Prevalence of Adverse Childhood Experiences Among Veterans

The adverse childhood experiences (ACE) study showed that childhood trauma is common in the general population and has enduring effects on adult emotional and physical health. Levels of childhood adversity among individuals with a history of military service have been found to match or exceed those among individuals with no history of military service. Most studies to date have found that ACEs are associated with poorer mental health outcomes among service members and veterans, although the ways in which childhood adversity may contribute to vulnerability or resilience are not fully understood. Further, the prevalence of ACEs specifically among veterans has not been clearly established. We evaluated the prevalence of childhood adversity at a community-based outpatient mental health clinic within the Department of Veterans Affairs (VA) and found that 85.0% of participating veterans reported experiencing at least one category of ACE before the age of 18, while nearly half of veteran participants (46.0%) reported experiencing four or more categories. We discuss the implications of a high burden of childhood adversity for neurobiological development and psychological functioning among veterans, and for mental health treatment within the VA. Further, we describe the development of a trauma-informed program which utilizes a phase-based, modular approach to better address the psychological sequelae of childhood adversity, and foster resilience and posttraumatic growth. Several case examples are discussed, along with recommendations for future research.