Prospective Longitudinal Associations Between Adverse Childhood Experiences and Adult Mental Health Outcomes: Systematic Review and Meta-Analysis.
Christina Thurston, Aja Louise Murray, Hannabeth Franchino-Olsen et al.
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In 30 seconds
This systematic review and meta-analysis examined prospective associations between adverse childhood experiences (ACEs) and adult mental health outcomes. It included 62 studies from 15 countries, with 95% of publications from high-income countries. Random-effects meta-analyses found the strongest pooled association for PTSD (OR = 2.26; 95% CI [1.75, 2.77]), followed by anxiety, depression, psychotic-like experiences, and suicidality. The findings support ACEs as a risk factor for adult mental ill-health, while the limited representation of countries outside high-income settings leaves important gaps in the evidence.
Key findings
- The pooled association was strongest for PTSD (OR = 2.26; 95% CI [1.75, 2.77]).
- Associations were also reported for anxiety (OR = 1.78; 95% CI [1.45, 2.11]) and depression (OR = 1.61; 95% CI [1.45, 1.76]).
- Smaller pooled associations were found for psychotic-like experiences (OR = 1.34; 95% CI [1.13, 1.54]) and suicidality (OR = 1.28; 95% CI [1.13, 1.43]).
- Violence- or maltreatment-related ACEs were significant risk factors for adult depression compared with household ACEs.
Why it matters
Prospective evidence links childhood adversity with several forms of adult mental ill-health, underscoring the potential value of considering early experiences when assessing mental health histories. The variation in associations across outcomes and the reported moderation by study location also caution against assuming uniform effects. Because evidence was concentrated in high-income countries, the findings may not represent populations in other settings.
What to keep in mind
Evidence was concentrated in high-income countries: 95% of publications came from these settings, with only three studies from upper-middle-income countries.