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. 2024 Jun 1;81(6):586-594.
doi: 10.1001/jamapsychiatry.2024.0039.

Adverse Childhood Experiences and Adult Mental Health Outcomes

Hilda Björk Daníelsdóttir  1   2 , Thor Aspelund  1 , Qing Shen  1   2   3   4 , Thorhildur Halldorsdottir  5 , Jóhanna Jakobsdóttir  1 , Huan Song  1   2   6 , Donghao Lu  2 , Ralf Kuja-Halkola  7 , Henrik Larsson  7 , Katja Fall  2   8 , Patrik K E Magnusson  7 , Fang Fang  2 , Jacob Bergstedt  2 , Unnur Anna Valdimarsdóttir  1   2   9
Affiliations

Adverse Childhood Experiences and Adult Mental Health Outcomes

Hilda Björk Daníelsdóttir et al. JAMA Psychiatry. .

Abstract

Importance: Exposure to adverse childhood experiences (ACEs) has consistently been associated with multiple negative mental health outcomes extending into adulthood. However, given that ACEs and psychiatric disorders cluster within families, it remains to be comprehensively assessed to what extent familial confounding contributes to associations between ACEs and clinically confirmed adult psychiatric disorders.

Objective: To investigate whether associations between ACEs and adult mental health outcomes remain after adjusting for familial (genetic and environmental) confounding.

Design, setting, and participants: This Swedish twin cohort study used a discordant twin pair design based on monozygotic (MZ) and dizygotic (DZ) twins. A total of 25 252 adult twins (aged 18-47 years) from the Swedish Twin Registry born between 1959 and 1998 were followed up from age 19 years until 2016, with a maximum follow-up time of 39 years. Data were analyzed from April 2022 to November 2023.

Exposures: A total of 7 ACEs, including family violence, emotional abuse or neglect, physical neglect, physical abuse, sexual abuse, rape, and hate crime, were assessed with items from the Life Stressor Checklist-Revised in a web-based survey.

Main outcomes and measures: Adult (ages >18 years) clinical diagnosis of psychiatric disorders (ie, depressive, anxiety, alcohol or drug misuse, or stress-related disorders) were obtained from the Swedish National Patient Register.

Results: Of 25 252 twins included in the study (15 038 female [59.6%]; mean [SD] age at ACE assessment, 29.9 [8.7] years), 9751 individuals (38.6%) reported exposure to at least 1 ACE. A greater number of ACEs was associated with increased odds of any psychiatric disorder in the full cohort (odds ratio [OR] per additional ACE, 1.52; 95% CI, 1.48-1.57). The association remained but ORs per additional ACE were attenuated in DZ (1.29; 95% CI, 1.14-1.47) and MZ (1.20; 95% CI, 1.02-1.40) twin pairs. Individuals who were exposed to sexual abuse compared with those who were not exposed had increased odds of any clinically confirmed psychiatric disorder in all comparisons: full cohort (OR, 3.09; 95% CI, 2.68-3.56), DZ twin pairs (OR, 2.10; 95% CI, 1.33-3.32), and MZ twin pairs (1.80; 95% CI, 1.04-3.11).

Conclusions and relevance: This study found that associations between ACEs and adult mental health outcomes remained after controlling for shared genetic and environmental factors, which was particularly evident after multiple ACEs or sexual abuse. These findings suggest that targeted interventions may be associated with reduced risks of future psychopathology.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Shen reported receiving grants from the Outstanding Clinical Discipline Project of Shanghai Pudong and Fundamental Research Fund for the Central Universities in China outside the submitted work. Dr Larsson reported receiving grants from Shire/Takeda and personal fees from Shire/Takeda, Evolan, and Medici outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Flowchart of Sample Selection
ACE indicates adverse childhood experience; CATSS, Child and Adolescent Twin Study in Sweden; LSC-R, Life Stressor Checklist-Revised; STAGE, Study of Twin Adults: Genes and Environment; YATSS, Young Adult Twins in Sweden Study.
Figure 2.
Figure 2.. Associations Between Number of Adverse Childhood Experiences and Adult Psychiatric Disorder Subtypes
Associations are given in the full cohort and in exposure-discordant twin pairs; odds ratios (ORs) are per additional ACE. Models were adjusted for age and sex; 95% CIs are based on robust standard errors calculated using generalized estimating equations. DZ indicates dizygotic twins; MZ, monozygotic twins; OR, odds ratio.
Figure 3.
Figure 3.. Associations Between Adverse Childhood Experience (ACE) Subtypes and Any Adult Psychiatric Disorder
Associations are given in the full cohort and in exposure-discordant twin pairs; odds ratios (ORs) are for any ACE vs no ACE. Models were adjusted for age and sex; 95% CIs are based on robust standard errors calculated using generalized estimating equations. DZ indicates dizygotic twins; MZ, monozygotic twins.
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