532 - Adverse Childhood Experiences in Children in Immigrant Families: Better if None, Worse if Even One

Poster Number: 532
Publication Number: 532.423

Yaa O. Asante, Cohen Children's Medical Center, GLEN OAKS, NY, United States; Duy Q. Pham, Cohen Children's Medical Center, New York, NY, United States; Anna Krevskaya, Northwell Health, Syosset, NY, United States; Ruth Milanaik, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Great Neck, NY, United States

Background: Exposure to adverse childhood experiences (ACE) is linked to poorer mental health outcomes. Children in immigrant families (CIF) are children born outside the United States (US) or having 1 or more foreign-born parents (FBP). Previous research has shown CIF are reported to have lower ACE exposures. It is unknown to what extent CIF who have ACE exposure are at increased risk for externalizing (attention deficit hyperactivity disorder (ADHD) and behavior/conduct problems) and internalizing (anxiety and depression) conditions and if ACE exposure worsens severity.

Objective: To examine associations between exposure to ACE and the reported diagnosis and severity of externalizing or internalizing conditions in CIF using nationally representative data.

Design/Methods: The National Survey of Children’s Health (NSCH) provides data on the health of non-institutionalized children in the US. Children were considered to be CIF if they had at least 1 FBP. ACE studied were exposure to household substance abuse problems, mental illness, domestic/neighborhood violence, parental divorce/death/incarceration, or race/ethnicity-based discrimination, and economic hardship. Using combined NSCH datasets from 2016 to 2019, logistic regression was performed to compute the relevant odds ratios (OR), adjusted odds ratios (aOR), and 95% confidence intervals (95% CI), with adjustment for potential sociodemographic confounders.

Results: The total eligible sample included 13,477 children, of which 3,596 had 1 FBP and 9,881 had 2 FBP. ACE exposure in CIF led to a higher likelihood of being diagnosed with anxiety, depression, and behavioral or conduct disorder (Table 1). They were almost 3 times more likely to be diagnosed with anxiety (aOR=2.97, 95% CI: [1.88, 4.67]) and more than 7 times more likely to be diagnosed with depression (aOR=7.73, 95% CI: [3.55, 16.84]). We did not find a similar likelihood of diagnosis with ADHD (Table 1). In addition, there was no significant association between exposure to ACE and severity of the conditions (Table 2).  Conclusion(s): While previous research has found that CIF have fewer ACE exposure, we found that any ACE exposure significantly increased the risk for a diagnosis of a mental or behavioral health disorder. ACE exposure however did not have a significant impact on the severity of the condition. It is imperative that CIF be screened for ACE, and children identified as being exposed to ACE are referred for appropriate management. Of note, traditional measures of ACE may not fully encapsulate the adversity that CIF face due to immigration and this needs to be explored further.
Yaa Ofosuaa Asante - CV 122021.pdf
Table 2. Association Between ACEs and Severity of Externalizing and Internalizing Conditions, 2016-2019 National Survey of Children’s Health (n=13,477)