect. Structural support remained highly protective, but functional support only appeared to be protective in those with good physical health.
  
  
  CONCLUSIONS
  ACEs are highly prevalent in working-age US adults with a disability, particularly young adults. ACEs are associated with decreased support, lower educational attainment and worse adult health. Health care providers are encouraged to screen for ACEs. Addressing the effects of ACEs on health and support, in addition to education and retraining, may increase ability to work in those with a disability.
authors.affiliation: Spinal Cord Injury Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, California, United States of America.|Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, United States of America.
authors.forename: Sophia Miryam
authors.identifier: http://orcid.org/0000-0002-6311-6671
authors.initials: SM
authors.lastname: Schüssler-Fiorenza Rose
authors.affiliation: Center on Trauma and Children, Department of Psychiatry, College of Medicine, University of Kentucky, Lexington, Kentucky, United States of America.
authors.forename: Jessica G
authors.initials: JG
authors.lastname: Eslinger
authors.affiliation: Dissemination and Training Division, National Center for Posttraumatic Stress Disorders, Veterans Affairs Palo Alto Health Care System, Menlo Park, California, United States of America.|Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, United States of America.
authors.forename: Lindsey
authors.initials: L
authors.lastname: Zimmerman
authors.affiliation: Adler School of Professional Psychology, Chicago, Illinois, United States of America.
authors.forename: Jamie
authors.initials: J
authors.lastname: Scaccia
authors.affiliation: School of Public Health, Georgia State University, Atlanta, Georgia, United States of America.
authors.forename: Betty S
authors.initials: BS
authors.lastname: Lai
authors.affiliation: National Centre for Mental Health, Cardiff University Institute of Psychological Medicine and Clinical Neurosciences, Cardiff, Wales, United Kingdom.
authors.forename: Catrin
authors.initials: C
authors.lastname: Lewis
authors.affiliation: Monash University Accident Research Centre, Monash University, Melbourne, Australia.|Department of Psychosomatics and Psychiatry, University Children's Hospital Zurich, Zurich, Switzerland.
authors.forename: Eva
authors.initials: E
authors.lastname: Alisic
mesh_terms: D000293:Adolescent; D000328:Adult; D054523:Adult Survivors of Child Abuse / Q000523:psychology / Q000706:statistics & numerical data*; D040343:Behavioral Risk Factor Surveillance System; D002648:Child; D002649:Child Abuse / Q000523:psychology / Q000706:statistics & numerical data*; D004185:Disability Evaluation; D006233:Persons with Disabilities / Q000523:psychology / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D008960:Models, Psychological; D010465:Perception; D011363:Professional Impairment / Q000523:psychology / Q000706:statistics & numerical data; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods / Q000706:statistics & numerical data; D012944:Social Support; D014937:Work / Q000523:psychology / Q000706:statistics & numerical data*; D055815:Young Adult