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      Trauma: An Ideology in Search of Evidence and its Implications for the Social in Social Welfare

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      Scottish Affairs
      Edinburgh University Press

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          Abstract

          A recent special issue of this journal focussed on the emergence of the Adverse Childhood Experiences (ACEs) movement as a key driver of Scottish social policy. In this article, we extend the critiques advanced therein by locating ACEs within a wider cultural turn towards psychological trauma which, over the past decade, has become reified as a master theory across social welfare. Yet, the concept is insubstantial and ill-defined, and the claims made for policy based upon it are at best disputable. Its prominence is less evidence-based than it is testimony to how a particular (cultural and professional) ideology, regardless of its intellectual merit, can be insinuated into policy discourse. ACEs, we suggest, is utilised to provide the trauma paradigm with some ostensibly quantifiable substance. We illustrate our argument through reference to the Scottish Government’s National Trauma Training Programme (2020). We go on to consider some of the implications of such ideological capture for the direction of Scottish social welfare policy and practice. The prominence given to trauma perspectives has potentially iatrogenic consequences for those identified or self-identifying as traumatised. At a wider level, it reflects a professional and epistemic privileging of a narrow, ostensibly therapeutic, worldview which, in turn, acts to marginalise ‘the social’ that characterised erstwhile Scottish approaches to welfare.

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          Most cited references67

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          Diagnostic and Statistical Manual of Mental Disorders

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            Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults

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              Adverse childhood experiences and the risk of premature mortality.

              Strong, graded relationships between exposure to childhood traumatic stressors and numerous negative health behaviors and outcomes, healthcare utilization, and overall health status inspired the question of whether these adverse childhood experiences (ACEs) are associated with premature death during adulthood. This study aims to determine whether ACEs are associated with an increased risk of premature death during adulthood. Baseline survey data on health behaviors, health status, and exposure to ACEs were collected from 17,337 adults aged >18 years during 1995-1997. The ACEs included abuse (emotional, physical, sexual); witnessing domestic violence; parental separation or divorce; and growing up in a household where members were mentally ill, substance abusers, or sent to prison. The ACE score (an integer count of the eight categories of ACEs) was used as a measure of cumulative exposure to traumatic stress during childhood. Deaths were identified during follow-up assessments (between baseline appointment date and December 31, 2006) using mortality records obtained from a search of the National Death Index. Expected years of life lost (YLL) and years of potential life lost (YPLL) were computed using standard methods. The relative risk of death from all causes at age < or =65 years and at age < or =75 years was estimated across the number of categories of ACEs using multivariable-adjusted Cox proportional hazards regression. Analysis was conducted during January-February 2009. Overall, 1539 people died during follow-up; the crude death rate was 91.0 per 1000; the age-adjusted rate was 54.7 per 1000. People with six or more ACEs died nearly 20 years earlier on average than those without ACEs (60.6 years, 95% CI=56.2, 65.1, vs 79.1 years, 95% CI=78.4, 79.9). Average YLL per death was nearly three times greater among people with six or more ACEs (25.2 years) than those without ACEs (9.2 years). Roughly one third (n=526) of those who died during follow-up were aged < or =75 years at the time of death, accounting for 4792 YPLL. After multivariable adjustment, adults with six or more ACEs were 1.7 (95% CI=1.06, 2.83) times more likely to die when aged < or =75 years and 2.4 (95% CI=1.30, 4.39) times more likely to die when aged < or =65 years. ACEs are associated with an increased risk of premature death, although a graded increase in the risk of premature death was not observed across the number of categories of ACEs. The increase in risk was only partly explained by documented ACE-related health and social problems, suggesting other possible mechanisms by which ACEs may contribute to premature death.
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                Author and article information

                Journal
                Scottish Affairs
                Scottish Affairs
                Edinburgh University Press
                0966-0356
                2053-888X
                November 2021
                November 2021
                : 30
                : 4
                : 472-492
                Article
                10.3366/scot.2021.0385
                bf06090b-c3cc-43ac-b709-0d17228b6048
                © 2021

                https://www.euppublishing.com/customer-services/librarians/text-and-data-mining-tdm

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