The impact of Adverse Childhood Experiences on social determinants among Saudi adults.

Background: Early exposure to violence has deleterious effect on the child's brain development. The aims for this project were to assess the prevalence of Adverse Childhood Experiences (ACEs) and their impact on social determinants in Saudi Arabia (SA). Methods: A cross-sectional, national study conducted in all regions of SA using the World Health Organization-ACE-International Questionnaire to determine the association between ACEs and socioeconomic outcomes. Results: A total of 10 156 participants completed the questionnaire with five main ACE categories (abuse, neglect, family dysfunction, peer and community violence). Over half of the sample (52%) experienced emotional abuse, followed by physical abuse (42%), bullying (39%), neglect (29%) and sexual abuse (21%). The most common family dysfunction was witnessing domestic violence against any household member (57%) and the least prevalent was living with a substance abuser (9%). Low educational attainment, disruption in marital life and substance abuse were significantly affected by all ACE categories. However, unemployment was marginally affected only by neglect and household dysfunction. Conclusions: ACEs are highly prevalent in SA and have significant negative impact on life opportunities. National preventive programs should be implemented to reduce ACE and their deleterious outcomes.

Child maltreatment prevention strategies: Saudi youth perspectives.

BACKGROUND AND OBJECTIVES: Child maltreatment (CM) is a global problem that has long-term negative outcomes. The objective of this study is to explore the knowledge and perceptions of youth regarding CM prevention. METHODS: The study was conducted in Saudi Arabia using International Child Abuse Screening Tool (ICAST). Answers to open-ended questions were analyzed and a list of CM prevention strategies was generated. RESULTS: Participants identified a range of preventive strategies that were grouped into three main themes: 1) collective preventive efforts; 2) recognizing and responding to CM; 3) gaining closure. For each overarching theme, a list of subthemes were derived. Subthemes included raising awareness through the mass media; school professionals' capacity building and curriculum advancement; strengthening family relationships; enact CM preventive legislations and policies; monitoring media content and video games and limiting access to firearms for the first theme. The second theme comprised the subthemes reporting services and protective services. As for the third theme it included rehabilitation; punishment for CM crimes and connection to spirituality. CONCLUSION: Gathering youth perspectives on CM prevention will help us in designing future prevention strategies.

Relationship between childhood bullying and addictive and anti-social behaviors among adults in Saudi Arabia: a cross-sectional national study.

Background Bullying is a widespread public health problem among youth with potentially far reaching negative implications. Objective To determine the prevalence of childhood bullying and its association with addictive and anti-social behaviors among adults. Subjects Adults (n = 10,156) aged ≥18 years were invited to participate. Methods A cross-sectional, national study utilizing Adverse Childhood Experiences International Questionnaire (ACE-IQ) was conducted in Saudi Arabia (SA). Odds ratios (OR) and 95% confidence intervals (CIs) were calculated for bullying in relation to the outcome. Results Participant's mean age was 34.3 ± 11.3 years and 52% were male. Thirty-nine percent of the participants reported being bullied. Significant gender differences were found in terms of prevalence of different types of bullying. Men reported higher prevalence of physical (40% vs. 33%, p < 0.01) and sexual (19% vs. 10%, p < 0.01) types of bullying. In contrast, women tend to report higher prevalence of psychological (16% vs. 9%, p < 0.01) and social (14% vs. 10%, p < 0.01) types of bullying. Bullying victims were 1.8 (95% CI 1.6-2.1) times more likely to smoke, 2.3 (95% CI 1.9-2.7) times more likely to drink alcohol, 2.9 (95% CI 2.4-3.4) times more likely to use drugs, 2.1 (95% CI 1.8-2.4) times more likely to have ever had out of wedlock sexual relations, and 2.5 (95% CI 2.1-3.0) times more likely to have suicidal thoughts compared to those who were not bullied. Conclusion Childhood bullying increases the chances of risky behaviors among adults in SA. Prevention of bullying should be in the national agenda of the Ministry of Education.

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.