In 2021, Umesh Venkatesan, PhD, who directs the Brain Trauma and Behavior (BraTBehavior) Laboratory, launched a project examining social factors that may affect the recovery of adults with traumatic brain injury (TBI). Funded by the Albert Einstein Society, this work focused on adverse childhood experiences (ACEs), or potentially traumatic events encountered before the age of 18, such as emotional or physical abuse, which have been shown to have negative consequences for health in the general adult population. Dr. Venkatesan predicted that, given their powerful influence, early experiences of adversity in the home and community would continue to impact health even after a TBI in adulthood.
The primary results from this study were recently published in the Disability and Health Journal and support Dr. Venkatesan’s prediction. In a group of adults with varying levels of ACE exposure, his research team found that the total number of reported ACEs was related to greater mental health (e.g., depression and anxiety) symptoms and poorer health-related quality of life (i.e., how satisfied people are with their health after brain injury). Importantly, these associations between ACEs and health outcomes were independent of demographic factors like age or education level, the initial severity of the TBI, and the time elapsed since the TBI.
What these results suggest is that pre-injury life experiences, including those that happened a long time ago, shape who we are and continue to impact our health—especially our mental health—even after a significant medical event like TBI. Oftentimes what we think of as “brain injury outcomes” are in fact much more than that. When we ask someone how they are doing emotionally or about their social relationships, we are not just capturing their life now (since their injury) but the effects of all their life experiences (before and after injury) combined. In other words, TBI changes someone’s life, but it does not erase who they were before their brain injury.
Dr. Venkatesan’s study also sheds light on the different types of ACEs individuals with TBI have encountered, including experiences within the home and in the community. The most commonly reported household-level ACEs were emotional abuse, physical abuse, and alcohol abuse by a household member. Witnessing community violence was the single most common community-level ACE. Interestingly, the pattern of reported ACEs was extremely variable across people in the study, with almost as many patterns as individuals and with most people reporting multiple types of ACEs. This points to the systemic nature of adversity and the need to consider each individual’s unique social history in monitoring and treating health problems.
While the goal of this study was not to directly compare the prevalence of ACEs between the general and TBI populations, Dr. Venkatesan’s team did observe much higher rates of ACEs in individuals with TBI compared to general population estimates. For example, a previous study found 19.7% of Philadelphians had four or more ACEs, contrasted with 36.5% in Dr. Venkatesan’s study of a group of individuals with TBI in the Philadelphia area. Although we cannot say for sure that individuals with TBI have more ACEs than those without TBI, this is certainly a possibility that should be further investigated.
This study on the long-term health impact of ACEs in individuals with TBI is the first of its kind and contributes to the growing appreciation of “life course” factors in the management of chronic health conditions like TBI. The science is clear: acknowledging the life experiences patients bring to rehabilitation and ensuring that they feel safe and empowered in their care are critical components of maximizing quality of life and long-term functional potential after TBI.