Gender-based disparities in the impact of adverse childhood experiences on adult health: findings from a national study in the Kingdom of Saudi Arabia.
BACKGROUND
Adverse Childhood Experiences (ACEs) have been linked to an increased risk of health and social problems throughout life. Studies on gender differences from developing countries are scarce. In this paper, we will examine gender variations in the types of reported ACEs and gender-specific relationships between cumulative ACEs and physical and mental health, and Risky Health Behaviors (RHB) in adulthood in the Kingdom of Saudi Arabia (KSA).


METHODS
A cross sectional national study was conducted in all of the 13 regions in KSA in 2013 using the ACE- International Questionnaire (ACE-IQ). We used multivariate logistic regression to examine the relationship between 4 + ACEs and physical, mental health and RHBs for both men and women separately after adjusting for age, education, marital status and current employment.


RESULTS
The total number of participants was 10,156 and women comprised 48% of the sample. The majority of respondents (80%) reported at least one ACE. Women had higher percentages of < =2 ACEs (65% vs 55%; p <0.05) while men were more likely to have 4+ ACEs (33% vs 25%; p < 0.05). When compared to participants with 0 ACE, men who reported 4+ ACEs were associated with the highest likelihood of using drugs (OR = 9.7; 95% CI: 6.4-14.5) and drinking alcohol (OR = 9.2; 95% CI: 6.3-13.6). On the other hand, women who experienced 4+ ACEs were associated with the highest likelihood of depression (OR = 7.0; 95% CI: 5.2-9.4), anxiety (OR = 6.4; 95% CI: 5.0-8.2) and other mental illnesses (OR = 7.4; 95% CI: 5.2-10.6). As for chronic diseases, abused men and women in childhood showed similarly a twofold increased risk of developing diabetes, hypertension, coronary heart disease and obesity when compared to non-abused participants.


CONCLUSION
Findings highlight the need to consider gender specific differences in the development of preventive strategies to address ACEs in KSA.
['Almuneef|Maha|M|', 'ElChoueiry|Nathalie|N|', 'Saleheen|Hassan N|HN|', 'Al-Eissa|Majid|M|']
D000328:Adult D000069586:Adult Survivors of Child Adverse Events D002908:Chronic Disease D003430:Cross-Sectional Studies D005260:Female D000073599:Health Risk Behaviors D054624:Health Status Disparities D006801:Humans D008297:Male D001523:Mental Disorders D012529:Saudi Arabia D017678:Sex Distribution
Adverse childhood experiences Kingdom of Saudi Arabia Chronic illness Health risk behaviors Mental health problems