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Sub-categories of Adverse Childhood Experiences used in this review.
Source publication
Adverse childhood experiences (ACEs) have been associated with causes of early death, addiction, mental illness, and poor health. However, studies investigating underlying mechanisms often rely on cross-sectional data or inappropriate study designs. To prevent the negative sequelae associated with ACEs, it is imperative to understand the mechanisms...
Contexts in source publication
Context 1
... was defined as the measurement of two or more exposures to ACEs previously defined by Felitti et al., 1998 and revised by Finkelhor et al., 2015. Using these definitions, several ACEs were focused on in this review (see Table 1). ...Similar publications
Adolescents who experience community violence are exposed to toxic stressors at a critical period of growth and development. The purpose of this study was to examine the relationship between community violence exposure and stress reactivity in African American and non-Latino white adolescents with overweight/obesity. Fifty-one adolescents (47% fema...
Background
This paper enumerates and characterizes latent classes of adverse childhood experiences and investigates how they relate to prenatal substance use (i.e., smoking, alcohol, and other drugs) and poor infant outcomes (i.e., infant prematurity and low birthweight) across eight low- and middle-income countries (LMICs).
Methods
A total of 118...
Males are routinely identified as both the victims and perpetrators of knife-related crime. Explanations have typically fallen into two categories: fear of further victimization (i.e., need for protection) and masculine gender norms (e.g., a display of “toughness”). However, these two works of literature have not yet been brought together to provid...
Sexual and gender minority adolescents and young adults assigned female at birth (SGM-AFAB) report high rates of intimate partner violence (IPV) victimization. Despite adverse health outcomes of IPV, many survivors, particularly SGM-AFAB, do not seek help. This study (1) examined the proportion of SGM-AFAB who reported severe IPV victimization who...
The role of contextual-level factors in bullying is still not clear, and evidence is mostly from high-income countries. Our objective was to investigate the association between community violence, disorder, school environment and bullying among school adolescents. We used data from a representative sample of 9th grade Brazilian adolescents (n = 210...
Citations
... The concept of adverse childhood experiences or ACEs became prominent with the seminal article by Felitti and colleagues (1998) who found a linear relationship between the number of ACEs experienced and many of the leading chronic health conditions among adults. ACE research has flourished in Western countries focusing on biological and psychological mechanisms (Berens et al., 2017;Lang et al., 2020;Su et al., 2015); mediators and buffering effects of ACE exposure (Boyce et al., 2021;Brody et al., 2017;Hales et al., 2023); and the cost of disease burden attributable to ACEs (Bellis et al., 2019). The original concept of ACEs focused primarily on intra-familial experiences, and several researchers have discussed expanding ACE definitions to include additional adverse experiences (e.g., food insecurity, community violence) including those relevant to particular populations such as racism, and especially for adversities common in international settings (Afifi, 2020;Cronholm et al., 2015;Finkelhor et al., 2015;Massetti et al., 2020;Mersky et al., 2017;Ports et al., 2020). ...
... Among the few studies in this area, there have been mixed findings regarding the moderating effects of sex/gender (C. Cavanaugh et al., 2023;Hales et al., 2023;Iverson et al., 2013;Lee & Chen, 2017). Sex/gender was found to moderate most associations between ACEs (i.e., child abuse, child neglect, and child household dysfunction) and IPV with mental disorders, particularly substance use disorders (C. ...
Objective: This cross-sectional study explored sex/gender differences in the associations between adverse childhood experiences (ACEs) and intimate partner violence (IPV) with mental health problems (i.e., attempted suicide and mental disorders), including whether sex/gender differences varied by race/ethnicity. Method: Data were used from participants in the National Epidemiologic Survey on Alcohol and Related Conditions in the United States of America (Wave II: 2004–2005). Logistic regressions tested associations between ACEs (i.e., child abuse, child neglect, and child household dysfunction) and IPV or cumulative trauma with mental health problems along with sex/gender and race/ethnicity interactions. Results: Females who experienced child abuse or three to four cumulative traumas had greater odds of attempted suicide than males with the same experiences. Males who experienced IPV had greater odds of attempted suicide than females who experienced IPV. There were significant sex/gender differences in the associations between cumulative trauma and mental disorders (i.e., mood disorder, anxiety disorder, alcohol use disorder, and nicotine dependence), except posttraumatic stress disorder. For example, females with cumulative trauma had greater odds of substance use disorders. Many sex/gender differences in associations between ACEs and IPV or cumulative trauma with mental health problems varied by race/ethnicity. For example, child neglect was associated with greater odds of attempted suicide for non-Hispanic Black males (adjusted odds ratio [AOR] = 3.53 vs. AOR = 1.29 for females), whereas no sex/gender differences in this association were revealed for non-Hispanic White or Hispanic adults. Conclusions: Findings show sex/gender differences in associations between trauma and mental health problems that vary by race/ethnicity and warrant further study.
... Childhood adversity sets individuals on different trajectories of life course health by shaping the development of health behaviors, coping mechanisms, and access to resources and opportunities (Campbell, Walker, and Egede 2016;Felitti et al. 1998;Ferraro et al. 2016). ACES have been linked to many health outcomes, including poor mental health (Felitti et al. 1998;Hales et al. 2023;Juwariah et al. 2022). A fairly linear relationship exists between the number of ACES and mental health challenges such as depression, suicide attempts, and anxiety disorders (McLaughlin et al. 2010;Merrick et al. 2017). ...
Seminary students have been found to be at a higher risk of experiencing abuse in childhood compared with the general U.S. population, as well as demonstrate mental health struggles. This study aims to understand how R/S struggles might explain the relationship between childhood abuse (emotional, physical, and sexual) among a sample of seminary students, a group that is at a higher risk of experiencing emotional and physical abuse in childhood compared to the general U.S. population. Drawing on a unique sample of seminary students at a Mainline Protestant seminary, ( N = 535), regression results suggest that among seminary students, all forms of childhood abuse studied (emotional, physical, and sexual) were associated with greater depressive and anxiety symptoms. We also found consistent evidence that R/S struggles were a mediator of this pathway, explaining anywhere between 20 percent and 35 percent of the overall association between each form of childhood abuse and depressive and anxiety symptoms. This study adds to the growing body of literature describing the associations between childhood trauma and mental health, as well as the role of R/S struggles. We also discuss how seminaries and divinity schools should implement targeted programs for students with a history of childhood abuse.
... Early life adversity has been shown to have long-lasting detrimental effects on a variety of biopsychosocial outcomes (i.e., physical health, mental health, lifestyles, cognition, and brain atrophy) [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16]. Multiple lines of evidence also show that early life adversity may directly or indirectly affect cognition and thus increase the risk of dementia (e.g., [17][18][19][20][21][22][23]). ...
... These results are in line with the literature showing a negative effect of early adversity on mental health, and cognition (e.g., [2,3,5,[10][11][12][13]15]). However, the findings do not support previous research showing a negative effect of early adversity on physical health and lifestyle (e.g., [3,9,11,12,16]). The role of a mediator may be hypothesized as underlying the association between physical neglect and physical health, as well as smoking status. ...
... Education was associated with numerous outcomes in both cohorts, therefore education may (fully and partially) mediate the effects of early adversity on the outcomes of interest in both cohorts [9]. Importantly, education has been found to be important for resilience [75]. ...
Background
Early life adversity has been shown to have long-lasting detrimental effects on a variety of biopsychosocial outcomes. Early adversity and its consequences may directly or indirectly affect cognitive aging and increase the risk of developing dementia in older age. Investigating the biopsychosocial outcomes associated with early adverse experiences is essential to inform health policies and promote healthy cognitive development across the life course.
Methods
The aim of this study is to investigate the effect of early adversity (i.e., abuse and deprivation) on selected outcomes (i.e., physical and mental health, lifestyle, and cognition) in two UK cohorts (the English Longitudinal Study of Ageing (ELSA), N = 12,653, Mdnage = 66, SDage = 9.58; UK Biobank, N = 502,360, Mdnage = 58, SDage = 8.09). In both cohorts, adversities were self-reported retrospectively, and only those adversity types assessed in both cohorts were utilized. A post-hoc analysis was performed to examine the role of education as a mediator of the association between early adversity and the selected outcomes.
Results
Most of the results show that early adversity is negatively associated with health (both physical and mental), lifestyle, and cognition while also highlighting the important mediating role of education. However, differences exist according to the specific adversity experienced and the cohort studied.
Conclusions
The results found bring into attention the complex associations between early adversity and multiple later life outcomes, and suggest that various mechanisms might be at play. Furthermore, the findings highlight the importance of multi-cohort comparisons for the generalization of the results.
... All analyses were conducted with Stata 18 (StataCorp LLC, College Station, TX, USA). We performed the analyses separately for women and men based on the literature 30 and several statistically significant gender interactions found between the measures of childhood disadvantage and psychological distress, and the measures of behavioral risk factors and psychological distress. We first tabulated descriptive statistics (numbers, percentages, and p-values from the Pearson Chi 2 tests) concerning all measures. ...
... On the contrary, adaptation to healthy behaviors after disadvantaged childhood may indicate higher levels of resilience and further better psychological well-being 57 . It is also notable that behavioral risk factors do not operate separately from other factors in the pathway, such as psychosocial, biological, and cognitive factors (e.g., stress, self-esteem, social support, and coping strategies) and individual's own socioeconomic position 30,53,54,57 . Additionally, the mediation mechanisms may differ between genders-for instance, due to different coping mechanisms in handling stressful circumstances- 30,58 , suggested also by our findings. ...
... It is also notable that behavioral risk factors do not operate separately from other factors in the pathway, such as psychosocial, biological, and cognitive factors (e.g., stress, self-esteem, social support, and coping strategies) and individual's own socioeconomic position 30,53,54,57 . Additionally, the mediation mechanisms may differ between genders-for instance, due to different coping mechanisms in handling stressful circumstances- 30,58 , suggested also by our findings. Given that the study settings (cross-sectional, prospective, retrospective) and the measures used widely vary between studies 30,53-55 , the comparisons are challenging. ...
Childhood disadvantage is associated with increased adult psychological distress, but the role of behavioral risk factors in the pathway remains unclear. We examined whether behavioral risk factors mediate the effects of childhood disadvantage on adult psychological distress. We used the Helsinki Health Study data of employees of the City of Helsinki, Finland, aged 19–39 (mean age 32.0) years at baseline (2017). We included women (n = 2397) and men (n = 586) who responded to both baseline and follow-up (2022) surveys. At baseline, eight types of childhood disadvantage were asked retrospectively, and six adult behavioral risk factors were included. Psychological distress was measured by the DASS-21 at follow-up. We conducted mediation analyses using generalized structural equation modeling. Among women, we found indirect path effects of childhood disadvantage on adult psychological distress through behavioral risk factors (symptoms of depression: β = 0.68, 95% CI 0.20–1.17; anxiety: β = 0.54, 95% CI 0.13–0.95; and stress: β = 0.69, 95% CI 0.20–1.09). Among men, childhood disadvantage contributed only directly to adult depressive (β = 0.71, 95% CI 0.16–1.26) and stress (β = 0.61, 95% CI 0.10–1.13) symptoms. Our findings suggest that behavioral risk factors can mediate some of the adverse effects of childhood disadvantage on adult psychological distress among women.
... ACEs were found to be associated with physiological changes in the immune, endocrine, cardiovascular, and nervous systems and to affect inflammatory and metabolic functioning, as well as brain structure and functioning (see meta-analysis in Cooke et al., 2023). As such, ACEs take a toll not only on health but also on the ability to function at cognitive, social, and emotional levels (Hales et al., 2022;Hughes et al., 2017). Studies consistently show that exposure to a higher number of ACEs is predictive of health-harming behaviors (e.g., Bellis et al., 2014), physical diseases, higher rates of mortality, increased psychological distress and psychopathology, lower educational attainment, and poorer socioeconomic outcomes (see meta-analyses in Hales et al., 2022;Hughes et al., 2017). ...
... As such, ACEs take a toll not only on health but also on the ability to function at cognitive, social, and emotional levels (Hales et al., 2022;Hughes et al., 2017). Studies consistently show that exposure to a higher number of ACEs is predictive of health-harming behaviors (e.g., Bellis et al., 2014), physical diseases, higher rates of mortality, increased psychological distress and psychopathology, lower educational attainment, and poorer socioeconomic outcomes (see meta-analyses in Hales et al., 2022;Hughes et al., 2017). ...
... A higher number of experiences of witnessing or experiencing abuse and a lack of emotional support from parents due to neglect or family dysfunction might lead to more negative and disorganized mental representations; parents may not be aware of these, but they are likely to color their interpretations of their child's signals and their behavioral responses to the child (Crowell et al., 2010;Murphy et al., 2014;Thomson & Jaque, 2017). The increased risk of psychological distress associated with ACEs (Hales et al., 2022) may also impede parents' ability to self-regulate and remain emotionally available to their child, particularly when the child is distressed. This, in turn, may hamper the development of the child's self-regulation skills and lead to increased behavior problems (Cooke et al., 2019). ...
Research points to the substantial impact of parents' exposure to adverse childhood experiences (ACEs) on parents and their children. However, most studies have been conducted in North America, and research on ACEs effects on observed parenting or on intergenerational transmission of ACE effects is limited. We therefore studied families from diverse ethnocultural backgrounds in Israel and examined whether mothers’ ACEs hampered maternal sensitivity and the quality of the home environment and whether mothers’ psychological distress mediated these links. We also explored whether mothers’ ACEs predicted children’s behavior problems indirectly through maternal psychological distress and whether maternal sensitivity and the home environment attenuated this mediating path. Participants were 232 mothers ( M child age = 18.40 months, SD = 1.76; 63.36% non-ultra-Orthodox Jewish, 17.24% ultra-Orthodox Jewish, 19.40% Arab Muslim). Results showed mothers’ ACEs were directly associated with decreased maternal sensitivity. Mothers’ ACEs were indirectly associated with more behavior problems in children through mothers’ higher psychological distress, and maternal sensitivity moderated this indirect link; it was significant only for mothers who showed lower sensitivity. Findings emphasize the significant role ACEs play in early mother-child relationships. The importance of including ACE assessment in research and practice with families of infants and toddlers is discussed.
... Yet, research on type, timing and pathological outcomes in children face two major problems: First, effects are difficult to examine in isolation due to high collinearity among maltreatment parameters (Hales et al., 2022;Wang et al., 2021). The DMAP (Dimensional Model of Adversity and Psychopathology) model of childhood adversity (Miller et al., 2018) categorizes experiences along dimensions of threat and deprivation (both physical and emotional), emphasizing how these distinct forms of CM uniquely affect developmental trajectories and psychopathological outcomes. ...
Background: While cumulative childhood maltreatment (CM) has been linked to psychopatho-logical outcomes, recent studies point to the relevance of the type and timing of exposure. The aim of the current study was to better understand their importance beyond the cumulative burden of CM for psychopathological symptoms in middle childhood. Methods: A total of N = 341 children (M = 9.92, SD = 1.51) were interviewed to assess trauma load (UCLA-University of California at Los Angeles Event List), exposure to CM (pediMACE-Maltreatment and Abuse Chronology of Exposure-Pediatric Interview) and different outcomes of psychopathology (UCLA Posttraumatic Stress Disorder Reaction Index, Children's Depression Inventory (CDI), Strengths and Difficulties Questionnaire (SDQ). We employed conditioned random forest regression, incorporating type, timing, and cumulative indicators of CM, to assess the importance of each predictor simultaneously. Results: Exposure to CM (abuse, neglect and cumulative indicators) exhibited a robust association with psychopathological outcomes. Recent abuse and recent neglect showed most robust associations with outcomes, neglect was stronger related to internalizing problems and timing of exposure showed clear associations with diverse pathological outcomes. Conclusion: Beyond the cumulative burden, type and timing of CM show direct and diverse associations to pathological outcomes in middle childhood. Our results highlight the critical importance of early and detailed identification of CM, particularly recent exposure. This finding is valuable for researchers and clinicians, as it can refine diagnostic assessments and pave the way for effective early intervention strategies for affected children.
... Experience of these risk factors in childhood is associated with negative physical, psychological, social, and economic consequences for children and families [7]. ACEs are understood to have a dose-response relationship, with greater exposure increasing the likelihood of negative outcomes [2]. ...
Background
Clustering and co-occurring of family adversities, including mental health problems, substance use, domestic violence and abuse, as well as poverty can increase health and behavioural risks for children, which persist throughout the life course. Yet, interventions that acknowledge and account for the complex interactive nature of such risks are limited. This study aimed to develop intervention principles based on reflections from mothers, fathers, and young people who experience multiple and interacting adversities. These principles will show how family members perceive an intervention may bring about positive change and highlight key insights into design and delivery.
Methods
A series of six co-design workshops with mothers, fathers, and young people who experienced multiple and interacting adversities (n = 41) were iteratively conducted across two regions in England (London and North-East) by four researchers. Workshop content and co-design activities were informed by advisory groups. Data from facilitator notes and activities were analysed thematically, resulting in a set of intervention principles.
Results
The intervention principles highlighted that: (1) to reduce isolation and loneliness parents and young people wanted to be connected to services, resources, and peer support networks within their local community, particularly by a knowledgeable and friendly community worker; (2) to address feelings of being misunderstood, parents and young people wanted the development of specialised trauma informed training for practitioners and to have the space to build trusting, gradual, and non-stigmatising relationships with practitioners; and (3) to address the needs and strengths of individual family members, mothers, fathers, and young people wanted separate, tailored, and confidential support.
Conclusions
The current study has important implications for practice in supporting families that experience multiple and interacting adversities. The intervention principles from this study share common characteristics with other intervention models currently on offer in the United Kingdom, including social prescribing, but go beyond these to holistically consider the whole families’ needs, environments, and circumstances. There should be particular focus on the child’s as well as the mothers’ and fathers’ needs, independently of the family unit. Further refinement and piloting of the developing intervention are needed.
... Thus, it is likely that there are unmeasured parenting variables in the current study that are the more proximal moderators of the biological parent-child externalizing behavior association. Similarly, prior research reviews show clear linkages between exposure to childhood trauma and adult mental health (Hales et al., 2023;McKay et al., 2021;Xiao et al., 2023), which could then undermine parenting quality and skills. Connecting both of these aspects from the prior literature, a systematic review of the effects of parental ACES on parenting and child psychopathology found a direct association between parental ACES and parenting, and between parental ACES and child externalizing symptoms (Rowell & Neal-Barnett, 2022). ...
Development and Psychopathology has been a premier resource for understanding stressful childhood experiences and the intergenerational continuity of psychopathology. Building on that tradition, we examined the unique and joint influences of maternal stress on children’s effortful control (age 7) and externalizing behavior (age 11) as transmitted via genetics, the prenatal environment, and the postnatal environment. The sample included N = 561 adopted children and their biological and adoptive parents. Path models identified a direct effect of biological mother life stress on children’s effortful control ( β = −.08) and an indirect effect of her life stress on child externalizing behavior via effortful control ( β = .52), but no main or indirect effects of biological parent psychopathology, prenatal stress, or adoptive mother adverse childhood experiences (ACES). Adoptive mother ACES amplified the association between biological mother life stress and child effortful control ( β = −.08), externalizing behavior ( β = 1.41), and the indirect effect via effortful control, strengthening associations when adoptive mothers reported average or high ACES during their own childhoods. Results suggest that novel study designs are needed to enhance the understanding of how life stress gets “under the skin” to affect psychopathology in the offspring of adults who have experienced stress.
... Although ACE clusters have been widely studied, distinct patterns of ACE exposure are not always identified, as has been shown in similar birth cohorts such as the UK-based Millennium Cohort Study (Bevilacqua et al., 2021). Finally, the current study did not consider other factors involved in crime such as delinquent peers, school performance, employment problems, and mental health problems (Basto-Pereira and Farrington, 2022), which could be considered as potential mechanisms linking ACEs and crime in future studies (Hales et al., 2022). ...
This study aimed to investigate alternative approaches to a cumulative risk score in the relationship between adverse childhood experiences (ACEs) and crime. Using data from the 1993 Pelotas (Brazil) Birth Cohort (n = 3236), we measured 12 ACEs up to 15 years, and past-year violent and non-violent crime at 22 years. We used four analytical approaches: single adversities, cumulative risk, latent class analysis, and network analysis. When examined individually, physical abuse, emotional abuse, and domestic violence were associated with both crime outcomes, whereas maternal mental illness and discrimination were associated with violent crime only, and parental divorce and poverty with non-violent crime only. There was a cumulative effect of ACEs on crime. The class with child maltreatment and household challenges was associated with both crime outcomes; exposure to household challenges and social risks was associated with violent crime only. In network models, crime showed conditional associations with physical abuse, maternal mental illness, and parental divorce. Although cumulative ACEs did associate with crime, some individual and combinations of ACEs showed particularly strong and robust effects, which were not captured by the cumulative score. Many ACEs are closely connected and/or cluster together, and the usefulness of the ACE score needs to be further evaluated.
