The Prevalence and Profiles of Adverse Childhood Experiences and Their Associations with Adult Mental Health Outcomes in China: a Cross-sectional Study

Overview

Journal Lancet Reg Health West Pac

Date 2024 Dec 24

PMID 39717023

Authors

Peilin Xu

Zhaorui Liu

Yifeng Xu

Tao Li

Guangming Xu

Xiangdong Xu

Limin Wang

Yongping Yan

Shuiyuan Xiao

Lingjiang Li

Tingting Zhang

Jie Yan

Yaqin Yu

Xiufeng Xu

Zhizhong Wang

Bo Wang

Wanjun Guo

Yueqin Huang

Affiliations

Soon will be listed here.

Abstract

Background: Adverse childhood experiences (ACEs) are common and associated with mental disorders. However, the prevalence and co-occurrence of ACEs and their association with mental health outcomes among Chinese adults have not been well demonstrated.

Methods: China Mental Health Survey, a cross-sectional nationally representative survey consisting of 28,140 adults, was conducted from July 2013 to March 2015. Twelve ACEs and mental health outcomes, including mood disorder, anxiety disorder, substance-use disorder, and suicide were measured using the Composite International Diagnostic Interview (CIDI) 3.0 in a weighted representative subsample of 9378 respondents. Latent class analysis was used to identify the co-occurrence profiles of ACEs, and logistic regression was applied to examine the association between ACEs and mental health outcomes. Population-attributable fractions (PAFs) were calculated to quantify the attribution of ACEs to these outcomes.

Findings: Among the 9378 respondents, the weighted count (proportion) of females was 4642 (49.5%), with a weighted mean (SD) age of 43.0 (15.8) years. In this study, 27.1% of respondents showed at least one ACE, with multiple ACEs common (37.6%) among those affected. Neglect was the most prevalent ACE (11.3%), followed by physical abuse (9.1%). Latent class analysis identified four co-occurrence profiles: low risk of ACEs, maltreatment, caregiver's maladjustment and parental loss. The strongest association with mental health outcomes was found in the caregiver's maladjustment group (OR, 4.9; 95% CI, 3.2-7.6). Estimates of PAFs indicated that all ACEs together explained 39.4% (95% CI, 31.3%-47.4%) of observed mental health outcomes. Gender differences were noted in prevalence and associations with outcomes.

Interpretation: ACEs are highly prevalent and interrelated in China, attributing to over one-third of the mental disorder burden. In resource-limited settings, prioritizing the reduction of the most prevalent and impactful ACEs through education and policy can more effectively alleviate the disease burden.

Funding: The National Twelfth Five-Year Plan for Science and Technology Support from the Chinese Ministry of Science and Technology (grant numbers 2012BAI01B01 & 2015BAI13B00), and the National Key R&D Program of China (grant numbers 2017YFC0907800 and 2017YFC0907801).

Citing Articles

Adverse childhood experiences, their co-occurrence profiles, and mental disorders in adults in China.

Chen R Lancet Reg Health West Pac. 2025; 55:101478.

PMID: 39926366 PMC: 11803848. DOI: 10.1016/j.lanwpc.2025.101478.

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