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SERVICES
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Adverse Childhood Experiences and Worker Health and Job Performance
Vladimir I. Fleisher, MD, PhD1
Vincent J. Felitti, MD, FACP2
Robert F. Anda, MD, MS1
Valerie J. Edwards, PhD1
Charles L. Whitfield, MD3
David F. Williamson, MS, PhD1
1 National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA.
2 Department of Preventive Medicine, Southern California Permanente Medical Group (Kaiser Permanente), San Diego, CA.
3 Private practice of trauma psychology and addiction medicine, Atlanta, GA.
Corresponding Author
Vladimir Fleisher, MD, PhD
Mail stop K-47
Centers for Disease Control and Prevention
4770 Buford Hwy NE, Atlanta, GA 30341-3724
Word count: 2993
Tables: 5
Figures: 1
Key words: Occupational Health, Employee Assistance Programs, Substance Abuse, Mental Health, Somatization, Interpersonal Relationships, Work Performance, Child Abuse, Domestic Violence, Impaired Parents, Economy
Objective: To assess the effect of adverse childhood experiences (ACEs) on factors that can affect worker performance.
Design: A retrospective cohort study of adults regarding eight types of adverse childhood experiences.
Setting: A large HMO in California
Participants: 26,824 currently employed adult HMO members (mean age 47.9 years)
Main outcome measures: Three indicators of worker performance: serious job problems, financial problems, and absenteeism; and four areas of health and well-being: marital or family problems, dissatisfaction with sex life; emotional distress (depression, panic reactions, difficulty controlling anger); somatic symptoms (back pain, headaches, joint problems); and substance abuse (alcoholism, smoking, drug abuse).
Results: Individual ACEs were all associated with worker performance, health, and well-being. The total number of ACEs showed a strong, graded relationship to these outcomes (p<0.0001). The mechanism of this relationship was revealed by adjusting for the number of problems in the four areas of health and well-being which reduced the strength of the relationship between the ACEs and worker performance by 50-100% (P<0.001).
Conclusions: We found that childhood abuse and exposure to household dysfunction impair worker performance decades later. Four areas of health and well-being mediate this damage and need to be addressed in the practice of medicine. Adverse childhood experiences have major human and economic costs and affect the nation's productivity and social fabric. They merit serious attention by business leaders and the medical profession.
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