Adverse Childhood Experiences in Non-Westernized Nations: Implications for Immigrant and Refugee Health.

As the immigrant and refugee population continues to increase in the United States, healthcare providers need to be aware of Adverse Childhood Experiences (ACEs) these populations may have endured, and the potential health effects of these events. ACE research has been conducted with predominantly highly-educated, older Caucasians living in high-income countries which limits generalizability. A systematic review examined ACE prevalence and outcomes in persons living in poor, low-, and middle-income nations, often the home countries of U.S. immigrants and refugees. Fourteen studies conducted in 17 nations were included. Two main ACE measures were used. Prevalence of reporting at least one ACE ranged from 1.9% (Lebanon) to 80% (Saudi Arabia). Analysis established a graded dose-response, with increases in ACEs associated with increased risky behavior and negative health outcomes across all countries. Results reveal immigrants and refugees within the U.S. need to be evaluated for ACE exposure.