Young Adult Mental Health Problem Incidence Varies by Specific Combinations of Adverse Childhood Experiences

Abstract

AbstractAdverse childhood experiences (ACEs) have been shown to impact mental health. Risk associated with ACEs is commonly estimated based on counts from the conventional ACE types, but ACEs may not all carry the same health risk, either individually or in combination. Evidence is needed to understand the health impact of different ACE types and combinations of ACE types. We aimed to assess variation in risk of mental illness diagnosis and severe psychological distress in young adulthood based on differences in exposure to individual ACEs and combinations of ACEs, which can improve precision of ACE-based risk assessment. We used data from six waves of the Transition to Adulthood Supplement (2007–2017; n = 1832 young adults ages 18–28) of the Panel Study of Income Dynamics. We used logistic regression with cluster-robust variation estimation to test associations between each ACE, pairwise combinations of ACEs, and outcomes including new or existing mental illness diagnoses and severe psychological distress. Individual ACEs associated with greatest risk for new or existing mental illness diagnoses and severe psychological distress were parental mental illness and sexual abuse. Combinations of ACEs associated with greatest risk were parental mental illness-plus-sexual abuse and parental mental illness-plus-emotional neglect. ACEs associated with the lowest risk were parental substance use, physical abuse, and household violence. In this nationally representative longitudinal study of mental health outcomes in young adults, different individual and combinations of ACEs were associated with varying levels of mental health risk. This carries implications for risk assessment and ACE intervention prioritization.