A new study published in BMJ Public Health finds that extrafamilial violence (EFV), such as bullying, collective, and community violence, is linked to mental health issues, substance use, chronic pain, and frequent health service contact in Northern Ireland.
The current work, led by Colm Walsh of Queen’s University Belfast, additionally finds that including EFV in measures of adverse childhood experiences (ACEs) improves the predictive ability of those models. This study also finds that ACEs are linked to mental health problems, physical health issues, arrests, poor health behaviors, and more frequent use of emergency rooms.
The authors write:
“As elsewhere, ACEs were linked to major public health burdens, with strongest effects on mental health and risk behaviours. Community violence remains under-evaluated in ACE studies. Given that including EFV improved predictive accuracy, omitting EFV may miss key contributors to adult outcomes.”
The goal of the current research was to examine the prevalence of ACE and EFV in Northern Ireland, as well as links between these factors and poor mental health, poor physical health, criminal justice system involvement, and health service utilization. Additionally, the authors wanted to investigate the impact of EFV independent of other ACEs.
The authors recruited participants by randomly selecting households in Northern Ireland for inclusion in the study. Two thousand three hundred fifty-five households were contacted and asked to participate. In total, the authors administered 1,203 interviews. The included participants were roughly representative of the Northern Ireland population in terms of age, gender, religion, ethnicity, and deprivation.
Measures
The authors assessed deprivation using the Northern Ireland Multiple Deprivation measure. ACEs were measured using the ACE-IQ, a WHO-developed survey that assesses 13 categories of adverse experiences, including EFV. Participants can rate each category as 1 (present) or 0 (absent).
Mental health problems were assessed using three separate questionnaires: the International Trauma Questionnaire for post-traumatic stress disorder, the Warwick-Edinburgh Mental Well-being Scale for overall mental health, and the Patient Health Questionnaire-4 4 for anxiety and depression.
Physical health was measured by asking participants if they had any physical health conditions that had lasted, or were expected to last, for 12 months or more. Participants were also asked whether they had any of 17 common chronic illnesses listed. The authors only included physical health conditions reported by 50 or more participants in the final analysis.
Criminal justice involvement and poor health behaviors, such as smoking, drug use, poor diet, and sedentary lifestyle, were measured using data from the Bellis study and the Centers for Disease Control and Prevention survey.
Overall ACEs
The majority of participants (60%) reported experiencing at least one ACE. The most common ACEs reported by participants were parental separation (24.2%), domestic abuse (20.3%), collective violence (20.5%), and emotional neglect (17.8%). When using the most commonly researched ACEs (maltreatment and household adversity), 12.8% of participants reported four or more ACEs. When EFV was included as well, that number rose to 17.6%.
Participants who reported four or more ACEs were at significantly increased risk of mental health problems. They were nearly 7.5 times more likely than those with no ACEs to report current anxiety, 8.6 times more likely to report current depression, 6.56 times more likely to have poor mental well-being, and 14.76 times more likely to have current PTSD or CPTSD. Overall, this group was nearly 10 times more likely (9.56) to receive a mental health diagnosis as an adult.
The participants with four or more ACEs also reported more physical health issues. They were significantly more likely to report angina (2.32 times more likely), asthma (2.75), cancer (2.06), chronic pain (5.12), poor sleep or insomnia (4.3), and rheumatoid arthritis (2.11). Overall, this group was 5.39 times more likely to report physical health issues compared to participants who had no ACEs.
The group with four or more ACEs was also at increased risk for poor health behaviors. They were more likely to smoke or vape (2.59 times more likely), use drugs (2.95), drink alcohol excessively (1.86), consume no fruits or vegetables (1.64), and have a sedentary lifestyle (2.05). They also had much higher arrest rates (8.3 times more likely), went to the emergency room more often in the past three months (2.92), and contacted general practitioners more often in the past three months (2.85).
EFV
According to the authors, EFV was a stronger predictor of mental health problems than any of the other ACEs when isolated. The authors estimate that EFV alone contributed to 18.3% of reported current anxiety, 16.9% of current depression, 13% of poor mental well-being, 13.1% of PTSD and CPTSD, and 17.5% of any mental health diagnosis. EFV was somewhat associated with physical health issues, but these links were far weaker than their contribution to mental health problems. EFV was marginally associated with drug and alcohol use, and was estimated to contribute to 10.1% of smoking and vaping. The authors note that including EFV in ACE measures greatly improves the predictive ability of these models.
Limitations
The authors acknowledge several limitations to the current work. Many of the measures were self-report surveys, which are prone to misremembering. Self-report surveys also likely underestimate sensitive experiences such as abuse and violence. The study’s design means that the authors can only speak to associations, not causation. In other words, the data here can not definitively say that ACEs cause mental health issues, only that there is a robust association between these two things. The small number of participants in some subgroups limited subgroup analysis.
Research from around the world, including Turkey, Kenya, Vietnam, Indonesia, the U.S, the U.K., Brazil, Australia, Ireland, Canada, Ethiopia, Germany, Norway, Austria, France, Honduras, Mexico, Japan, China, and Spain, has linked ACEs to mental health problems.
Childhood maltreatment and ACEs have also been linked to anxiety and depression, regardless of background, as well as ADHD, lower mental well-being, distress later in life, poor sleep, lower academic achievement, psychosis, poorer recovery from first episode psychosis, treatment-resistant schizophrenia, higher levels of distress in voice hearers, and lifelong physical health consequences such as cancer, heart attack, stroke, diabetes, and chronic obstructive pulmonary disease.
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Walsh C., Bunting L., Davidson G., et al. Prevalence and impact of adverse childhood experiences and extrafamilial violence: a representative survey of adults in Northern Ireland. BMJ Public Health 2025;3:e003360. doi:10.1136/bmjph-2025-003360
“[T]he data here can not definitively say that ACEs cause mental health issues, only that there is a robust association between these two things.”
But I will say, this societal problem is most likely caused by, or at least made much worse due to, the faustian deal that the psychologists have made with the pastors … what was confessed to me to be “the dirty little secret of the two original educated professions.”
I do have evidence in my medical records that an ex-pastor of mine lied to a psychologist, who wrote in her medical records, “Don thought she was the second coming of Jesus.” Apparently the medical and religious industries’ “dirty little secret” is that claiming someone to be Jesus is doctor/pastor/priest code for sacrifice this person.
But I was eventually handed over medical evidence of the abuse of my child, that happened by friends of my unethical ex-pastor. So, systemically covering up child abuse, by the psychologists, for the pastors, is apparently the faustian “dirty little secret of the two original educated professions.”
This faustian “dirty little secret” is likely the primary cause of the now blatant correlation between ACEs and defamation with the scientifically “invalid” DSM “mental illnesses” … albeit the fact that no “mental health” worker today may ever bill to help any child abuse survivor ever, according to the DSM, is also a huge part of the systemic problem.
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I’m sorry, are people just not allowed to criticize Mad in America at all? How is that in any way okay? Why even have a comment section at all if they’re just going to post insulting garbage articles like this and then delete any comments that dare question why they would be so backwards as to allow this stuff?
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Posting as moderator
People criticize MIA all the time. I haven’t deleted any comments at this point. Comments are not published if they fail to meet the Posting Guidelines. There is no content screening going on. And Bob is very clear that criticizing MIA is totally OK, in fact, he encourages it.
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Interesting that “chronic pain” is sometimes mentioned above along with other signs/symptoms of emotional distress above…and sometimes not.
https://www.youtube.com/watch?v=pv8PtT_4rjk
https://www.youtube.com/watch?v=qINdA6E14Sk
https://youtu.be/kYK7utae7Cg
https://www.youtube.com/watch?v=0VyH1laOd2M
https://youtu.be/rYz_ApWYeg0?si=U39uhugfZ6SYnUzE
My understanding is that, in a majority of cases of chronic (six-months-plus duration) pain, one’s “subconscious mind” may and does so faithfully and repeatedly and consistently produce feelings of physical pain that seem to originate from various parts of the body that it endlessly fools us into believing we must have actual structural problems producing those sensations at those sites when we do not, and that, as well as or instead, our distressed subconscious minds can and do produce various “neuroses” and a host of other (possible) syndromes (at least some of which may also be produced by actual physical illness/es, mind you…) such as
“conversion disorder,” https://en.wikipedia.org/wiki/Conversion_disorder ,
“sickness behavior,” https://www.sciencedirect.com/topics/neuroscience/sickness-behavior ,
https://en.wikipedia.org/wiki/Sickness_behavior ,
chronic fatigue, insomnia, “brain fog,” IBD, fibromyalgia/ME/CFS, “dry eye syndrome,” vertigo, idiopathic epilepsy, and possibly some “chronic Lyme disease” and “Long Covid,” and more, as well as exacerbating if not causing certain autoimmune illnesses, and variously impairing our immune systems with all that that may entail.
“The study’s design means that the authors can only speak to associations, not causation. In other words, the data here can not definitively say that ACEs cause mental health issues, only that there is a robust association between these two things.”
Not only can the authors “not definitively say that ACEs cause mental health issues,” of course – however one might attempt to define an “ACE” or a “mental health issue,” they cannot say to what, if any extent, “mental health issues” may have caused or contributed to the said “ACE’s” in the first place.
IF I was a real little horror, a proper prat, a diminutive delinquent, a fun-loving child criminal (and I do not definitively say I was or was not), then I suggest it’s just possible that I might have grown up to be a middle-aged delinquent and, along the way, to have experienced more than my share of adverse experiences, all of my own making, as well as contributing to the adverse experiences of others, also.
But, granted that we can absolutely, totally and utterly rule out that we any of us come here as other than tabulae rasae, apart from, perhaps, the most extraordinarily obvious cases of fetal alcohol and/or other drug syndromes,
and granted that we Irish, both north and south of a border which once officially divided Northern Ireland from “Southern Ireland” (which latter, by the way, contained Donegal, the island’s northernmost county, wherein I worked for most of my life), are perfectly representative of the rest of humanity,
and granted that we can rule out the possibility that God invented alcohol so that we Irish would not conquer the world and a sense of humor so that the English would,
and granted the fact that everyone knows that Chesterton could not possibly have been more wrong about us when, in his “The Ballad of the White Horse” he wrote
“The great Gaels of Ireland are the men that God made mad,
For all their wars are merry, and all their songs are sad.,”
and given that the remotest possibility of reincarnation and of such things as past-life experiences may be utterly and entirely scientifically ruled out as being even worthy of consideration,
and given that such things as “character” and our “temperament” and “subconscious minds” have been consistently abolished by a series of DSM’s and ICD’s as well as by many psychologists,
and given that behaving like a cad, a bounder, a blighter, a belligerent, a hostile, a paranoiac, an egotist/narcissist or a complete ass at any age could not possibly increase the likelihood of one’s becoming involved in any “adverse experiences,”
I guess we can safely assume that any causal relationship can only indicate that the (positively negative) respondents were, to a man, woman and child, hapless and wholly innocent victims of circumstance and of others.
Right?
“God,” I love MIA. MIA, I love “God!”
Tom.
PS: “I had recently read that 3.7 million Americans, according to a Gallup poll, believed that they had been abducted by aliens at one time or another, so it was clear that my people needed me.”
–On his move back to America after living in England for twenty years.
― Bill Bryson, “Notes from a Small Island.”
I fear the numbers from Ireland, even Northern and “Southern” together, are even more dismal, being well below 3.7 million, and that many more who have encountered aliens may not yet realize it so that, altogether, it seems my country needs me, too.
PPS: Of course, obviously, lacking alien aid, the only reason why we Irish, like anyone else, ever feel miserable is because we have been led to believe that we have screwed up the one and only single solitary little go we will ever get at life, and to forget the one and only, single solitary little lesson our druids used to do their very best to teach us, which is, obviously, that nothing, but nothing could possibly be farther from the Truth
(an opinion echoed by Carl Jung with his
“The first half of life is devoted to forming a healthy ego, the second half is going inward and letting go of it.”
“I have treated many hundreds of patients. Among those in the second half of life – that is to say, over 35 – there has not been one whose problem in the last resort was not that of finding a religious outlook on life. It is safe to say that every one of them fell ill because he had lost that which the living religions of every age have given their followers, and none of them has really been healed who did not regain his religious outlook.”):
‘Philosophy
Alexander Cornelius Polyhistor referred to the druids as philosophers, and called their doctrine of the immortality of the soul and metempsychosis (reincarnation), “Pythagorean”:
The Pythagorean doctrine prevails among the Gauls’ teaching that the souls of men are immortal, and that after a fixed number of years they will enter into another body
Caesar made similar observations:
With regard to their actual course of studies, the main object of all education is, in their opinion, to imbue their scholars with a firm belief in the indestructibility of the human soul, which, according to their belief, merely passes at death from one tenement to another; for by such doctrine alone, they say, which robs death of all its terrors, can the highest form of human courage be developed. Subsidiary to the teachings of this main principle, they hold various lectures and discussions on the stars and their movement, on the extent and geographical distribution of the earth, on the different branches of natural philosophy, and on many problems connected with religion.
— Julius Caesar, De Bello Gallico, VI, 14
Diodorus Siculus, writing in 36 BCE, described how the druids followed “the Pythagorean doctrine”, that human souls “are immortal, and after a prescribed number of years they commence a new life in a new body”.[41] In 1928, the folklorist Donald A. Mackenzie speculated that Buddhist missionaries had been sent by the Indian king Ashoka.[42] Caesar noted the druidic doctrine that the original ancestor of the tribe was the god that he referred to as “Dispater”, which means “Father Dis”.
from https://en.wikipedia.org/wiki/Druid
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