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Are Adverse Childhood Experiences Associated with Metabolic Syndrome in Patients with Severe Mental Illness?
Neslihan Cansel1, Merve Çelik Özer1, Şahide Nur İpek Melez2
1Department of Psychiatry, Inonu University Faculty of Medicine, Malatya, Turkey.
Insights
Adverse childhood experiences (ACEs) significantly increase the risk of metabolic syndrome (MetS) in patients with severe mental disorders (SMD). Trauma-informed care is crucial for managing metabolic health in this population.
Area of Science:
- Psychiatry
- Metabolic Health
- Public Health
Background:
- Patients with severe mental disorders (SMD) face a high risk of metabolic syndrome (MetS), a major contributor to cardiovascular disease and mortality.
- Adverse childhood experiences (ACEs) are linked to metabolic dysregulation, but their specific role in MetS among SMD patients is unclear.
Purpose of the Study:
- To examine the association between ACEs and MetS in outpatients with bipolar disorder (BD) and schizophrenia (SZ) in clinical remission.
- To identify independent and incremental predictors of MetS using a hierarchical analytical framework.
Main Methods:
- A cross-sectional study of 140 outpatients with SMD (BD and SZ) in clinical remission.
- MetS assessed by NCEP-ATP III criteria; ACEs by the Adverse Childhood Experiences Scale (ACE-TR).
- Hierarchical and multivariable logistic regression analyses were employed.
Main Results:
- Metabolic syndrome (MetS) prevalence was high (46.4%).
- ACE-TR total score was independently associated with MetS (OR=1.71), with each unit increase raising odds by ~71%.
- Sexual abuse, emotional neglect, and physical neglect were more common in the MetS group; ACE-TR correlated with waist circumference and triglycerides.
Conclusions:
- A strong association exists between ACEs and MetS in SMD patients.
- Findings highlight the need for trauma-informed care in psychiatric settings to address metabolic comorbidities and reduce premature mortality.
Background:
Patients with severe mental disorders (SMD) are at substantially elevated risk for metabolic syndrome (MetS), contributing to excess cardiovascular morbidity and premature mortality. Adverse childhood experiences (ACEs) have been associated with dysregulation of metabolic pathways, yet their contribution to MetS risk in SMD remains poorly understood.
Objective:
This study aimed to investigate the association between ACEs and MetS in outpatients with bipolar disorder (BD) and schizophrenia (SZ) in clinical remission and to identify independent and incremental predictors of MetS using a hierarchical analytical framework.
Methods:
This cross-sectional study included 140 outpatients with SMD (96 with BD and 44 with SZ) in clinical remission, recruited from a university hospital in Eastern Turkey. MetS was defined according to NCEP-ATP III criteria, and ACEs were assessed using the Turkish version of the Adverse Childhood Experiences Scale (ACE-TR). Hierarchical and multivariable logistic regression analyses were performed to examine factors associated with MetS.
Results:
MetS was highly prevalent in this sample (46.4%). ACE-TR total score was independently and consistently associated with MetS across all hierarchical models (odds ratio [OR] range: 1.68-1.77), with each one-unit increase conferring approximately 71% higher odds in the fully adjusted model (OR = 1.71; 95% confidence interval [CI] 1.26-2.32; P = 0.001). The number of hospitalizations was the only other independently associated variable (OR = 1.19; 95% CI 1.02-1.39). Sexual abuse (16.9% vs. 2.7%; P = 0.004), emotional neglect (63.1% vs. 30.7%; P < 0.001), and physical neglect (30.8% vs. 14.7%; P = 0.022) were significantly more prevalent in the MetS group. ACE-TR total score was positively correlated with waist circumference and triglyceride levels.
Conclusion:
The strong and consistent association between ACEs and MetS underscores the importance of trauma-informed care models in psychiatric practice, where metabolic comorbidity remains a leading cause of premature mortality.
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