Adverse childhood experiences and adolescent mental health: trajectories of internalizing, externalizing and prosocial behaviour in a longitudinal cohort study
Abstract Aims Adverse childhood experiences (ACEs) shape children’s socioemotional development, yet longitudinal evidence from low- and middle-income countries remains limited. This study examined how ACEs relate to internalizing, externalizing and prosocial behaviours from childhood to adolescence in a rural Pakistani cohort. Methods Data were drawn from the Bachpan Cohort, a longitudinal study including 1,791 observations across three waves: ages 4–5, 8–9 and 12–15 years. ACEs were assessed using an adapted ACE-International Questionnaire. Outcomes were measured using the Strengths and Difficulties Questionnaire. Network analysis, dose-response modelling and moderation analyses were employed. Results Emotional neglect was the most prevalent ACE (83.7%). Parental psychiatric issues, parental trauma exposure and emotional neglect were the most central ACE stressors. A dose-response relationship emerged: compared to children with no ACEs, those with four or more ACEs showed higher internalizing (incidence ratio [IR] = 4.24) and externalizing problems (IR = 3.42) and lower prosocial behaviour (IR = 0.90). Girls showed greater internalizing vulnerability; boys showed more externalizing problems. ACE effects on internalizing problems strengthened with age. Conclusions ACEs are strongly associated with internalizing, externalizing and prosocial outcomes from childhood to adolescence. Findings highlight the need for tiered, gender-sensitive and developmentally appropriate interventions in low-resource settings.
Childhood adversities can have long-term impacts on quality of life (QoL), health, and well-being. We surveyed an adult population to assess the prevalence of three common adverse childhood experiences (ACEs): parental alcohol problems, parental mental illness, and violence from caregivers, as well as the overlap between them. We additionally examined the prevalence of adult support across ACE exposure and how this support related to perceived childhood difficulties and adult QoL. This cross-sectional study used retrospective data from the Norwegian Counties Public Health Survey in Agder 2023. Data were summarized descriptively, and a Venn diagram illustrated the overlap between ACEs. We examined associations between cumulative exposure and the presence or lack of adult support and how these factors related to perceptions of childhood difficulties and adult QoL using one-way analysis of variance. The most prevalent ACEs were parental mental illness and parental alcohol problems (16% and 14%, respectively), while ~ 10% reported violence from a caregiver. We observed substantial overlap amongst the three ACE categories, with 2.4% having experienced all three. Adult support was inversely associated with higher levels of ACE exposure, and analysis showed a pattern of increasing perceived childhood difficulties and decreasing QoL scores. Adult support was consistently associated with the perception of a less difficult childhood and higher QoL, among subjects with the same level of ACE exposure. Our findings emphasize the importance of adult support within the context of ACEs, and the need for enhanced measures aimed at supporting those most affected.
Cathrine Hørte, John-Kåre Vederhus, Monica Strømland et al.· Discover Public Health· 0 citations
Adverse childhood experiences (ACEs) affect a third of all children in the United States. However, less is understood about how specific aspects of ACEs, such as household dysfunction, influence the behavioral development of children as they enter adolescence and whether collective efficacy can buffer this relationship. This study used longitudinal data from the Adolescent Brain Cognitive Development (ABCD) study (n = 11,868, baseline Mage = 9.9, SDage = 0.6, 52% male; 52% White, 20% Hispanic, 15% Black, 2% Asian, and 11% Other race/ethnicity). Multiple regression analyses suggested that baseline household dysfunction positively predicted externalizing behaviors two and three years later, and that these associations were attenuated by high levels of collective efficacy at the two-year follow-up. These findings suggest the joint roles of household- and neighborhood-level contexts in shaping adolescent behavioral health and indicate that collective efficacy can serve as a promotive and protective resilience factor in the trajectory of externalizing behaviors.
Ashlee J. Saxon, Edna C. Alfaro, Eunjin Seo et al.· Adolescents· 0 citations
Cumulative Adverse Childhood Experiences (ACEs) and low household income are associated with adolescent depression and anxiety, but it is unclear whether distinct ACE subdomains - maltreatment (e.g., abuse) versus parent challenges (e.g., parental mental illness) - when experienced in distinct developmental periods exert a unique influence on adolescent mental health, or how ACEs and economic disadvantage operate together to influence outcomes. Thus, we aimed to (1) examine associations between baseline household income, early childhood ACEs (ages 0-5; sub-indexed as Maltreatment vs. Parent Challenges) and adolescent depression and anxiety symptoms (age 15), and (2) investigate whether household income moderates the associations between ACE sub-indices and each mental health outcome. We used serial linear regressions and data from the United States-based, longitudinal, racially/ethnically and socioeconomically diverse Future of Families and Child Wellbeing Study (n = 2523; 51% female; 51% non-Hispanic Black; 36% in poverty at birth). The Parent Challenges sub-index (but not the Maltreatment sub-index) was associated with depression and anxiety symptoms. Low household income was associated with depression symptoms. Income moderated the association between the Parent Challenges sub-index and anxiety symptoms; youth from the lowest and highest income strata were at greatest risk. Strategies are urgently needed for ACE prevention and to support parents of very young children (or expectant parents) who are experiencing behavioral health challenges, interpersonal violence, criminalized behavior, and/or poverty to promote healthy child development and adolescent mental health. Health professionals are well-positioned to advocate for supportive policies, promote trauma-informed environments, and identify/address significant parental challenges early in development.
Chelsea R. Moore, Phillip Veliz, Alison L. Miller et al.· Research in Nursing and Heal...· 0 citations
INTRODUCTION
Adverse Childhood Experiences (ACEs) are associated with multiple deleterious life-course outcomes, with salient repercussions during adolescence. Evidence on vulnerable peripheral adolescents remains scarce, especially in Brazil. This study examined the association between self-reported ACEs (family/community violence, abuse, and neglect) and body satisfaction among adolescents aged 10 to 14 years living in an impoverished peripheral community of São Paulo, Brazil.
METHODS
This quantitative cross-sectional investigation used 2021 baseline data from the Global Early Adolescent Study (GEAS). The sample comprised 974 cisgender adolescents aged 10 to 14 years recruited through Primary Health Care Units. Body satisfaction was measured using a four-item index derived from the Health Behaviour in School-aged Children (HBSC) instrument. ACEs were assessed through a standardized instrument covering 11 adversity categories. Descriptive, bivariate, and multiple linear regression analyses were conducted, adjusting for sociodemographic and contextual variables.
RESULTS
ACE exposure was frequent: 81.2% of adolescents reported at least one adversity and 33.8% reported four or more exposures, particularly girls. Fear of emotional aggression (61.7%), emotional neglect (58.8%), and physical neglect (49.0%) were most frequent. Girls showed lower body satisfaction than boys. Emotional neglect, bullying, fear of emotional aggression, physical neglect, and caregivers' emotional distress remained significantly associated with lower body satisfaction means.
CONCLUSION
Frequent reports of ACEs, particularly emotional aggression and neglect, suggest that body satisfaction during early adolescence is closely related to relational experiences and gender differences. These findings highlight the need for health and educational strategies addressing violence and neglect in vulnerable peripheral contexts.
Nicolas Kimura Generoso, Cristiane Da Silva Cabral· International Journal of Chi...· 0 citations
Background Adverse childhood experiences (ACEs) are a measure of childhood adversity, reflecting exposures to abuse, neglect, and household dysfunction prior to the age of 18. They have consistently been associated with worse adult health outcomes, as caused by psychological stress. Although these outcomes include metabolic disease, few studies have been able to examine the association of ACEs directly with adult stress eating. Thus, we examined the association of ACEs and frequent adult stress eating in a largely low-income and racially diverse population in the southern US. Methods Among 32,209 Southern Community Cohort Study participants primarily recruited from clinics that serve the un- and under-insured in 12 southeastern states, we used logistic regression to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for the association of ACEs with frequent adult stress eating, adjusted for age, sex, and income. As a secondary analysis, we calculated ORs further adjusted for adult mental and emotional well-being. Results Individuals with any ACE were more likely to report frequent stress eating as an adult compared to those without ACEs (OR 1.47; 95% CI 1.38, 1.56). By number of ACEs, there was a significant dose-response trend, with ORs rising from 1.16 (95% CI 1.07, 1.25) for 1 ACE to 1.93 (95% CI 1.78, 2.09) for 4 or more ACEs (p for trend <0.0001) for the likelihood of frequent adult stress eating. These findings remained significant after further adjusting for mental and emotional well-being. Conclusions With the finding that ACEs are associated with adult stress eating across populations, even beyond the impact of depression and other mental-emotional well-being factors, research is needed to explore whether trauma intervention strategies can mitigate adult stress eating behavior and related poor health outcomes.
Sydney Aquilina, M. Shrubsole, J. Butt et al.· Research Square· 0 citations
OBJECTIVE
Accumulating research conducted in high-income countries has reported that early life environmental factors (ELF) are linked to emotional-behavioral problems. However, approximately 90% of the world's children live in low- and middle-income countries, where research remains limited. We investigated the prospective associations between ELF and emotional-behavioral problems in South African children and adolescents.
METHOD
Data were drawn from the Safe Passage Study, a population-derived birth cohort (5,889 mother-child dyads). ELF (pre-, peri-, and postnatal) were collected by questionnaires and clinical assessments and medical records at inception. In this Biomarkers of Neurodevelopmental Outcomes (BONO) follow-up, emotional-behavioral problems (externalizing and internalizing problems) were measured once using caregiver-reported Strengths and Difficulties Questionnaire at age 5-16 years (n=1,284). Associations were examined using regression models adjusted for the child's sex and age at assessment.
RESULTS
Of the 104 ELF, prenatal factors associated with both increased externalizing and internalizing problems were maternal mental health i.e., self-harm (externalizing problems: beta coefficient (β)=0.69; internalizing problems: β=0.60), depression (externalizing problems: β=0.06, internalizing problems: β=0.08) and anxiety (externalizing problems: β=0.05; internalizing problems: β=0.04) and infections (externalizing problems: β=0.65; internalizing problems: β=0.45). Factors only associated with externalizing problems included prenatal maternal substance use, asthma, paternal education, and infant secondhand smoke exposure. Enlarged placenta was associated with internalizing problems. Fetal, birth, and other placental factors showed modest associations.
CONCLUSION
In this South African setting, prenatal maternal mental health and infections emerged as consistent risk factors for both externalizing and internalizing problems. Future studies are needed to elucidate the impact of co-occurring ELF and investigate the mechanisms through which these ELF contribute to the emergence of emotional-behavioral problems.
Cindy Pham, H. Odendaal, Lucy T. Brink et al.· Journal of the American Acad...· 0 citations
