1. The Association of Exposure to Adverse
Childhood Experiences and Receipt of
Social Security Disability Benefits
Nathaniel Taylor, MPH1, Phaedra Corso, PhD1, and
Sally Sexton, PsyD2
1 Department of Health Policy and Management,
College of Public Health, University of Georgia
2 Independent Researcher
Introduction
The association between exposure to adverse childhood experiences and poor health outcomes is well known. These health outcomes can persist throughout adolescence and into adulthood, sometimes resulting in long-term disability. In this study, we investigate the association between exposure to adverse childhood experiences and long-term disability using receipt of Social Security Disability Insurance (SSDI) benefits as a proxy for disability and measure of economic impact.
Adverse Childhood Experiences (ACE) Study
Developed by the Centers for Disease Control and Prevention and Kaiser Permanente’s Health Appraisal Clinic
The initial phase of the ACE Study was conducted between 1997 and 1999
Included more than 17,000 HMO members to assess associations between negative childhood exposures and health outcomes in adults
Found that respondents self-reporting exposure to adverse childhood experiences had an increased risk for substance use, poor health and obesity
No additional participants were enrolled but researchers are currently monitoring long-term health outcomes for the original participants
The study is being replicated in other countries
ACE Study Questionnaire used for this study
Social Security Disability Insurance (SSDI) Benefits
Cost the United States over $143 billion in 2013
Increased at a near exponential rate between 1980 and 2010, in part, because the burden of proof of continued eligibility lies on the reviewer, not the participant
Social Security Disability Insurance Trust Fund Expenditures,
Results
The response rate was 64% (N=96 out of 150 participants in the general population approached)
Respondents were mostly female (75%)
Average age was 48.2 years (range: 19-92)
Respondents who received SSDI benefits (n=27) were significantly more likely than their counterparts (n=69) to report exposure to:
sexual abuse (p=0.014)
neglect (p=0.046)
household member with mental illness (p=0.012).
Mean total ACE score was significantly larger for respondents that reported receiving SSDI benefits compared to those who did not receive benefits, 4.30 vs (p=0.037)
Table 1: Answer of “Yes” on each ACE Study questionnaire item compared to receipt of Social Security Disability Insurance (SSDI) benefits and mean total ACE Study questionnaire scores compared to receipt of SSDI benefits for all participants (N=96)
Social Security Disability Insurance (SSDI) benefits as a proxy for disability
Original ACE Study found association between adverse childhood experiences and poor health outcomes, sometimes resulting in long-term disability
SSDI program cost the United States over $143 billion in 2013
Increased at near exponential rate between 1980 and 2010
Discussion / Conclusions / Significance
In this study, respondents that received SSDI benefits had significantly larger scores on the ACE Study questionnaire. Further, these individuals were significantly more likely to report exposure to several types of abuse and to a household member struggling with mental illness. These results suggest that the economic impact of child maltreatment may be underestimated if the long-term effect on the ability to work is overlooked.
Conclusions and Significance
No previous studies have been conducted to determine the association of adverse childhood experiences and costly SSDI benefits
Additional research is needed to determine whether similar associations are present in a more generalized population
Investigating the association between adverse childhood exposures and adult impacts on disability will provide policy makers with an understanding of the true economic burden of these events and, ultimately, lead to more resources to prevent these exposures.
Limitations
Participants were not randomly drawn from a large sampling frame, limiting generalizability. But the convenience of this sample for pilot work is appropriate and results are significant, suggesting the next step in this research is to test for these associations in a large, random and national sample.
There may be additional socioeconomic factors that influence the results that were not controlled for in this survey
Due to the exploratory nature of this study, important details such as the value of benefits received were not included.
Methods / Approach
Data Collection
ACE Survey data were obtained over an eight-month period ending in March 2014
Convenience sample of patients seen in a general psychology practice and from a general population in western Nebraska
Respondents were also asked for the status of SSDI applications, receipt of disability benefits from any other source, and demographic questions
ACE Survey Questionnaire
Asks participants to respond to ten “yes or no” questions regarding exposure to abuse, neglect, mental health-related issues, and other adverse family exposures
The total ACE score is a count of the number of questions with a “yes” response, with a maximum possible score of 10, indicating more adverse exposures
Statistical Analysis
N=96 participants out of 150 completed the ACE Survey
The Student’s t-test was used to test for a statistically significant difference of total ACE score by receipt of SSDI benefits.
The two-sample test of proportions was used to test for a statistically significant difference in the proportion of respondents responding “Yes” to individual ACE Study questions by receipt of SSDI benefits.
Statistical tests were considered statistically significant when p≤0.05. All calculations were carried out in Stata version 12
*One sample test of a proportion: ACE Study questionnaire item by receipt of SSDI
† One sample t test of mean total ACE Study questionnaire score by receipt of SSDI
‡ Non Parametric: two-sample rank-sum test of mean total ACE Study questionnaire score of SSDI (Z=2.105, p=0.035)
Investigating the association between adverse childhood exposures and adult impacts on disability will provide policy makers with an understanding of the true economic burden of these events and, ultimately, lead to more resources to prevent these exposures.