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State of Alaska

Health Indicator Report of Adverse Childhood Experiences: Mental Illness in Household

Mental health problems are common in the United States - about one in four adults suffer from a diagnosable mental disorder in a given year.^2^ Mental illness can cause disturbances and inability to cope with life's ordinary demands. Consequently, it can have a significant impact on family stability. Family members often become preoccupied with managing the illness, and much of the family's attention is directed to that person. Children may take on an inappropriate level of responsibility in caring for themselves and managing the household. Parents with mental health problems may struggle to manage their parenting role. When parents are depressed, for example, they may become less emotionally involved and invested in their children's daily lives. Children whose parents have a mental illness are at risk of developing social, emotional, and behavioral problems.^3^ As a child experiences living with someone who is depressed, mentally ill, or suicidal, the impacts of overwhelming stress on the brain continue into adulthood and can have generational impacts. As Alaska children are exposed to household mental illness, they may find negative ways to cope with their damaged stress responses. When adults start families of their own, these behaviors can become ACEs for another generation.^4^ The Adverse Childhood Experiences (ACE) Study, a collaborative between the Centers for Disease Control and Prevention and Kaiser Permanente's Health Appraisal Clinic in San Diego, assessed associations between childhood maltreatment and later-life health and well-being.^1^ It is critical to understand how some of the worst health and social problems can arise as a consequence of adverse childhood experiences. Sixteen of the Healthy Alaskans 2020 measures have been shown through peer-reviewed journal articles to be negatively impacted by adverse childhood experiences. Alaska takes on the burden of approximately $82 million in costs (e.g., health care costs, welfare costs, special education costs) each year due to nonfatal child maltreatment. Realizing these connections is likely to improve efforts towards prevention and recovery.^5^[[br]] [[br]] ---- {{class .SmallerFont 1. U.S. Centers for Disease Control and Prevention (CDC). Adverse Childhood Experiences (ACE) Study. [http://www.cdc.gov/violenceprevention/acestudy/index.html]. Updated April 1, 2016. Accessed April 26, 2016. 2. Duckworth, K. Mental illness facts and numbers. National Alliance on Mental Illness. [http://www2.nami.org/factsheets/mentalillness_factsheet.pdf]. Published March 2013. Accessed April 26, 2016. 3. Social Work Today. Reaching out to children of parents with mental illness. [http://www.socialworktoday.com/archive/septoct2007p26.shtml]. Accessed April 26, 2016. 4. Alaska Department of Health and Social Services. Alaska Mental Health Board and the Advisory Board on Alcoholism and Drug Abuse. Investing in prevention: working together in early childhood for healthy Alaskan children, families, and communities 2015. [http://dhss.alaska.gov/abada/ace-ak/Documents/State_Interagency_Prevention_2015.pdf]. Accessed April 26, 2016. 5. Sidmore P. Alaska Department of Health and Social Services. Alaska Mental Health Board and the Advisory Board on Alcoholism and Drug Abuse. Economic costs of adverse childhood experiences in Alaska. [http://dhss.alaska.gov/abada/aceak/ Documents/ACEsEconomicCosts-AK.pdf]. Accessed April 26, 2016. }}

Data Source

Alaska Data: [http://dhss.alaska.gov/dph/Chronic/Pages/brfss/default.aspx Behavioral Risk Factor Surveillance System], Alaska Department of Health and Social Services, DPH, Section of Chronic Disease Prevention and Health Promotion

Data Interpretation Issues

The preamble to each of the Adverse Childhood Experiences (ACEs) question was: "I'd like to ask you some questions about events that happened during your childhood. This information will allow us to better understand problems that may occur early in life, and may help others in the future. This is a sensitive topic and some people may feel uncomfortable with these questions. At the end of this section, I will give you a phone number for an organization that can provide information and referral for these issues. Please keep in mind that you can ask me to skip any question you do not want to answer. All questions refer to the time period before you were 18 years of age. Now, looking back before you were 18 years of age ---" While the individual adverse childhood experience (ACE) an Alaska adult may have experienced is important, the strength of the research lies in the often multiple ACEs an individual has during childhood: "The ACE score, a total sum of the different categories of ACEs reported by participants, is used to assess cumulative childhood stress. Study findings repeatedly reveal a graded dose-response relationship between ACEs and negative health and well-being outcomes across the life course...Dose response describes the changes in an outcome (e.g., alcoholism) associated with differing levels of exposure (or doses) to a stressor (e.g., ACEs). A graded dose-response means that as the dose of the stressor increases the intensity of the outcome also increases."^1^ The ACEs question on mental illness in the household was asked in 2013 through 2015.[[br]] [[br]] ---- {{class .SmallerFont 1. U.S. Centers for Disease Control and Prevention (CDC). Adverse Childhood Experiences (ACE) Study. [http://www.cdc.gov/violenceprevention/acestudy/index.html]. Updated April 1, 2016. Accessed April 26, 2016.}}

Definition

Percentage of adults 18 years of age and older who responded "Yes" on the [http://dhss.alaska.gov/dph/Chronic/Pages/brfss/default.aspx Behavioral Risk Factor Surveillance System (BRFSS)] to the question: "Did you live with anyone who was depressed, mentally ill, or suicidal?"

Numerator

Weighted number of adults (18+) who responded "Yes" on the BRFSS to the question: "Did you live with anyone who was depressed, mentally ill, or suicidal?"

Denominator

Weighted number of adults (18+) who responded to the household mental illness question on the BRFSS, excluding those with missing or "Refused" responses. Those who responded "Don't know/Not sure" are defined as a negative response.

How Are We Doing?

In 2013-2015 combined, 21.4% of Alaska adults reported having experienced living with a household member who was depressed, mentally ill, or suicidal. There were significant differences in the reporting of experiencing mental illness in the household between males (17.7%) and females (25.4%). The percentage of Alaska adults reporting exposure to mental illness in the household while growing up was lower in the older age groupings. Asians (6.8%) and Native Hawaiian and other Pacific Islanders (8.3%) were significantly less likely to report exposure than were Alaskans of other races. Individuals who were married (17.7%) or widowed (10.0%) reported less exposure than those who were divorced/separated (22.1%), never married (27.9%), or were living with a partner (35.4%). Those unable to work reported exposure at 34.2%, significantly higher than those who were employed (21.0%) or not in the work force (18.9%). No significant differences were seen based upon income or poverty levels. Alaska Native adults living in road-connected areas of the state reported equal or higher percentages of exposure to household mental illness while growing up as those residing in rural settings. Rates of mental illness in household members during childhood from the BRFSS are initially presented for all Alaskans and Alaska Native people for the combined 3-year period from 2013-2015. Subsequent analyses were conducted for demographic subpopulations (i.e., sex, age, race/ethnicity, ethnicity, marital status, education, employment status, income, and poverty status). Crosstabulations were also conducted for 3-year averages by body mass index, current smoking, sexual orientation, and disability. Significant differences were evident in contrasts by current smoking, sexual orientation, and disability. Rates of mental illness in household members during childhood by regions of Alaska are presented for all Alaskans and Alaska Native people for the 3-year average of surveys conducted between 2013-2015: 1) 7 Alaska Public Health Regions, 2) 5 Metropolitan and Micropolitan Statistics Areas and rural remainder, 3) 10 behavioral health assessment regions based upon aggregations of 20,000 population, 4) 29 boroughs and census areas, and 5) 12 tribal health organization regions.

How Do We Compare With the U.S.?

There are no national statistics on ACEs available. However in 2009, the CDC released a study comparing ACEs data from five states (Arkansas, Louisiana, Tennessee, New Mexico, Washington) that used the BRFSS ACEs module. When compared to the five states, Alaska reported the second highest rate of adults who had experienced living with someone with a mental illness.^1^ Compared to data from adults from the 10 states (i.e., Hawaii, Maine, Nebraska, Nevada, Ohio, Pennsylvania, Utah, Vermont, Washington, and Wisconsin) that implemented the ACEs module in 2010, the rate of Alaskan adults reporting experiencing household mental illness was lower.^6^[[br]] [[br]] ---- {{class .SmallerFont 1. U.S. Centers for Disease Control and Prevention (CDC). Adverse Childhood Experiences (ACE) Study. [http://www.cdc.gov/violenceprevention/acestudy/index.html]. Updated April 1, 2016. Accessed April 26, 2016. 6. U.S. Centers for Disease Control and Prevention (CDC). Adverse childhood experiences reported by adults - five states, 2009. MMWR 2010;59(49):1609-13. }}

What Is Being Done?

The [http://hss.state.ak.us/ha2020/ Healthy Alaskans 2020] initiative lists "Reduce the number of Alaskans experiencing poor mental health" and "Increase the proportion of Alaska youth with family and/or social support" as leading health priorities for Alaska. The initiative compiles evidence-based health improvement strategies, actions and key partners to help support achievement of improving these priorities and reaching target health goals.^7^ Alaska also has many groups working on preventing childhood trauma and easing the effects of damage already done. Here are a few examples (as of early 2015):^8^ The Division of Behavioral Health has promoted trauma-informed care for several years. Efforts include development of "Trauma 101" and "Trauma 201" curriculum for behavioral health providers, used around the state. [http://tundrapeace.org/programs/taav/ Teens Acting Against Violence (TAAV)] is a violence-prevention and youth empowerment program at the [http://tundrapeace.org/ Tundra Women's Coalition] for teenagers living in Bethel. Participation is voluntary and open for any interested teens age 12-18.^9^[[br]] [[br]] ---- {{class .SmallerFont 7. Alaska Department of Health and Social Services. Healthy Alaskans 2020. [http://hss.state.ak.us/ha2020/]. Accessed April 26, 2016. 8. Alaska Department of Health and Social Services. Alaska Mental Health Board and the Advisory Board on Alcoholism and Drug Abuse. Adverse childhood experiences - overcoming ACEs in Alaska. [http://dhss.alaska.gov/abada/ace-ak/Documents/ACEsReportAlaska.pdf]. Published January 2015. Accessed April 26, 2016. 9. Teens Acting Against Violence. Tundra Women's Coalition - Crisis Line - 1-800-478-7799 or 907-543-3456 website. [http://tundrapeace.org/programs/taav/]. Accessed April 26, 2016. }}

Evidence-based Practices

The [http://hss.state.ak.us/ha2020/ Healthy Alaskans 2020] initiative developed strategies by content experts to increase youth with family and/or social support. Their strategies were based on evidence-based practices and include: 1. A positive school climate promotes childhood and youth development and fosters connectedness. School connectedness is the belief by students that adults and peers in the school care about their learning as well as about them as individuals. Relationships are essential to adolescent health. Connections with parents, peers, and other adults/mentors support and influence youth development. 2. Research shows that healthy youth development strategies that provide all youth with the supports needed to become successful and competent adults are promising approaches for preventing or reducing a wide range of adolescent health-risk behaviors. Positive Youth Development (PYD) programs promote mental and emotional wellbeing by providing the supports and opportunities youth need to successfully transition to adulthood. PYD programs build on young persons' strengths and talents to help them gain the knowledge and skills they need to become healthy and productive adults. PYD programs are most effective when implemented by entire communities with meaningful youth participation.^7^ Recovering from trauma is a challenging process. Building resiliency and having a supportive adult in your life can help with recovery. Positive experiences - such as exposure to environments rich in a range of developmentally appropriate opportunities for social play and exploration - can compensate for and even reverse the negative consequences of stress Efforts during childhood are essential because over time, some stress-induced detriments are increasingly resistant to reversal. Trauma-focused cognitive behavioral therapy (TF-CBT) is an evidence-based treatment approach shown to help children, adolescents, and their caregivers overcome trauma-related difficulties. It is designed to reduce negative emotional and behavioral responses following traumatic events. The treatment - based on learning and cognitive theories - addresses distorted beliefs and attributions related to the abuse and provides a supportive environment in which children are encouraged to talk about their traumatic experience. TF-CBT also helps parents who were not abusive to cope effectively with their own emotional distress and develop skills that support their children.^10^ ACEs are best addressed through a coordinated effort to implement prevention programs across multiple settings and populations. Research indicates the majority of health and social challenges are interconnected and often share the same root causes. The following steps need to be taken to address these root causes: 1. Support quality early childhood programs. 2. Ensure access to health care including behavioral health care. 3. Strengthen capacity for social emotional learning throughout Alaska's schools. 4. Maintain and expand prevention efforts that have proven to be effective.^4^ The [http://www.cssp.org/ Center for the Study of Social Policy] spent two years researching and identifying five protective factors that prevent child abuse and neglect. These are: parental resilience, social connections, concrete support in times of need, knowledge of parenting and child development, and social and emotional competence of children. Research studies support the common-sense notion that when these Protective Factors are well established in a family, the likelihood of child abuse and neglect diminishes. Research shows that these Protective Factors are also "promotive" factors that build family strengths and a family environment that promotes optimal child and youth development.^11^[[br]] [[br]] ---- {{class .SmallerFont See the "Resources and References" page for references. }}
Page Content Updated On 12/14/2016, Published on 12/14/2016
The information provided above is from the Alaska Department of Health and Social Services' Center for Health Data and Statistics, Alaska Indicator-Based Information System for Public Health (Ak-IBIS) web site (http://ibis.dhss.alaska.gov). The information published on this website may be reproduced without permission. Please use the following citation: " Retrieved Tue, 20 November 2018 from Alaska Department of Health and Social Services, Center for Health Data and Statistics, Alaska Indicator-Based Information System for Public Health web site: http://ibis.dhss.alaska.gov ".

Content updated: Wed, 14 Dec 2016 15:35:54 AKST
The information provided above is from the Alaska Department of Health and Social Services' Center for Health Data and Statistics AK-IBIS web site (http://ibis.dhss.alaska.gov/). The information published on this website may be reproduced without permission. Please use the following citation: " Retrieved Tue, 20 November 2018 16:50:01 from Alaska Department of Health and Social Services, Center for Health Data and Statistics, Indicator-Based Information System for Public Health Web site: http://ibis.dhss.alaska.gov/ ".

Content updated: Wed, 14 Dec 2016 15:35:54 AKST