ACEs screening in adolescent primary care

Hostutler,  Snider, Wolf,  & Grant (2022) published “ACEs Screening in Adolescent Primary Care: Psychological flexibility as a moderator” in Families, Systems, & Health. I have posted about ACEs before and the challenge of knowing when asking about them can be harmful. In this study, they argue that screening for psychological flexibility may be important in order to work first on modifying flexibility before examining ACEs. Here’s the abstract:

Purpose: Screening for adverse childhood experiences (ACEs) is increasingly recommended in medical settings; however, there is more to learn about which patients experience negative outcomes following ACEs and how to intervene. This study sought to determine whether psychological flexibility moderated the relationship between ACEs and 2 important health outcomes: depression and elevated body mass index (BMI). Specifically, we hypothesized that as psychological flexibility increased, the relationship between ACEs and these mental and physical health outcomes would weaken. Method: Exposure to ACEs, psychological flexibility (AFQ-Y8), depressive symptoms (PHQ9a), and BMI percentiles were assessed using validated, self-report rating scales during adolescent well-child checks in urban primary care practices. A total sample of 402 predominately Black (72.6%), publicly insured (81.8%), and female (63.4%) adolescents with complete data were included in analysis. Results: Psychological flexibility moderated the relationship between self-reported ACEs and depressive symptoms. Patients with high psychological flexibility reported fewer depressive symptoms when they experienced more ACEs, those with average psychological flexibility demonstrated no relationship between ACEs and depressive symptoms, and those with low psychological flexibility reported more depressive symptoms when experiencing higher numbers of ACEs. ACEs were only related to BMIs greater than 99th percentile in this study and moderation was not supported. Conclusions: Psychological flexibility was helpful in differentiating those who experience increased depressive symptoms following ACE exposure in a primary care setting. Psychological flexibility is a modifiable process and may represent an important population health variable to develop prior to exposure or reduce negative outcomes following ACEs. 

It is also helpful to know that teens with BMIs below the 99th percentile, in this sample, were not likely to experience depression when asked about ACEs. This is also helpful research in that short self-report scales are used to assess flexibility, depression, and ACEs. This is another area where a multidisciplinary team can work much better in meeting the needs of teenagers.