Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Correspondence
  • Published:

Trauma and warfare and clinicians’ role

Pediatric Research (2024)Cite this article

The evidence base for the wide ranging and long-lasting impact from adverse childhood experiences (ACEs) has grown exponentially. The initial study by Felitti et al., found a dose response relationship between childhood exposure to abuse/neglect (physical, sexual, or emotional) or household dysfunction (parental separation, domestic violence, or parental mental illness) and later adult morbidity and mortality.1 In their study, individuals who had experienced 4 or more ACEs showed a 12-fold increase in adult physical and mental health morbidity. This cumulative nature of ACEs has been replicated in more recent studies, as has the recognition that the personal meaning and experience of adversities vary between individuals. In addition to risk, research has identified potential mitigating effects, such as having a good attachment with adult, and basic needs, including education being met.

The framework of developmental cascades describes the various interactions and transactions occurring in and across developing biological and family systems where each interaction can affect the other.2 These cascades or chain reactions account for the varied impact of specific ACEs on individual development, identity formation, and interpersonal relationships. They also explain potential longer-term impact on family systems spanning generations. Hence exposure to salient events years prior may travel through generations, significantly and distally impacting others even in the absence of any current exposure. To talk about ACEs in the absence of an understanding of a generational context is unwise.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

References

  1. Felitti, V. J. et al. Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The adverse childhood experiences (ACE) study. Am. J. Prev. Med. 14, 245–258 (1998).

    Article  CAS  PubMed  Google Scholar 

  2. Masten A. S. Ordinary Magic: Resilience in Development (Guilford Press, 2015).

  3. Cooke, E. M., Connolly, E. J., Boisvert, D. L. & Hayes, B. E. A systematic review of the biological correlates and consequences of childhood maltreatment and adverse childhood experiences. Trauma Violence Abus. 24, 156–173 (2023).

    Article  Google Scholar 

  4. Global trends of war and their humanitarian impacts | International Committee of the Red Cross Statement on 17 October 2018 (icrc.org, accessed 21 December 2023). https://www.icrc.org/en/document/global-trends-war-and-their-humanitarian-impacts-0#:~:text=Our%20research%20shows%20that%20more,10%20or%20more%20parties%20involved.

  5. Simeoni U., Armengaud J. B., Siddeek B. & Tolsa J. F. Perinatal origins of adult disease. Neonatology 113, 393–399 (2018).

  6. Workneh, A. F. The State of Knowledge on Posttraumatic Stress Disorder, Depression and Anxiety among Refugee Women in Africa: A Scoping Review (Doctoral dissertation, Université d’Ottawa/University of Ottawa, 2017).

  7. Sternberg, R. J. A duplex theory of hate: development and application to terrorism, massacres, and genocide. Rev. Gen. Psychol. 7, 299–328 (2003).

    Article  Google Scholar 

  8. ACLED (i). https://acleddata.com/2023/01/31/global-disorder-2022-the-year-in-review/#s1 (2023).

  9. ACLED (ii). https://acleddata.com/conflict-watchlist-2023/ukraine/ (2023).

  10. Human Rights Watch: https://www.hrw.org/news/2024/01/11/israel/palestine-unprecedented-killings-repression#:~:text=More%20than%201%2C200%20Israelis%20and,in%20Gaza%20that%20have%20included.

  11. Griffin, B. J. et al. Moral injury: an integrative review. J. Trauma. Stress 32, 350–362 (2019). Jun.

    Article  PubMed  Google Scholar 

  12. Hegarty S. et al. ‘It hurts your heart’: frontline healthcare worker experiences of moral injury during the COVID-19 pandemic. Eur. J. Psychotraumatol. 13, 2128028 (2022).

  13. Shay, J. Moral injury. Psychoanal. Psychol. 31, 182 (2014).

    Article  Google Scholar 

  14. Hayes, S. C. & Lillis, J. The therapy process. in Acceptance and Commitment Therapy (eds. S. C. Hayes & J. Lillis) (65–116) (American Psychological Association, 2012).

Download references

Author information

Authors and Affiliations

  1. Children’s Health Ireland, Crumlin, Dublin, Ireland

    Fiona McNicholas

  2. Lucena CAMHS, Dublin, Ireland

    Fiona McNicholas

  3. School of Medicine and Medical Science, University College Dublin, Dublin, Ireland

    Fiona McNicholas

  4. Children’s Health Ireland, Temple St, Dublin, Ireland

    Aoife Twohig

  5. School of Medicine, Trinity College, Dublin, Ireland

    Aoife Twohig

Authors
  1. Fiona McNicholas
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Aoife Twohig
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Fiona McNicholas.

Ethics declarations

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

McNicholas, F., Twohig, A. Trauma and warfare and clinicians’ role. Pediatr Res (2024). https://doi.org/10.1038/s41390-024-03124-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1038/s41390-024-03124-4

Search

Advanced search

Quick links