Association of adverse childhood experiences with health-related behaviors and mental health among adults in China: findings from the China Health and Retirement Longitudinal Study (Preprint)

Abstract

Adverse childhood experiences (ACEs) refer to some of the most intensive and frequently occurring sources of stress that children may suffer early in life. There is an extensive amount of literature reporting the negative impact of ACEs on adults’ mental health. However, evidence on the association between ACEs and health-related behaviors and mental health, using a nationally representative survey of Chinese people is relatively scarce.

This study investigated the association of ACEs with health-related behaviors and mental health and the independent effect of ACE components.

We analyzed data for 10119 adults from the 2015 China Health and Retirement Longitudinal Study (CHARLS) and the 2014 CHARLS life history survey. Twelve ACE indicators were collected via a self-reported questionnaire. Health-related behaviors (i.e. binge drinking, heavy drinking, smoking, insufficient and long sleep) and mental health (i.e. loneliness, social isolation, and life satisfaction) were measured via a self-reported questionnaire. Multiple logistic regression and linear regression assessed the association of ACE score categories and individual ACE components with outcomes.

A total of 79.5% (8041/10119) of participants reported at least one ACE and 11.9% (1209/10119) reported experienced four or more ACEs. Compared with individuals without ACE, those who experienced four or more had a higher risk of heavy drinking (OR=1.47, 95%CI: 1.17, 1.83), insufficient sleep (OR=1.54, 95%CI: 1.31, 1.83), loneliness (OR=1.87, 95%CI: 1.54, 2.27), more social isolation (β=0.10, 95%CI: 0.01, 0.16), and lower life satisfaction (β=-0.20, 95%CI: -0.25, -0.15). Trend analyses showed a dose-response association of ACEs with outcomes (all P<0.001). Additionally, the individual components had different effects on health-related behaviors and mental health.

Our findings indicated that there is a cumulative effect of ACEs on heavy drinking, insufficient sleep, loneliness, social isolation, and life satisfaction. Individual ACE components have differential relationship with health-related behaviors and mental health. Childhood experiences are a good target for preventing adult health-related behaviors and mental health programs.