Impact of adverse childhood experiences on adult mental health

Abstract

Adverse Childhood Experiences (ACEs) is a constellation of negative events that have public health concern with well-established sequelae. However, compared to research conducted in other countries, only limited exploration of ACEs and their impact has been carried out in Bangladesh. The limited understanding of long-term mental health impact of ACEs in Bangladesh called for this research. Objective: The objectives of this study were to determine: (1) prevalence of ACEs among clinical and general populations, (2) the relationships among ACEs and mental health outcomes in adulthood, and (3) whether resilience, social support, and subjective well-being mediate the relationship between ACEs and psychopathological symptoms, and (4) connection between specific ACEs and overall mental health state. Method: Cross-sectional survey data on childhood exposure to ACEs, psychological factors (mental health outcomes measure and indicators), three presumed mediating variables, and socio demographic factors were collected from 390 adults consisting of both community and clinical sample, aged 18–67 (M = 29.87, SD = 9.36) via face-to-face interview. WHO guidelines for measuring ACEs that encompasses 13 conventional ACEs were used along with 3 extended ACEs resulting in total ACE scores ranged from 0 to 16. Multiple logistic regression models were used to evaluate the relationship between ACEs and adult mental health outcomes, adjusting for socio-demographic covariates. IV Results: High proportion of clinical (97.9%) and non-clinical (85.5%) participants reported at least one type of adversity. Exposure to four or more ACEs were also reported by high number of participants (73.7% for clinical and 38.5% for non-clinical). The most prevalent form of ACE was emotional neglect among clinical (68.4%) and non-clinical (48.5%) sample, followed by domestic violence from household dysfunction domain (59.0% in clinical and 41.0% in non-clinical) and then exposure to collective violence, from the violence outside the home domain (clinical - 51.1% and non-clinical - 29.0%). The relationship between ACE and adult mental health state was examined for clinical and non-clinical separately, which revealed significant correlation between ACEs and six other variables (SRQ, physical health, psychological health, social relationships, environmental health, and well-being), r(388) = .43 to .52. The number of ACEs was positively associated with psychological symptoms, domains of quality of life but negative association was found with the level of well-being. Results also revealed statistically significant differences in mental health for 16 ACE measured using retrospectively collected reports from the participants. A regression model was carried out controlling for gender, age, and socio-economic status for mental health and ACEs: one adversity, two adversities, three adversities, four or more adversities. The risk of well-being, SRQ, self-harm & suicide, and substance abuse was higher among those who had experienced three or more ACEs compared to those with none. Results of parallel mediation analyses showed social support, resilience, and self-esteem statistically mediated the relationships between ACEs and psychopathological outcomes in adulthood. Furthermore, among all categories of ACEs, emotional neglect, collective violence, and experiencing racism and discrimination increased the likelihood of well-being issues (OR ranges from 0.44 to 0.48). Reports of emotional neglect, parental substance V abuse, exposure to collective violence, racism & discrimination, and witnessing violence towards the mother also accounted for higher probabilities of presenting psychological severity (OR ranges from 0.23 to 2.77). In participants reporting early sexual abuse have a greater risk of engaging in suicide & self-harm (OR=2.25, 95% CI=1.37, 3.69) and health risk behavior (OR=1.80; 95% CI=1.12, 2.88). Odds for mental health issues due to racism & discrimination were also significant (OR ranges from 0.48 for well-being to 3.77 for self harm and suicide). Results indicated a graded dose-response relationship between ACEs and adult mental health outcomes. Conclusion: Exposure to ACEs in childhood has been found to be a highly prevalent among adult population in Bangladesh. Childhood exposure has been shown to be associated with significant mental health impacts in the later life. The result urges for proactive action to reduce the occurrence of ACEs as well as to minimize its impacts.